Rural healthcare is in crisis.
Across the United States, rural hospitals are facing closures, staffing shortages, and revenue decline. According to the Center for Healthcare Quality and Payment Reform, more than 30% of rural hospitals are at risk of closing in the near future due to financial instability (CHQPR, 2023).
With a pending $70 billion cut to Medicaid funding, which was signed into legislation in July 2025, rural hospitals are about to lose 21 cents on every Medicaid dollar.
Patients are waiting too long, driving too far, and often giving up on the idea that they can get high-quality care close to home.
Hospital executives are stuck between shrinking budgets and growing needs. How can you keep the doors open, support your medical staff, and meet your community’s expectations—all at once?
The answer lies in innovative partnerships and new care models.
At VirtuCare, we help rural hospitals thrive again by launching high-demand, high-revenue outpatient urology clinics with board-certified specialists, often in 4 months or less. Here’s how our model helps solve six of the most pressing challenges in rural healthcare today.
1. The Growing Physician Shortage in Rural Healthcare
The Problem:
Rural hospitals struggle to recruit and retain physicians, especially specialists. As of 2021, nearly 80% of rural counties in the U.S. are designated as medically underserved areas (HRSA).
Urology is particularly strained, with only around 13,000 practicing urologists nationwide and over half nearing retirement age (AUA Census, 2023). Over 60% of U.S. counties have no practicing urologist (AUA Census, 2023).
Outreach clinics, while well-intentioned, often disappear when physicians get too busy at their main site. Relying on a single physician to indefinitely provide coverage in your community is like balancing your hospital’s budget on one payer contract — one change, and everything collapses.
95% of new urology graduates are choosing to work in mid-to-large sized metropolitan service areas. Interestingly, offering larger salaries does not seem to be the answer. Younger physicians are choosing big city quality of life over the charm and financial security of rural America.
The simple truth is that we are losing physicians in rural communities.
But what about the patients? They continue to age and require more specialized care. Again looking at urology, most urological conditions are not only incredibly common, but they are diseases of aging:
- 50% of men by age 50 will have erectile dysfunction.
- Almost 1 in 10 U.S. adults will have a kidney stone in their lifetime.
- Urinary difficulties such as BPH and overactive bladder will affect 25% of us.
Demand is increasing. Supply is declining. What can we do? Innovate.
The Solution:
Leverage. You need to work smarter, not harder. Our team has developed an innovative team-based patient care model. We combine:
- Board-certified urologists working remotely
- Local nurse practitioners or physician assistants
- Telehealth technology for virtual consults
- Traveling surgeons for procedures
This approach provides year-round access to specialty care without requiring you to recruit a full-time specialist. A team of fractional urologists do 98% of the work of the full-time, in-person hire you can’t recruit or retain.
The best part? You are investing in a system and a team, rather than a single person. Physicians age, get sick, and relocate their families. Systems, when built correctly, become foundational, consistent streams of revenue for your hospital.
Speaking of revenue . . . let’s dive into problem #2.
2. Declining Revenue and Hospital Closures
The Problem:
Rural hospitals are closing at record rates. Since 2010, more than 140 rural hospitals have shut their doors, with many more at risk (NC Rural Health Research Program). Many lack high-margin service lines, like surgery or specialty care, and over-rely on emergency room or primary care visits for revenue. That model simply isn’t sustainable.
The business of healthcare is complex to say the least. There are also a number of factors that hospital executives have little to zero control over.
- Insurance companies dictate your fees – sure you can renegotiate your contracts if you have some leverage. But the resources it takes rarely equates with a large enough increase in reimbursement to sustain your revenue.
- Rising overhead costs – cumulative inflation in the U.S. from 2005 to 2025 is about 65% (SmartAsset Inflation Calculator). The cost of doing business as usual is far outpacing gains in revenue. Post-pandemic supply chain issues and staffing shortages have exacerbated these expenses even further.
- Increasing administrative burden – According to a report by the American Hospital Association, 40% of hospital expenses are due to the administrative burden of delivering patient care.
This leaves hospital executives with two choices. Cutting costs often exacerbates staffing shortages or limits patient services. You can only save so much, and at what price?
On the other hand, there are countless revenue opportunities which are being overlooked. Revenue opportunities that can turn your hospital around.
The Solution:
Expand, don’t contract. This is the time to invest in new, highly profitable service lines like GI or urology. While everyone is focused on acute care, your patients care about quality-of-life issues:
- Urinary symptoms due to an enlarged prostate (BPH) or overactive bladder (OAB)
- Urinary and fecal incontinence
- Erectile dysfunction
- Pelvic pain
Outpatient urology clinics, even at 0.5 FTE, can generate $100K+ in new monthly revenue on average through clinic visits, ancillary tests, and outpatient surgical procedures.
Empty operating rooms lead to empty hospitals. Fill your OR block schedule with bread-and-butter cases that generate a strong ROI.
3. Physician Turnover and Burnout
The Problem:
When rural physicians are asked to cover everything—ER, inpatient, call, and outpatient—burnout is inevitable. A recent study found that 63% of physicians report symptoms of burnout, with specialists in high-demand fields like urology among the most affected (Medscape Physician Burnout Report, 2023).
Unless you provide your medical staff with comprehensive support, it’s a matter of time before your physicians burnout and leave. Now you have a recruiting problem with the odds stacked against you.
The Solution:
Everyone operates at the top of licensure. Asking primary care physicians to click buttons in your EHR is equivalent to asking your CFO to personally call patients with overdue balances. Treat physicians like the highly skilled, limited assets they are by eliminating, delegating, or automating all tasks that can be performed by someone else.
Virtual or AI scribes, executive assistants, and automated care pathways start freeing up valuable time. Updating your outdated bylaws with physician input is essential to remove unnecessary bureaucracy from patient care.
Lastly, keep your surgeons in the operating room, where they are most productive and happiest. Train advanced practice providers (APPs) to cover the outpatient clinic with the support of remote board-certified physicians. Routine new and follow up visits can be handled by well-trained and supervised APPs. Utilizing APPs also improves patient access, shortening wait times, and improving patient satisfaction scores.
4. Overreliance on Transfers and Delays in Care
The Problem:
Without local specialty support, even manageable cases end up being transferred. This creates unnecessary delays, worsens outcomes, and frustrates patients who want to stay close to home.
Nationally, 40% of rural patients report difficulty accessing specialty care, often resulting in delayed diagnoses and poor treatment adherence (National Rural Health Association). It also starts a vicious cycle of patients leaving your community.
Delayed care > Higher acuity of patients > transfer for care outside of your hospital system
Once patients leak out of your system for care elsewhere, it’s just a matter of time before they transfer all of their medical care elsewhere.
The Solution:
Remote care via telemedicine. Telemedicine has a bad reputation because many organizations don’t deploy it correctly. Telemedicine is just a tool. If you use it to deliver high-quality care, then it can be an effective tool. Look no further than tele-stroke and tele-psychiatry programs which have improved patient access. But why stop there? Telemedicine can be deployed in the outpatient setting by partnering with remote board-certified physicians to work alongside local APPs. Believe it or not, most outpatient urologic conditions can be treated without an intervention in your community. By leveraging telemedicine, you can prevent avoidable transfers, improve outcomes, and keep patients loyal to your hospital.
5. Eroding Trust and Community Perception
The Problem:
Patients judge the quality of their local hospital based on the services it offers. Without specialty care, many view rural hospitals as limited or outdated. This perception drives outmigration to other medical facilities.
With patient migration, there’s a subsequent loss of trust, reputation, and revenue. Patients don’t care how wonderful your staff is or how new your facility is if they perceive you cannot deliver the highest quality of care.
The Solution:
Innovate. Nothing signals exceptional healthcare like innovation. When community members see you invest in new equipment, facilities, and service lines, it gives them confidence that your hospital delivers great care. Innovation tells your community:
- We are growing, not shrinking
- We invest in your health
- You don’t have to travel for quality care
Why Urology First?
Urology is the ideal specialty to kickstart your outpatient services strategy. It’s a service line that:
- Quickly scales to high patient volumes, high revenue because . . .
- Urological conditions are common in aging populations and can be treated with . . .
- Short procedural times with excellent outcomes
- Require long-term follow up, increasing the lifetime value (LTV) of your patients
But you don’t have a local urologist. Recruitment efforts have yielded zero strong candidates who are willing to move to your community. That’s where our team at VirtuCare can help.
The VirtuCare Advantage
We’ve developed a novel hybrid patient care model that is comprehensive without sacrificing quality. Our process includes:
- Assisting in the recruitment and hiring of a local APP (nurse practitioner or PA) in your community.
- Training the APP with a comprehensive urology curriculum.
- Pairing the APP with a remote board-certified urologist to ensure that patient care is exceptional from the moment you open your brand new urology clinic
- Sending an excellent surgeon to your facility on a monthly basis to perform outpatient surgical procedures.
The best part? Our team removes the guess work and delivers a white glove implementation plan to launch your new service line in under 4 months. Our additional services include:
- Inventory of surgical equipment with vendor introductions.
- Surgeon preference cards, pre- and post-operative orders.
- Proforma calculator to predict the ROI on a VirtuCare partnership (4x top-line revenue in most cases).
- Marketing recommendations including example pieces of collateral.
- Recommendations on surgical block times, clinic staffing and scheduling templates.
We do all the heavy lifting. You get the credit.
Ready to Future-Proof Your Rural Healthcare System?
Let’s build something great together.
Book a free strategy call to learn how VirtuCare can bring comprehensive, profitable specialty care to your community.
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