Opinion: Colorado has new rural healthcare dollars, but it still needs more hands at the bedside
Colorado healthcare facilities have submitted applications for the state’s Rural Health Transformation Program deadline, positioning applicants to compete for an annual share of $200 million over five years to strengthen care in rural and frontier communities.
As Colorado moves from application to implementation, the Colorado Department of Health Care Policy and Financing’s emphasis on workforce recruitment and retention should remain central, alongside technology upgrades, care coordination and stabilizing rural hospital finances.
That focus is encouraging because it reflects what clinicians, administrators and patients already know: Colorado needs more people able to staff a bedside at 3 a.m., respond to emergencies close to home, and care for aging family members and neighbors.
The state’s population has surpassed 6 million, and roughly 17% of Coloradans are now 65 or older, according to the latest census data. As that share grows, so will the need for emergency, inpatient and post-acute care.
The workforce challenge is especially acute outside metropolitan areas. Nationally, the Health Resources and Services Administration projects a shortage of nearly 109,000 full-time-equivalent registered nurses by 2038. The gap is expected to be far more severe in nonmetro communities, where HRSA projects an 11% registered nurse shortfall compared with 2% in metro areas. In Colorado, HRSA estimates that the state will have just 59,000 full-time equivalent nurses by 2038, a 7% shortfall.
That divide is exactly where Colorado’s rural transformation program can matter most, particularly for the 52 rural and frontier counties — including 23 frontier counties (areas that have six or fewer people per square mile) — the state has identified as facing limited access to specialty and behavioral health services.
Colorado should allocate these federal dollars to build the workforce it will need for the long term: expanding nursing education, supporting faculty, creating more clinical training sites, strengthening career pathways and targeting investments to the communities with the greatest gaps. Hospitals must also continue addressing burnout, workplace safety and the day-to-day conditions that determine whether clinicians stay at the bedside or leave it.
But training a new clinician takes years, and a facility facing an uncovered shift tonight can’t solve that problem by pointing to a pending award decision or a five-year work plan, however well designed. Colorado needs both: a durable workforce strategy and practical tools that help facilities maintain safe staffing now.
One such tool is technology that allows licensed clinicians who want flexible, independent work to identify and accept available shifts at healthcare facilities. These platforms can help hospitals and long-term care facilities reach qualified professionals who may not want, or may not be able, to hold a conventional full-time position but are still willing to contribute clinically.
This may look like experienced nurses balancing caregiving responsibilities, clinicians pursuing advanced education, semi-retired professionals who want to work selectively and people building schedules around family. Flexibility can keep some licensed clinicians connected to patient care who might otherwise leave the workforce entirely.
In 2022, St. Louis-based Mercy Health designed a cloud-based platform that allowed credential nurses hired by the system to choose hospital shifts ranging from two to eight hours, according to Society for Human Resource Management (SHRM) — a model that has since reduced its reliance on agency staffing, cutting costs by 62%.
ShiftKey, a Dallas-based technology company, allows nurses and other healthcare professionals to search for per diem shifts in their area, bid on those shifts and then build their schedules, per Mobi Health News. Similarly, Banner Health maintains a per diem staffing pool where clinicians can choose shifts on an as-needed basis and work across facilities.
This model is not a substitute for permanent hospital employees, nor should it be presented as one. Core teams provide continuity, institutional knowledge and leadership. The goal is to support those teams by helping facilities fill unexpected vacancies, respond to surges and avoid asking an already stretched workforce to carry an unsafe burden.
That support must come with guardrails: Facilities need confidence that clinicians are appropriately licensed and credentialed, workers need transparent information about pay and conditions, and policymakers should protect patient safety without creating barriers that keep qualified clinicians from choosing flexible work.
Colorado cannot manufacture experienced clinicians overnight, and it cannot wait five years to find out whether its rural transformation plan worked. In the meantime, it can make better use of the licensed professionals it already has — including those seeking greater control over when and where they work — while new federal dollars build toward a more durable fix.
The Rural Health Transformation Program is a genuine opportunity for Colorado — and a multiyear undertaking. These dollars should fund the training programs, care models and infrastructure that rural communities need for the future.
As the state turns from application to execution, it should also recognize the urgency of today’s workforce gaps and support responsible ways to expand access to clinicians now. Coloradans deserve both.
Dr. Deborah L. Birx, of Maryland, is a physician and immunologist who served as White House Coronavirus Response Coordinator and previously led the U.S. President’s Emergency Plan for AIDS Relief as U.S. Global AIDS Coordinator.
The Colorado Sun is a nonpartisan news organization, and the opinions of columnists and editorial writers do not reflect the opinions of the newsroom. Read our ethics policy for more on The Sun’s opinion policy. Learn how to submit a column. Reach the opinion editor at opinion@coloradosun.com.
Follow Colorado Sun Opinion on Facebook.