Protecting Rural Health Care Starts with Building South Dakota's Workforce

During a recent visit to Mitchell, I heard from Dr. Lucio Margallo, who served as a primary care provider in that community for over 46 years. He expressed his concern that we are facing a severe physician shortage in our state, making it difficult for hospitals to sustain consistent, high-quality services.

This on-the-ground observation is backed by data. The majority of our rural counties are already designated by the South Dakota Department of Health as Health Professional Shortage Areas, many with shortages of primary care providers, dentists, and mental health providers. South Dakota is projected to have the third-highest shortage of registered nurses in the country by 2030. Every effort we make to sustain rural hospitals, nursing homes, dental clinics, pharmacies, and ambulance services depends on having a strong health care workforce to serve in those settings. Without a rural health care workforce, we have no rural health care.

The good news is that we know what works to build and sustain a strong health care workforce. It simply requires long-term vision, persistence, and real investment in strategies that strengthen the pipeline into health professions, train more providers in rural communities, and create incentives for them to serve in the places that need them most.

If I were elected to represent South Dakota in the U.S. Congress, there are three programs that I would reform and expand.

Reform Graduate Medical Education to Better Serve Rural America

Medicare is the federal government’s largest source of support for physician residency training. In 2023, Medicare paid about $22 billion to support graduate medical education at more than 1,400 hospitals. The location of that residency training is one of the biggest factors in determining where doctors ultimately practice. Yet funding for residency training still reflects old hospital patterns, not today’s workforce needs.

The result is a system that favors urban America. Although about 14 percent of Americans live in a rural community, only about 2-3% of GME programs and residents were located in rural areas.

South Dakota’s universities along with health systems like Sanford, Avera, and Monument are all doing innovative work – see here and here – to increase the number of health care providers who are being trained across our state, but more is needed to level the playing field. Congress should modernize Medicare’s GME funding and expand rural and community-based training programs. If we want more physicians and other health care workforce to serve in South Dakota, we must train more of them here.

Grow Our Own Workforce

As important as the location of training is, some of the most cost-effective and impactful strategies begin long before medical school.

Research shows that students from rural communities are more likely to return to rural practice, especiallywhen they train in rural settings during their education. One of the best ways to build South Dakota’s future health workforce is to invest in South Dakota’s young people.

South Dakota already has an incredible resource in that South Dakota HOSA–Future Health Professionalsalready engages students in over 50 middle and high school chapters across the state. These HOSA chapters introduce students to careers in medicine, nursing, dentistry, pharmacy, behavioral health, emergency medical services, laboratory science, public health, and more. Through leadership development, competitions, community service, and hands-on learning, students gain the confidence and exposure needed to pursue health careers.

Unfortunately, their federal funding is under threat every year. The current Administration recommended no funding Area Health Education Centers (AHECs, which resource this critical program) its fiscal year 26 and 27 budgets. As a member of Congress, I would not only sustain but increase our investment in proven programs that help South Dakota youth prepare for high-paying, impactful health care jobs they can do right here in South Dakota.

Strengthen the National Health Service Corps

In addition to recruiting rural people into health professions and enabling more of them to train closer to home, we also need to make sure that student loans and other financial barriers don’t prevent mission-driven providers from working in areas where there are shortages.

Many physicians, dentists, nurse practitioners, physician assistants, and behavioral health professionals graduate with substantial student debt. The National Health Service Corps (NHSC) helps address that challenge by offering scholarships and loan repayment to clinicians who commit to serving communities with health professional shortages.

For more than 50 years, the NHSC has been a long-running, evidence-backed program. Thousands of clinicians have served rural and underserved communities through it, and many remain in those communities long after their service commitments end.

But demand consistently exceeds available funding. That means many qualified clinicians never get the chance to participate. Congress should make a major new investment in the NHSC, which is a proven, cost-effective program currently making a real difference in equalizing the distribution of health care providers.

Building the Workforce South Dakota Deserves

These three priorities reinforce one another.

Expanding Graduate Medical Education increases the number of physicians training in rural communities.

Building stronger career pathways through organizations like South Dakota HOSA prepares the next generation to enter those professions in the first place.

Strengthening the National Health Service Corps helps those clinicians choose to stay in underserved areas.

No single policy will solve South Dakota’s health care workforce shortage overnight. Together, however, these investments can create a durable pipeline of professionals ready to serve rural communities for decades.

In Congress, I would work with local communities, educators, and health systems to direct federal resources toward the workforce strategies that are already producing results. The future of rural health care in South Dakota depends on the choices congressional leaders make today.