During US Senate hearing, Maryland Choptank Community Health System CEO says more workforce support, expansion of school-based care are key to improving rural healthcare access


Hannah Saunders


The US Senate’s Committee on Finance held a hearing on May 17th to discuss barriers and opportunities for improving healthcare access within rural communities. Several individuals spoke as witnesses, including Choptank Community Health System CEO and President Sara Rich.

Choptank provides primary healthcare services and has a mission of providing access to exceptional, comprehensive, and integrated healthcare for all individuals. In 2021, Choptank provided services to over 30 million individuals, according to Rich. In 2022, the health system saw over 33,000 patients, representing over 99,000 visits. 


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“Choptank, along with other rural health centers—and really healthcare systems all over the country—are experiencing unprecedented shortages in attracting and maintaining a qualified workforce,” Rich said at the hearing. 

Rural communities experience greater gaps in the healthcare system due to a lack of access to an array of providers. Many individuals in rural communities are required to travel long distances to seek care, and some may not have access to a car, or be able to take time off from work. Living far away from providers and hospitals may also be both inconvenient and life-threatening during emergencies. Another major threat facing rural communities is the increasing number of hospital closures.

Choptank currently has 43 open positions, with 15 vacancies for providers and 28 openings for clinical and support staff. Rich mentioned how a pipeline of providers and clinical staff is crucial to keeping staffing levels adequate, and that facilities should look at ‘grow-your-own’ programs.

“Some of our efforts include a collaboration with the University of Maryland School of Medicine, and the University of Shore Regional Health to design a rural family medicine training experience for graduated new physicians,” Rich said. “We know that physicians who train in a health center are nearly twice as likely to begin their careers in a similar setting, providing significant benefits in the rural communities that they serve.”

Rich shared how Choptank is meeting the needs of community members through various avenues. In 1999, Choptank became involved with school-based health centers, which Choptank currently have 30 of and that provide medical, dental, behavioral health, and nutrition services for students. In addition, Choptank has added three mobile units to their access delivery model to reach more communities. 

“New access point funding for new health centers, including funding for mobile health units and school-based health centers is needed,” Rich said. “We certainly recognize that there are budgetary restrictions, but we do know that investing in health centers saves the health system an estimated $24 billion annually, and reduces medical expenditures.”

Chairman Sen. Benjamin L. Cardin (D – Maryland) inquired about what federal tools have assisted with the implementation of some of the initiatives, and what additional incentives are needed to provide services in rural communities.

“In Maryland, we have a Total Cost of Care Model, which is, I think, the ultimate in value-based [care],” Cardin said. “What other incentives do we need to allow you to move forward in those initiatives?” 

Rich emphasized how school-based health centers are a powerful tool, and that Choptank has many other useful tools at their disposal. She highlighted how Choptank recently expanded two school-based health centers to reach not only students, but also residents of the surrounding community, since those communities are located far away from other healthcare access points.

“[We need] additional support funding for school-based health centers,” Rich said. “Mobile health units as well.” 

Sen. Debbie Stabenow (D – Michigan) asked Rich how accessing comprehensive care through school-based health centers expands access for both children and families. Rich explained how a variety of care can be accomplished at school-based health centers, such as lab testing, acute needs, chronic conditions such as asthma, and creating connections for students who may have additional needs.

“When children are in pain—whether it’s from a dental infection, they have strep throat, they’re just not feeling well because maybe something happened with some friends and they’re feeling down—having that access in the school makes all the difference, especially for those of us who live in rural areas,” Rich said. “I’ve used our school-based health centers, and often parents work out of county.” 

Rich said that having that nearby access point creates peace of mind for parents and families who sometimes work 30 to 40 miles away from where their children learn. She also said it creates relief for students and school staff, since healthy students become healthy learners.

She thinks that any actions taken to assist with the retention of providers in rural areas, particularly for behavioral health workers, is something that needs to be taken very seriously, including financial incentives for providers. Rich added that a challenge has been the lack of new access point funding for mobile healthcare units over the last several years.

“I think this hearing has been very helpful for us to focus on the areas where we still need to make progress providing the right incentives at the federal level, and partnerships with the other stakeholders we have in order to fill the needs out there,” Cardin said.