I’m a family medicine-trained doctor working in a rural ER. I drive 90 minutes to get there, and I do it because if I don’t, no one will. The county I serve has seen its nearest hospital close. The OB unit is long gone. Specialist referrals are hit or miss. And the patients? They’re sick. Sicker than they should be. Because when access to health care disappears, what follows is predictable: Late diagnoses, unmanaged chronic disease, preventable death.

We don’t have enough doctors. We don’t have enough nurses. And yet, policy experts and political think tanks are floating ideas like “just replace them with volunteers.” That’s what Project 2025 is proposing. Replace trained, credentialed physicians with well-meaning volunteers to fix the rural health care crisis. I almost laughed when I read it—until I remembered that people with real power are pushing this. And people in rural America—many of whom voted for the very leaders now gutting their care—are going to suffer the most.

This isn’t theoretical. Since 2010, over 140 rural hospitals have closed, and more than 600 are currently vulnerable. The cost to operate is higher, the payer mix leans toward Medicaid and uninsured, and reimbursement is unreliable. And yet the need is staggering. Nearly 80 percent of rural counties are designated health professional shortage areas. And while rural Americans are older, sicker, and poorer than their urban counterparts, only 4 percent of new medical school graduates plan to practice in rural areas.

Why? Because we’ve made rural practice a punishment. It’s isolated. Understaffed. Underpaid. Politically volatile. In many places, dangerous. And yet, physicians like me keep showing up. We do it not for accolades, but because we know what happens when we don’t.

Maternal care, in particular, is on life support. Over half of U.S. counties now have no OB/GYN. Between 2011 and 2021, more than 200 rural hospitals closed their labor and delivery units. That’s not just a service loss—it’s a threat to life. Pregnant women are now traveling hours for care or going without it altogether. In a country with the highest maternal mortality rate among industrialized nations, this is unconscionable. For Black women, it’s even more deadly. We are nearly three times more likely to die from pregnancy-related causes than white women.

I’ve lived this firsthand. During my own first pregnancy, I developed pre-eclampsia. I was young, on Medicaid, and even though I was in medical school, I had to fight to be taken seriously. I essentially diagnosed myself and demanded action. In my second pregnancy, I carried twins while finishing residency. I knew it was high risk, and I had to navigate every step with hypervigilance. My training helped me survive. Most women don’t have that advantage.

Today, in the ER, I see women hemorrhaging after birth who never had prenatal care. I see babies born in backseats of cars en route to hospitals two counties away. I see mental health crises, untreated hypertension, missed cancer diagnoses—all because care is too far, too late, or just gone.

And I’m exhausted. Not just by the clinical work, but by the policy landscape that treats rural health care like a charity project or worse, a political pawn. The Teaching Health Center GME program—the one that trains primary care doctors in underserved areas—is at risk of losing funding. The proposed solution? Volunteerism.

With all due respect: You can’t staff an emergency room with good intentions. You can’t deliver a baby in a maternity desert with prayers alone. And you can’t replace structural collapse with slogans.

We need real investment. Loan repayment programs. Residency slots in rural hospitals. Fair reimbursement for rural providers. Better pay for nurses and techs. We need legislation that values rural lives as much as urban ones.

Because when you defund rural care, you’re not just cutting costs. You’re cutting lives short. And the people who suffer aren’t the ones making the decisions—they’re the mothers who die from preventable complications, the babies born too early and too far from help, the elderly patients with no transportation and no doctor within 50 miles.

I didn’t become a doctor to write policy, but now I have to speak up. Because what’s happening isn’t just unsustainable—it’s immoral. And if we don’t change course, we’ll look back and realize we didn’t just lose hospitals. We lost whole communities.

Pamela Buchanan is a board-certified physician, speaker, and thought leader dedicated to transforming health care and championing mental well-being. With more than 20 years of medical experience, she is a TEDx speaker known for her powerful talk on “Emotional Flatline,” which explores the emotional toll of high-stress professions, particularly in emergency rooms during the pandemic. As the author of The Oxygen Mask Principle and Emotional Flatline, Dr. Buchanan teaches self-care as a revolutionary act for working mothers, health care professionals, and high achievers.

In addition to her work as a physician advocate and ambassador with the Lorna Breen Foundation, her work extends to coaching and consulting, focusing on helping physicians navigate burnout and preventing burnout in medical students and residents. She strives to keep more physicians practicing. Dr. Buchanan’s mission is to help people break free from burnout, prioritize self-care, and live with purpose.

Dr. Buchanan is the founder of Strong Medicine and can be contacted for coaching, workshops, and speaking engagements. She can also be reached on TikTok and Instagram.