From revenue risk to resilience: A new financial model for rural physicians

Independent physicians in rural America are no strangers to adversity. An alarming 80% of rural America is medically underserved, and clinicians are feeling the pinch. In fact, between 2019 and 2024, the number of independent doctors in rural areas fell by 43%, and residents in rural areas had access to 11% fewer medical practices.

With many rural hospitals operating at a loss and at risk of closure, many small and medium-sized practices are now forced to shoulder a growing share of the patient care burden, without the financial infrastructure of larger systems. This financial strain is particularly acute in regions with older, diverse and low-income populations reliant on Medicare and Medicaid. Rural patients also have lower rates of employer-sponsored commercial insurance, resulting in higher out-of-pocket costs and greater financial pressure on physicians.

The proportion of U.S. adults classified as cost desperate, indicating an inability to afford necessary health care and medications, has reached a record high of 11%, with disparities emerging across demographic groups. Notably, Black and Hispanic adults, along with those from lower-income households, are disproportionately affected, exacerbating existing gaps in access to quality, affordable care.

The cost of traditional financial metrics

Historically, many health systems and private practices have used margin per patient as a benchmark of success. However, in rural care settings, that model can often fall short. Unlike urban, high-volume organizations that can prioritize profitable service lines, rural physicians must care for every patient who walks through the door, regardless of insurance status or income level.

When margins are thin and uncompensated care is on the rise, traditional financial models can push practices toward dangerous territory. Denying care isn’t an option, but delivering it without reimbursement isn’t sustainable. That disconnect isn’t just hurting the bottom line; it’s driving delayed care, skipped treatments and growing medical debt.

Medical debt is fueling the crisis

Unpaid medical bills are among the biggest threats to rural hospitals and their patients. Recent studies have found that a larger portion of adults in rural counties carry medical debt, higher than the national average and significantly higher than in urban areas. This debt doesn’t just sit on spreadsheets. It has real consequences: damaged credit, financial strain, skipped prescriptions and delayed treatment.

And it’s not just uninsured patients. High-deductible plans and rising out-of-pocket costs have made it harder for insured patients to manage their medical bills. In many cases, the bills they receive aren’t just unaffordable — they’re unpredictable.

This dynamic is especially harmful in rural areas, where many patients live on fixed incomes or don’t qualify for traditional credit. When affordability becomes a barrier to care, patients wait until it’s urgent. They often show up in the emergency room for a condition that could have been managed earlier and more affordably. These late-stage interventions cost more, strain the system and frequently go unpaid.

A shift in strategy: Financing with compassion

To survive, many forward-thinking rural physicians and other clinicians are adopting a different financial lens, one that prioritizes systemwide revenue margin and community economic health over per-patient profitability. One emerging solution is patient-first financing. Similar to retailers, this proactive approach introduces affordable payment options at the start, where the consumer, or in this case the patient, stands to gain 0% interest payment financing at the point of scheduling or care rather than months later when the bill arrives.

Instead of chasing payments after care is delivered or navigating an in-house system, physicians and their teams work with third-party partners to offer flexible payment plans based on a patient’s ability to pay. Providers are often paid within 48 hours of a procedure, even if the patient repays over time to the lender. That’s better not just for the books but for the patient. Studies show that when financing is discussed up front, patients are more likely to move forward with care and less likely to cancel or no-show due to cost. This approach also reduces the need to send unpaid balances to collections, protecting the patient-provider relationship.

Expanding the care model for long-term sustainability

Independent physicians are on the front lines of the rural health crisis and deserve financial models that reflect the realities they face, not just metrics designed for large, perfectly functioning systems. By rethinking success as “healthy patients, healthy practices,” small and rural practices can shift toward financial strategies supporting community well-being and long-term viability. This includes leveraging telehealth, expanding roles for advanced practice providers (APPs) and addressing critical gaps in physician availability.

Additionally, the American College of Physicians recently emphasized the need for policy makers to evaluate and implement investments to address rural health disparities and access challenges. Aligning clinical innovation with policy-level change can help ensure rural providers aren’t navigating this crisis alone. But as potential reimbursement cuts and regulatory rollbacks loom, health systems can’t afford to wait for policy change. They must focus on where they can take action internally, building financial resilience and expanding patient access through proactive care models.

Many practices are turning to advanced practice providers, including nurse practitioners and physician assistants, who can extend access and provide high-quality care, especially for routine or preventive services. At the same time, telehealth adoption, which surged during the pandemic, remains a powerful tool for maintaining access in hard-to-reach areas. However, broadband limitations, regulatory uncertainties and reimbursement inconsistencies still create barriers to broader use. Policy makers and health plans must continue supporting virtual care to ensure it remains viable for rural practices and their patients.

Patient-first financing is one of many steps toward that future, but it is a meaningful one. With the right tools, physicians do not have to choose between doing what is right for their patients and what is necessary for their practices.

Meredith Kirchner is a seasoned health care operations leader with over 20 years of experience. She currently serves as the chief operating officer at Curae, where she focuses on improving operational efficiency and client satisfaction through innovative financial solutions for multi-hospital health systems. She has a strong background in health care consulting and technology, having held senior roles at Patientco and Ernst & Young. Her experience lies in optimizing organizational workflows and enhancing patient financial access, making her a pivotal figure in driving Curae’s growth and industry reputation.