In this episode, I will reveal to you an impending collision of a chronic problem in the American healthcare system and a current piece of legislation in front of Congress that could destroy the healthcare for 56 million people in the United States of America in a matter of months. This is a long-term weakness of the U.S. healthcare system and a short-term budgetary philosophy that could end up in disaster.

Let me show you where these two trends intersect — and what might happen if they do. Check it out.

Hello and welcome to the latest episode of the Stop Physician Burnout podcast — a physician leadership podcast where you will learn the skills so that we can join together and lead the charge to physician well-being. Skills to earn the respect of your colleagues on the front line. Skills to exercise true influence in the C-suite and take back your job, your practice, your career, and your life.

All of these tools have been proven effective in my 40,000-doctor physician coaching and training practice. And if I know one thing, I know you're super busy — so let's get started.

Hello again. Dr. Dike Drummond here, just outside of Tacoma, Washington, with a quick thank you. Thank you for your time and attention for today’s important podcast. I'm going to sound the alarm on an intersection of the American healthcare system, politics, and population health in the USA in a way that nobody else is talking about.

I really appreciate your attention, and please share this podcast if this is upsetting to you too. Fortunately, I’ve got a bit of a happy ending. At least, there appears to be a way to stop this freight train from running right off the tracks.

As I’m recording this, it’s May 7 of 2025. Donald Trump and his regime have just survived their first 100 days in office, and they're working on what they're calling a “big, beautiful” funding bill for the government. The plan is to cut Medicaid and other health-related programs, let the DoJ people cut the fat, and then give large tax breaks to the wealthier end of the American economic spectrum.

Hey, what could go wrong, right?

Except here's something I want to bring back on your radar — and it may not have been on your radar at all. It's a litany of articles that have shown just how fragile the American rural healthcare system is — especially American rural hospitals. This is a multi-year story that you can follow in the press. Let me just trace the last three years of it:

• In January of 2023, a report came out showing 600 rural hospitals are at risk of closing, with over 200 at immediate risk due to insufficient revenue and rising costs.

• In November of 2024, an analysis found 705 rural hospitals at risk of closure, with 364 facing immediate threat.

• In March of this year — last month — more than 768 rural hospitals were seen as at risk of closing, with 315 at immediate risk, according to the Centers for Healthcare Quality and Payment Reform.

• And in February, a report from CHART found 46% of rural hospitals are operating in the red, with 432 identified as vulnerable to closure — and 18 rural hospitals closed or converted in the past year.

Now let’s connect the dots between the crisis in the profitability of American rural hospitals and defunding Medicaid — which is what the “big, beautiful” budget bill is supposed to do. At least, that’s what they’re threatening at this point in time.

Let’s just notice that the majority of the funding of rural hospitals comes from Medicaid. And if they’re already teetering on the brink, we could lose hundreds of hospitals with just this one stroke of the pen.

Now you may be saying to yourself right now, “Well, who cares if a hospital closes in the boonies?”

Let’s talk about what we mean when we say “rural America.” The definition of rural is less than 500 people per square mile in density. Anything over 500 is considered urban.

And if I simply look at the lower 48 states in the U.S. of A, 71% of the land mass is classified as rural. That’s 3.12 million square miles. And in those 3.12 million square miles live 16.7% of our population — 56.8 million people.

Fifty-six point eight million people. Sixteen point seven percent of the population.

Remember those numbers, because I’m going to call you back to them in just a minute when I show you the twist.

Let me bring in another data point — and a twist — that hopefully can cause some flexibility in the plans to defund Medicaid nationwide.

If you look at a map of the United States and contrast the rural areas with lower population density to the urban areas on both coasts, it’s clear that the vast majority of America is rural. And in rural regions, the hospitals are farther apart. So if you have a heart attack in the middle of Wyoming, it could be quite an ambulance ride — even with the sirens going and you screaming along at 90 miles an hour — to get to the care that you might need.

So what ends up happening is: if we collapse hundreds of rural hospitals, we create huge areas of the United States that are a healthcare desert. And your ability to survive a trauma or an illness or a heart attack is going to be directly related to how close you are to a hospital — to your zip code, basically.

And then here’s the twist.

If you look at a political map of America — a map that shows the results of the last presidential election, 2024 — you’ll see something startling. There’s a map in the show notes here that shows that a county that went for Trump is red, and a county that went for Harris is blue. What you’ll notice is that there’s an almost exact overlay of the rural counties of America with the Republican voting regions of America.

What’s happening if they pass this bill to defund Medicaid is: they’ll collapse the healthcare system for the citizens that elected them into office.

That’s right. The collapse of the rural hospitals — and the healthcare desert it creates — overlaps completely with the red rural counties in America. The ones that, as I told you earlier, contain 56.8 million people — easily enough to swing any election, local, state, or nationwide.

All I can do is pray that some meaningful feedback will come from their rural voters in a way that adjusts the decimation of Medicaid funding, which is currently planned by the politicians in Washington.

So — rural hospitals already in big trouble. Defunding of Medicaid crashes them to the ground. That creates huge healthcare deserts across the United States of America. And those deserts correspond with the same areas that carried the current president in the last election.

I wonder how this all turns out.

I guess we’re just living the Chinese curse of “May you live in interesting times.”

I’d love to hear what you think about all of this. I’ve left a link in the show notes for you to click back to my website where I have a blog post on this exact topic. You can leave a comment at the bottom of the page. I’d love to hear from you.

I’m sounding the alarm because no one else is — not in the national press that I’ve heard. I don’t believe anybody in the Trump administration understands what would happen to rural healthcare if they undercut Medicaid, which supports all of those hospitals.

So I’m going to be watching this very, very closely — and hoping there is some wave of outrage that comes from their rural voters that will get them to take a human, practical, well-thought-out approach to the intersection of saving money and providing adequate healthcare to the rural citizens of our country.

That’s it for today’s podcast.

Until we’re together next time — keep doing your great work, keep breathing, and have a great rest of your week.

That’s it for this edition of the Stop Physician Burnout podcast — coming to you every week, just 10 minutes, a single proven tool to increase your leadership skill, earn the trust of your team members, and exert influence up the chain of command.

Everything comes from my 15-year, 40,000-doctor coaching and training practice. Learn a tool, put it to use this week, and I guarantee you’ll get results.

And until we’re together in the next podcast — keep breathing. Have a great rest of your day.