Three years ago, Lost Rivers Medical Center opened a day care. It was temporary at first, a result of petitions from employees who couldn’t find any other child care options in Arco, Idaho, population 879. The original arrangement could only host six kids at a time, but 19 months later, in December 2023, the hospital opened a dedicated child care facility, serving up to 24 children.
CEO Brad Huerta faced questions about his choice to fund the space. Of all the things for one of the most isolated hospitals in the country to invest in, why day care? His answer was easy: It was the best option available to combat looming provider shortages.
“They’re acute everywhere,” Huerta says of the shortages, “but especially acute in rural areas.” Areas like Arco, which is more rural than the definition of rural these days, and classified in the medical industry and by Huerta as a “frontier area.” The closest city, Idaho Falls, is about 70 miles away.
When Huerta took over in 2013, he admits he was the third choice for the job. The top two candidates couldn’t fathom living so isolated. “Everyone’s about being rural until it’s time to be rural,” Huerta says. “And that’s the same with doctors.” Which means he’s gotten creative about recruitment, from the day care to student loan forgiveness programs. He’s had to.
Medical recruitment and retention are major concerns that are becoming a problem everywhere. Specifically, a math problem: Older doctors are retiring, and medical schools aren’t producing enough new doctors to replace them as the American population ages. The Association of American Medical Colleges’ most recent report predicts a physician shortage of 86,000 nationwide by 2036, which could unleash longer wait times, reduced access and worse outcomes for patients.
The danger lurking in the widespread adoption of AI, telemedicine, texting platforms and other technological solutions is the further degradation of trust.
The way people receive care has already changed significantly, with the American Medical Association reporting private practice physicians are dwindling amid a rise in web-accessed and hospital-centered care that promises to reduce administrative burdens for doctors.
But technology could help fill the gap. “Not only can it help — it will have to,” says Dr. Joseph Kvedar, a Harvard Medical School professor and former president of the American Telemedicine Association. “This shortage is already manifesting. And if we don’t harness tech to do more work for us, we’re never going to get ahead of it.”
The key, he adds, will be using different technologies to supplement human-centered care and avoiding an overreliance on tech that further undermines the increasingly fragile trust between patients and providers.
“I am a big believer that technology can augment what we do to make care better,” adds Dr. Shivan Mehta, a gastroenterologist and Penn Medicine’s associate chief innovation officer. However, “just because you throw technology at something doesn’t mean it’s going to work well.”
Risks and rewards
The job of “doctor” in the modern, Western sense can be traced to 1910, when educator Abraham Flexner published “The Flexner Report,” a book documenting the haphazard state of the nation’s medical schools. An outgrowth of Jacksonian America, populism painted universal medical standards as an unfair monopoly, unleashing a range of water healers, herbalists and other alternative practitioners to compete directly with medical doctors.
“You could practice medicine if people believed you could practice medicine,” says Mary Fissell, a medical historian at Johns Hopkins University. “The Flexner Report” wasn’t perfect — critics point out that it codified racist and sexist practices that still impact patients today — but it also set the table for many rigorous medical education and certification standards.
Out of Flexner, many medical education best practices were borne, drastically elevating standards of care. The way people became doctors, and the way patients accessed them, took a formal shape as supply grew to match demand — especially once Medicare was established in the 1960s.
Where doctors once visited homes, patients started traveling to offices more frequently. The Medicare program also funneled federal dollars toward residencies and medical specializations, which led to a boom in doctors to meet the new demand from patients. Today, though, the equation isn’t working like it once did, leading to shortages. “You could say,” Fissell says, “that that is in part the very long shadow of Flexner.”
The link goes back to those rigorously enforced standards, which are made possible in part by federal funds. Between 1997 and 2021, though, those funds were fixed, effectively limiting the number of new doctors with an artificial cap. The American Medical Association supported this cap, believing that a doctor surplus would devalue medical degrees, until the problem became too big to ignore. Congress approved funding for additional residency slots in 2021, and again in 2023, with proposals to add even more in the years ahead. But for now, the supply is still drastically lagging.
“We do not train enough physicians,” Fissell says. “There are not enough medical schools or residency places.” With an aging population that’s ever more likely to require ongoing access to health care, that’s a problem. And for some places more than others. “Doctors are unevenly distributed,” Fissell says. “There are fewer in rural areas, which worsens shortages.”
Sophie Hofeldt, a pregnant woman in rural South Dakota, was born at a local hospital herself. But a May report from the Kaiser Family Foundation detailed how that local hospital — like many in rural America — had recently closed its birthing unit. Hofeldt was driving almost 100 miles for prenatal care, and would have to make that drive yet again to deliver her baby. She wanted her birth to be as natural as possible, but that meant difficult compromises.
“People are going to be either forced to pick an induction date when it wasn’t going to be their first choice,” another pregnant woman told KFF, “or they’re going to run the risk of having a baby on the side of the road.”
Big promises, big questions
As an industry, health care thrives on volume and efficiency. Money is made based on the number of patients who come through the doors, so providers are highly incentivized to see as many patients as possible, as quickly as possible. This tends to result in a much more impersonal kind of care.
“The old model where you would have a doctor for a long time, that would get to know you,” Fissell says, “for most people, that’s just a complete fairy tale.” Especially among younger people. A 2021 survey by Accenture, a tech consulting company, found that millennials and Generation Z are nearly six times more likely to switch providers than older Americans.
Short-lived patient-provider relationships come with some interesting side effects. Wellness influencers are ascending as cheaper, accessible alternatives to traditional medicine. And trust in physicians and hospitals declined by 31 percentage points between 2020 and 2024 alone, meaning that nearly a third of Americans lost trust in doctors in a four-year span.
We have problems in our health care system and are hoping that AI is a panacea. A lot of the enthusiasm is because there aren’t other good options.
— Dr. Adam Rodman
At a time when medical literature is widely accessible, many people, empowered by services from WebMD to ChatGPT, are taking diagnoses into their own hands. To Fissell, it’s a modern echo of Jacksonian America, when medicine was more about belief than standards. Nowadays, though, the key to reversing the trend isn’t new standards; it’s better access to the rigorous, scientific care landscape we’ve built in the last 100 years.
That’s where technology makes its biggest promises, starting with telehealth specifically. It’s become a mainstay post-pandemic, offering doctors and patients a previously unimaginable level of flexibility.
According to a study released by the National Center for Health Statistics in 2021, over 80 percent of physicians in office-based settings used telemedicine for patient care, up from 16 percent in 2019. Telehealth can open doors for patients to receive specialty care that used to be limited by geography, while also requiring less of a time commitment; not having to drive to and from the office, plus wait while there, can be empowering and convenient. And research has shown it offers similar quality-of-life benefits for doctors.
Telehealth can be especially helpful in isolated, rural areas, as long as those areas have reliable internet access and as long as insurance companies agree to cover it. “It changes the access equation,” says Kvedar, the telemedicine leader. But it also doesn’t make medicine much more efficient — let alone more human — because “you’re still tying two people up in time, and there’s only so much clinician time to go around.” But other technical solutions could close that gap, too.
Kvedar envisions a future where remote monitoring becomes the norm, especially for rural communities. If a doctor treats 100 patients, and she can track their blood pressure and other vitals remotely, she can focus her time on the patients who need her the most. That way, limited access can be prioritized for the most vulnerable without leaving anybody out.
But no technology embodies both the potential and pitfalls of using tech to bridge health care access gaps as much as artificial intelligence. It provides a microcosm for what can go right when tech makes health care more accessible. And what can go wrong.
AI programs like DeepScribe and Abridge perform “ambient listening” by taking chart notes during appointments, thus freeing up providers to interact more directly with patients. That’s good for patients, who can see their providers face-to-face. It’s also good for providers, who don’t have to spend time between visits charting and can instead see more patients.
Adam Rodman, an assistant professor at Harvard Medical School leading the school’s work on generative AI, says that’s exactly how AI — and technological solutions more broadly — can be leveraged effectively: as an extension of, rather than a replacement for, human treatment capabilities. “As opposed to what’s largely happening right now — which is smacking AI on a pretty dysfunctional system.”
The danger lurking in the widespread adoption of AI, telemedicine, texting platforms and other technological solutions is the further degradation of trust. Not just because of potential privacy concerns, like potential data breaches and profiteering by revenue-driven tech companies. But also, in a more big-picture way, by making medicine less human than it should be.
Kvedar is right that technological solutions will have to be part of the solution to the physician shortage and resulting threats to access. But tech also can’t solve the industry’s issues alone. “We have problems in our health care system and are hoping that AI is a panacea,” Rodman says. “A lot of the enthusiasm is because there aren’t other good options.”
Tech stopgaps, human fixes
When Arco’s lone pharmacist retired at 84, the town couldn’t find a replacement. No one wanted to move there to take over. That led Huerta to establish a partnership with Idaho State University, whose students could staff Lost Rivers’ pharmacy under remote supervision from licensed pharmacists in Pocatello. Thanks to telemedicine, residents of Arco wouldn’t have to drive 50 miles to the next closest pharmacy for their medications.
Similar programs already exist elsewhere. Project ECHO, for example, which started in New Mexico and has expanded to all 50 states and dozens of foreign countries, connects rural primary care doctors with virtual continuing education and specialist consultations. If a rural Nevada doctor can treat heart problems locally, by consulting through Project ECHO with a cardiologist in Reno or Las Vegas, patients can avoid traveling to distant cities.
If towns in rural Nevada, or places like Arco, didn’t have these kinds of programs, they’d almost certainly lose primary care entirely. It almost happened in Arco shortly after Huerta arrived.
Not only can technology help — it will have to.
— Dr. Joseph Kvedar
The hospital had declared bankruptcy and needed a $5.5 million bond measure to stage a comeback. “In genuinely rural areas, genuinely critical access areas, a hospital is probably the only clinic you have access to,” Huerta says. It’s an issue that could become more widespread in metro areas, too, as the number of providers shrinks relative to the population seeking care.
At Lost Rivers, one long-term solution is working with staffing agencies. Every hospital, he explains, uses staffing agencies to broker access with, essentially, “substitute doctors” — that is, doctors who can fill in quickly when needed. These doctors, called “locums,” are exceptionally expensive. But long term, staffing agencies can match hospitals in need with doctors over time, and for much less.
A doctor at Lost Rivers, for example, might spend one week in Arco every month before returning home to Boise or Salt Lake City. But that doctor would come back again and again, month after month, meaning patients could build a relationship with that doctor.
“I think this is the model of the future, frankly,” Huerta says. But how long will that hold as the shortage worsens? Especially when, in Arco and beyond, access is already threatened in other ways.
Shifting regulations, like Idaho’s recent Medicaid cuts, make effective administration nearly impossible. Even Huerta’s pharmacy innovation was initially rejected by a state board. And private insurers present even greater obstacles.
“The big thing killing health care, frankly, is the payers,” Huerta says. “The delay and denial of claims is standard practice.” Their response to telemedicine perfectly illustrates why technology alone can’t fix the access problem.
When telemedicine emerged, insurers refused to recognize it as legitimate. “Why would I adopt telemedicine,” Huerta asks, “if I’m not going to get paid for it?” Eventually, they covered it at a reduced rate but excluded certain visits, like those related to mental health treatment. “OK then,” Huerta thought, “what’s the point of having psychiatrists on staff?”
That’s why he’s turned not just to technology for fixes, like the virtual pharmacy, but to human ones, too. Like the day care. So far, that’s been enough.
For the first time in his tenure, Lost Rivers is fully staffed. Its turnover rate is dropping. And for that, Huerta credits not technological innovation but something with a pulse — something he tells people when he’s trying to recruit them: “This is the job you’re going to look back on when you’re old and retired and go, ‘Man, I really did something with my life,’” he says. “‘I made an important difference.’”
This story appears in the September 2025 issue of Deseret Magazine. Learn more about how to subscribe.