Key Takeaways
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Rural healthcare workforce shortages limit access to care because rural communities have fewer physicians, specialists and other healthcare professionals per capita than urban communities.
- Avel eCare’s Virtual Health System uses a clinician-to-clinician care model that supports, rather than replaces, the healthcare professionals already caring for patients in rural communities.
- The Rural Health Transformation Program provides states with federal funding that can be used to strengthen the rural healthcare workforce, expand access to care and build sustainable virtual health infrastructure.
- Avel eCare has spent more than 30 years building a Virtual Health System that helps rural healthcare organizations expand clinical capacity, support workforce recruitment and retention, reduce unnecessary transfers and keep more care close to home.
Rural America does not lack dedicated healthcare professionals. It lacks enough of them.
Across the country, rural hospitals, Critical Access Hospitals, emergency medical services and other healthcare organizations are being asked to provide increasingly complex care with smaller clinical teams, fewer specialists and greater distances separating patients from higher levels of care.
Avel eCare believes the solution is not to replace those local clinicians. It is to surround them with more clinical resources.
For more than 30 years, Avel eCare’s Virtual Health System has connected clinicians to clinicians, giving physicians, nurses, pharmacists, EMS professionals and other healthcare providers immediate access to additional clinical expertise when and where they need it.
Unlike consumer telehealth models that primarily connect an individual patient to a remote provider, Avel’s model embeds virtual clinicians into the existing local care team. The physician, nurse, paramedic or other clinician physically present with the patient remains a critical partner in care. Avel adds another layer of experienced clinical support around them.
That distinction is increasingly important as states begin putting historic federal investment in rural healthcare to work through the Rural Health Transformation Program.
The Rural Healthcare Challenge Is an Access Challenge
The health disparities facing rural America are well documented.
According to the Rural Health Information Hub, factors contributing to rural health disparities include geographic distance, healthcare workforce shortages, infrastructure limitations and reduced access to specialists and subspecialists. Rural residents can face significant travel distances to receive specialized care, while the availability of sophisticated and high-intensity healthcare services is generally lower in rural communities.
The consequences extend beyond convenience. Rural Health Information Hub reports that by 2019, the age-adjusted death rate in rural areas was 20% higher than in urban areas, with particularly significant rural-urban differences associated with heart disease, cancer and chronic lower respiratory disease.
At the center of many of these challenges is workforce.
A 2024 report from the WWAMI Rural Health Research Center at the University of Washington found that the supply of healthcare professionals per capita was lower in rural counties across a broad range of disciplines, including physicians, primary care physicians, nurse practitioners, physician assistants, behavioral health clinicians, obstetricians, dentists and surgeons.
The difference is especially significant among primary care physicians. Rural counties had 55.6 primary care physicians per 100,000 residents compared with 93.6 per 100,000 in urban counties. The researchers concluded that rural workforce shortages have persisted across much of the healthcare workforce despite growth in some professions, including nurse practitioners and physician assistants.
For rural hospitals, that disparity creates a difficult reality: the patient still arrives, whether or not the specialist is physically available.
What If Expertise Could Come to the Clinician?
That is the problem Avel eCare was built to solve.
Founded in 1993, Avel has spent more than three decades developing a Virtual Health System designed to extend the capabilities of local healthcare teams.
When a critically ill patient arrives at a rural emergency department in the middle of the night, Avel can bring experienced emergency clinicians into the room virtually to work alongside the local team.
When that patient needs to be transferred, Avel teams can help locate an appropriate receiving facility, coordinate transport and provide a report to the receiving physician, allowing the local clinician to remain focused on the patient.
When an ambulance is transporting a complex trauma, cardiac or other emergency patient, Avel can virtually place board-certified emergency physicians, experienced paramedics and nurses in the back of the ambulance alongside the EMS team.
When a hospital lacks around-the-clock pharmacy coverage, Avel pharmacists can assist with medication orders, review potential harmful drug interactions and provide another layer of medication expertise.
When a patient experiencing a mental health crisis arrives at a facility without an onsite behavioral health specialist, Avel can connect the local team with behavioral health expertise.
And when a rural hospital is caring for a critically ill patient without an intensivist onsite, Avel’s critical care clinicians can collaborate with the bedside team to help manage that patient’s care.
The technology makes those connections possible. The clinical partnership is what makes the model work.
Avel Chief Medical Officer Kelly Rhone, MD, has described Avel’s role as an extension rather than a replacement of local teams, emphasizing that its services are designed to partner, collaborate and bring additional expertise to the clinicians already caring for patients.
That philosophy is also reflected by Avel’s hospital partners. Leticia Rodriguez, CEO of Ward Memorial Hospital, a 25-bed Critical Access Hospital, described Avel as “another layer, another resource,” emphasizing that virtual support is not an indication that local providers do not know how to do their jobs. Instead, it provides another set of clinical eyes that can confirm the course of care or identify something the local team may not have seen.
A Workforce Strategy That Extends the Workforce Already in Place
Virtual health cannot manufacture thousands of new physicians, nurses, pharmacists, psychiatrists and specialists overnight.
It can make the expertise already available in the healthcare system accessible to significantly more communities.
That changes the workforce equation.
Instead of requiring every rural facility to independently recruit every specialty it may need around the clock, a Virtual Health System allows experienced clinicians to support multiple communities and collaborate with local providers.
It can also make practicing in rural communities more sustainable.
Avel clinicians have heard from rural providers that having access to emergency physicians, intensivists, pharmacists, hospitalists and experienced nurses gives them confidence that someone is available when difficult cases arise. Dr. Rhone has noted that this type of support can contribute to both recruitment and retention because rural clinicians know they do not have to face every complex situation alone.
That is particularly significant when workforce research shows that rural communities continue to operate with substantially fewer clinicians per capita than their urban counterparts.
Virtual health therefore should not be viewed simply as another piece of technology.
It is workforce infrastructure.
The Rural Health Transformation Program Creates an Opportunity to Build That Infrastructure
The federal Rural Health Transformation Program represents a historic opportunity to address these challenges.
Administered by the Centers for Medicare & Medicaid Services, the program provides $50 billion over five years, with $10 billion available annually from fiscal year 2026 through 2030. CMS has awarded funding to all 50 states, with first-year state awards ranging from approximately $147 million to $281 million.
The program specifically prioritizes goals that include strengthening and sustaining the rural healthcare workforce, expanding access, modernizing technology, supporting innovative care models and building more sustainable rural healthcare systems.
Those dollars create opportunity.
But funding alone does not create transformation.
The impact will ultimately depend on what states, health systems and rural facilities build with it.
Technology purchased without clinical integration does not solve a workforce shortage. A video connection alone does not create a care model. And a short-term solution that disappears when grant funding ends does not create a sustainable rural healthcare system.
Rural transformation requires infrastructure that connects technology, clinicians, workflows, quality standards and local care teams into one integrated system.
That is what Avel has spent more than three decades building.
From the Emergency Department to the Ambulance
Avel’s Virtual Health System is already demonstrating how this model can extend clinical capacity across rural healthcare.
In Nebraska, for example, more than two dozen rural EMS agencies implemented Avel’s virtual EMS model, connecting ambulances with board-certified emergency physicians, experienced paramedics and nurses. Program reporting showed hundreds of patient encounters involving conditions including trauma, cardiac emergencies and altered mental status. EMS personnel rated the value of the service 4.7 out of 5, while 72% of survey respondents said they believed the program would help with recruitment.
Inside hospitals, the same philosophy extends across emergency medicine, pharmacy, hospitalist care, behavioral health and critical care.
Avel’s critical care teams, for example, combine board-certified intensivists and experienced critical care nurses with the clinicians at the bedside. In Avel partner facilities, its critical care model has been associated with an average reduction of 1.75 ICU days and 13 fewer hours on a ventilator per patient, according to Avel’s Director of Acute Inpatient Services and Senior Care, Keith Holt.
The objective is not to move healthcare away from rural communities.
It is to give rural communities more of the clinical resources they need to provide care locally.
Turning Historic Investment Into Lasting Transformation
For states deciding how to deploy Rural Health Transformation funding, the question should not simply be what technology can be purchased.
The more important question is: What care infrastructure will remain when the initial funding is gone?
Rural communities need sustainable access to clinicians. Rural hospitals need ways to recruit and retain the people already providing care. EMS teams need expert backup when minutes matter. Local physicians need specialists they can consult without requiring every patient to travel hundreds of miles. And patients deserve access to high-quality care regardless of their ZIP code.
The federal government has made an unprecedented investment available to help address those challenges.
Avel eCare offers states and healthcare organizations a Virtual Health System that has already spent more than 30 years solving them.
The opportunity now is to use Rural Health Transformation funding not simply to purchase virtual health technology, but to build a proven virtual care infrastructure capable of strengthening rural healthcare for decades to come.