By Sara McCloskey, Kim Van Sickel, and Shea Wright

Rural hospitals and health systems make up about 35% of all hospitals in the United States, and nearly half of them have 25 or fewer beds, according to a report from the American Hospital Association (AHA).

Medical facilities serving rural communities often struggle to attract physicians and recruit specialized staff, making it harder to meet diverse health care needs. Between 2010 and 2021, at least 136 rural hospitals have closed or converted to another type of provider – giving patients increasingly less access to the care they need.

VCU Health is one of the health systems helping to provide care for the region’s rural populations in Virginia’s Northern Neck, Southside, and North Carolina’s Warren County. While we are also facing some of these unique challenges other rural health care providers are facing, VCU Health is dedicated to improving the health of all who need access to health care through innovation, research, and education.

“Our leadership is proud of the role team members at VCU Health Tappahannock Hospital and Community Memorial Hospital (CMH) are playing in providing quality, safe care for residents of the communities served,” said Sheryl Garland, executive director of the Office of Health Equity and VCU Health's chief of health impact. “Across the country, the estimated 1 in 5 Americans living in rural communities are faced with challenges that impact their health outcomes such as access to health care, provider shortages, and social and economic barriers. Many of these factors have led to the development of health disparities amongst rural populations when compared to those living in urban settings.”

Part of the solution for rural medical facilities like VCU Health Tappahannock Hospital and VCU Health Community Memorial Hospital (CMH) includes leaning on health system resources to expand and grow services. VCU Health’s flagship hospital, VCU Medical Center in Richmond, is a nationally ranked academic medical center with access to highly specialized experts and programs across all fields of medicine.

The medical center campus is unlike any other and includes Virginia Commonwealth University’s premier health science schools. As part of these ongoing collaborations to invest in the rural health care workforce, CMH and VCU School of Medicine launched the VCU Health Community Memorial Hospital Family Medicine Residency Program in the summer of 2024. Additionally, VCU Health Tappahannock Hospital hosts health science students completing clinical rotations from several institutions, including Rappahannock Community College and VCU.

“Being part of VCU Health brings added value to the community by leveraging the expertise and expanded resources of the entire system,” explains Liz Martin, president of VCU Health Tappahannock Hospital. “We’ve been able to attract providers, invest in new technologies and tap into grant-funded system initiatives designed to expand access to health care across our rural communities.”

Additionally, signature outreach programs from Pauley Heart Center and Massey Comprehensive Cancer Center have established a strong presence in Tappahannock and South Hill to extend access to care. And when an aging mobile PET/CT unit needed replacing at Tappahannock Hospital, the two rural hospitals were able to join forces and invest in a state-of-the-art new digital PET/CT mobile unit to better serve both communities with faster scan times and clearer images.

“We are committed to finding innovative ways to meet the needs of our rural community and ensure that everyone has the opportunity to live a healthier life,” said Sheldon Barr, president of VCU Health Community Memorial Hospital. “For us, a healthier population means fewer barriers to care, better management of chronic conditions, and more opportunities for people to enjoy a fulfilling life. We are bringing that care closer to home and helping our patients build a stronger foundation for long-term wellness.”

These centers and schools also work closely with our rural hospitals to include patients in clinical trials and research, ensuring they can also contribute to medical breakthroughs.

Assessing and addressing the health of the community

Hospitals nationwide conduct Community Health Needs Assessments (CHNAs) to identify critical needs in their communities, a requirement for nonprofit hospitals every three years under the Affordable Care Act. Insights from CHNAs inform community health improvement plans (CHIPs).

Rural Americans are more likely to face chronic diseases and shorter lifespans than urban residents. In 2024, Tappahannock Hospital and CMH completed CHNAs, identifying several key concerns. Both hospitals are now collaborating with community partners to develop programs that improve health outcomes.

“Feedback received from community members who participated in the recent CMH and Tappahannock community health needs assessments revealed concerns that echoed the national trends in the communities served by both acute care hospitals. Of note was concern regarding the impact of these issues on neighbors who were elderly, low income, living with disabilities, identified as minorities, or families with children,” Garland said. “VCU Health is committed to collaborating with residents, providers, and community partners to identify and address barriers in order to provide opportunities for populations we serve to achieve their optimal health.”

For Tappahannock Hospital, the identified top health priorities include chronic cardiac conditions, mental health, and cancer mortality. Two populations within the region – low income and Black/African American residents – are considered especially vulnerable.

Initiatives to increase access to services like screening, prevention, and treatment are central to the health improvement plan for the region. Several efforts that are already underway include using the VCU School of Nursing’s Mobile Health and Wellness Program to deliver preventative care and health education in remote communities. Blood pressure and cancer screenings encourage early detection and follow-up services for individuals without a health care provider.

“We are driving some important initiatives aimed at educating the community about how to take a more active role in their health,” Martin added. “[Through the CHNA] we have identified the issues impacting the health of the community and we are actively working with community partners to address the needs in a holistic manner – from knowing your blood pressure numbers and when to follow up with a provider to increasing access to healthy foods.”

For CMH, the CHNA identified top health priorities for the region as heart disease, mental health, and maternal and infant care. Those considered especially vulnerable are low-income households and residents who are Black/African American.
“A healthier population means more than just treating illness. It's about empowering individuals with the tools, resources, and support they need to thrive. By increasing capacity in our cardiology program, expanding telehealth and offering low-cost prescription services through programs like Pharmacy Connection, we’re addressing two critical gaps — access to providers and affordable medications — so our patients can focus on what matters most: their health,” Barr said.

As we strive to preserve and restore health for all Virginians and beyond, addressing the unique needs of rural communities remains a vital priority. By leveraging innovation in service delivery, advancing groundbreaking research and fostering education, we aim to bridge the gaps in health care access and outcomes for these underserved populations. We recognize that, as a health system, we can transform the health landscape, ensuring that every individual, no matter where they live, has the opportunity to thrive.

Learn more about VCU Health’s community impact