TYRONE — In rural Pennsylvania, there is about one primary care physician for every 522 residents, compared to the state’s urban areas where that ratio is about one physician for every 222 residents, according to state Secretary of Health Dr. Debra Bogen.

“That is fewer than half as many providers per resident in rural areas,” Bogen said. “How does this impact Pennsylvanians living in rural communities? We know they already have to travel farther to get to see their doctors, but they also have fewer to choose from when trying to access care.”

Bogen was joined by state Secretary of Human Services Dr. Val Arkoosh and Penn Highlands Healthcare System Chief Medical Officer Trina Abla at Penn Highlands Tyrone on Tuesday morning to discuss the Shapiro administration’s proposed investments in the rural health care workforce as part of the 2025-26 budget.

Abla stated that “roughly only 10 percent of our doctors choose to practice in rural settings, despite more than 20 percent of the U.S. population living in rural communities.”

“That shortage of skilled physicians and providers means that rural residents are sometimes required to travel long distances for access to basic medical care,” Abla said.

As rural populations are increasingly elderly, Abla said physicians in those communities often treat patients who tend to be “older, sicker and less well-insured.”

“It is also important to note that the Association of American Medical Colleges reports that many rural physicians are nearing retirement age,” Abla said. “It is becoming increasingly challenging to attract young doctors to serve in rural areas.”

More than 100 rural hospitals have closed across the nation in the last 10 years and an additional 600 rural hospitals are at risk of closing in the near future, she said.

“The primary cause of rural hospital closures is that the payments from health insurance plans are inadequate to sustain essential services,” Abla said. “As the population continues to age, especially in rural communities across Pennsylvania, reimbursement for health care services continues to shift to governmental payers Medicare and Medicaid, typically, which pay at 10 to 15 percent below cost.”

About 70% or more of their patients are on either Medicare or Medicaid, Abla said, meaning they have to rely heavily on “commercial payer contracts to subsidize the lack of reimbursement from government payers.”

Bogen said the Shapiro administration convened a rural health care working group in the last year that is composed of state government, private sector, health care and other stakeholders.

“The governor attended that first meeting and tasked the group with developing Pennsylvania-specific solutions to address rural health access,” Bogen said.

The 2025-26 proposed budget addresses “many of the challenges” facing the state’s rural hospitals “through a multi-pronged approach,” Bogen said.

First, it “seeks” $5 million to expand the Primary Care Loan Repayment Program, which offers loan repayment for health care providers that serve in rural communities, Bogen said.

“Currently, the program is assisting 19 health care providers here in the greater Blair County region and more than 200 doctors, nurses, dentists, psychologists and other health care professionals across the state,” Bogen said.

The budget also allocates $5 million to the education, training and recruitment of nurses through tuition support, “thereby ensuring a steady pipeline of highly trained professionals for our rural hospitals,” Bogen said.

In last year’s budget, about $10 million was included to “help support and stabilize our rural hospitals,” Arkoosh said.

“This investment of $10 million in state funds, if approved by the Center for Medicare and Medicaid Services, will enable the Department of Human Services to draw federal matching funds (of $27 million) to make that a total of $37 million to support access to hospital care,” Arkoosh said. “We’re hoping to get that sign off from CMS in the next few weeks, but we also know that we need to do more.”

In the 2025-26 proposed budget, another $10 million would again “draw down matching federal funds” of $25.1 million, Arkoosh said.

“In addition to that first $10 million that I mentioned, the state was able to invest a total of $60 million dollars more during 2025 than we were able to invest in our rural hospitals in 2024,” Arkoosh said. “So that starts to fill some of those gaps.”

Mirror Staff Writer Rachel Foor is at 814-946-7458.