Opportunities for Rural Transformation: Regional Public Colleges and Universities

Morgan Blazer grew up in Parrottsville, Tennessee, a small town in Cocke County with a population of 263 residents. Located in the heart of Appalachia, just outside of the Great Smoky Mountains National Park, Parrottsville is served by a community health center and the nearby Newport Medical Center. Morgan is typical of many youth in our region, saying that she loves “not only where I’m from, but the region itself.”

While attending East Tennessee State University (ETSU), a regional university dedicated to serving Appalachia, Morgan participated in the ETSU Quillen College of Medicine’s EQUIP (Extending Quillen to the Underserved through an Integrated Program), which provides mentoring and job shadowing opportunities to undergraduate students who wish to become primary care physicians committed to rural and underserved communities.

Regional Public Colleges and Universities (RPCUs) like ETSU exist in large part to promote the vitality of the often rural and economically challenged regions in which they are located. HR1, The One Big Beautiful Bill Act, passed by Congress in July, is estimated to reduce Medicaid spending in rural jurisdictions by an estimated $155 billion over 10 years. In an effort to at least partially offset these cuts, Congress authorized the Rural Health Transformation (RHT) Program, a $50 billion fund to “empower states to strengthen rural communities across America by improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem.”

As state policymakers apply for the OBBBA’s Rural Health Transformation funding, they have a significant opportunity to partner with their RPCUs to address the research, and especially, the workforce training needs of their rural communities.

Understanding RPCUs

RPCUs are the universities that often have cardinal directions in their names, be it east, west, north, south, or central. Described by the American Association of State Colleges and Universities as “stewards of place.” RPCUs serve rural, often underserved students and communities. By providing extra support and mentorship, RPCUs equip students with skills necessary for high-demand fields, contributing to regional job growth, and their research and training prioritizes issues of community and regional importance, including the health and economic prosperity of the rural communities they serve.

RPCUs are also home to leading faculty and researchers, and many provide advanced training in health disciplines, STEM disciplines, and education, with a focus on addressing workforce needs, including health care needs, within their regions.

Leaning In to Who We Are

ETSU is a member of the Regional Public Colleges and Universities Central Appalachia Health Consortium, comprising eight RPCUs spanning six central Appalachian states from Ohio to North Carolina. The consortium creates shared opportunities for students to pursue undergraduate and advanced health professions degrees, including medicine, nursing, public health, and occupational therapy. Our vision is to create seamless transitions for students, allowing them to seek opportunities across institutions through strategies like preferred admissions, in-state tuition agreements, and agreements to accept course credits across institutions.

We see this as a “grow-your-own” model, given that our undergraduate students largely come from within our immediate regions. Whereas students at other types of universities may come from all over the nation and return home when they complete their degrees, our students are already home. Studies have shown that growing up a rural area is closely associated with choosing rural health care practice. Furthermore, a recent National Rural Health Association policy brief on rural workforce recruitment and retention found that training in rural communities has had more success than loan repayment programs in recruiting and retaining health care providers to rural areas. By training students from our communities within a network of community-focused RPCUs, we know that they will be more likely to stay and serve in our region. 

Why Should Policymakers Care?

In today’s destabilized rural health care environment, ensuring a viable and well-trained health care workforce is critical. Having to spend extra resources on provider recruitment, training and travel/temporary providers can threaten a struggling health system’s financial viability. Facing the $155 billion loss in Medicaid funding, many rural hospitals, long-term care facilities, substance-use treatment facilities, and other health care provider organizations are at risk, making the need for cost-effective training and recruitment solutions even more critical.

RPCUs create unique opportunities for training providers for practice in areas that are often underserved. Here at East Tennessee State University, for example, our Quillen College of Medicine is a leader in training rural physicians, ranking second in the nation for having the most graduates practicing in rural underserved areas. Similar stories can be found at other RPCUs representing all points on the compass, such as Southern Illinois University, East Carolina University, Western Michigan University and Northern Arizona University, and across health disciplines ranging from audiology to X-ray technology. 

Along with training providers, RPCUs serve as vital hubs for community engagement, including cultural and civic activities, which are critical to recruiting and retaining health professionals and supporting economic growth.

As states consider how to allocate funds for Rural Health Transformation, RPCUs offer an opportunity to spend dollars wisely by their expanding rural training opportunities for students from rural backgrounds. Likewise, RPCUs are well-equipped to evaluate the impact of rural funding investments. Even beyond the Rural Health Transformation Program, policymakers should keep their RPCUs top-of-mind when making investments in higher education. As community-driven institutions of higher learning, RPCUs lift up rural communities, provide opportunities for our youth, support local economic growth, and are vital for creating and maintaining a regional workforce that can help to sustain our fragile rural health systems. 

Morgan Blazer is a prime example of how rural youth can be trained at rural-serving institutions to impact rural communities. Today, Morgan is a proud graduate of ETSU’s College of Public Health, and a medical student at ETSU’s Quillen College of Medicine. “I got to see physicians as community leaders and knew I would get the opportunity to serve my community in ways that will help preserve quality of life,” she said. “It would be such an honor to get to extend the quality of life for the people I love, so they can keep doing the things that they love.”