By Matthew L. Tobey, Jason Beste, Phuoc Le, Sriram Shamasunder, and Jeff Robison

Originally published on Health Affairs

The rural United States is a rich landscape of diverse communities and health systems. Yet, the nation has failed these communities and health systems, which experience increased mortality across racial/ethnic groups. These outcomes owe to factors including historical neglect, structural racismworkforce gaps, and structural urbanism—that is, health system design favoring urban locations. Many rural counties are considered highly socially vulnerable according to the Centers for Disease Control and Prevention’s Social Vulnerability Index and nearly 80 percent are health professional shortage areas.

While academic medical centers (AMCs) have a broad mandate, caring for the underserved is key to their collective mission. As directors of the nation’s four teaching hospital-based rural physician fellowships, we believe that the time has come to organize stakeholders and define a pathway to more fully engage AMCs in equitable rural health. That effort should be inclusive, forward-looking, and directly address the racist and urbanist structures that burden rural communities. Rural fellowships have a small but important place in that effort.


Jason Beste is Director of the MD-MPH Track for the UW Department of Global Health, Director of the Global Health Pathway for the UW School of Medicine, and Co-Director of the UW Global & Rural Health Fellowship.

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