The initiatives below represent a sampling of what, with targeted funding from the state, Texas’ medical schools and health-related institutions are doing to improve the health of Texans.
“Overall, the mission we want is to make more primary care physicians for rural East Texas,” said Townes Leigh, DO, founding program director of the Huntsville Memorial Hospital Family Medicine Residency. “The SHREC side of things is about the implementation of the mission … We’re trying to make it as high quality and high impact as it can be.”
When Amy Waer, MD, arrived to head the Texas A&M University Naresh K. Vashisht College of Medicine in 2019, she was already a rural medicine advocate based on her 14 years at the University of Arizona.
In 2020, Texas A&M started its rural medicine program – now part of the Rural Engagement Program that includes A&M’s Colleges of Nursing and Pharmacy, plus the Rural and Community Health Institute – admitting its first class of students in 2021.
Initially launching with no funding, program officials connected with foundations and donors to raise seed money before securing state funds during the 2023 legislative session. Funding continued in 2025 to expand the program beyond its then 16-county reach.
“It is one of our strategic pillar programs in the college, and I am super passionate about it, and even more passionate because [of] Texas leading the nation with rural hospital and clinic closures,” Dr. Waer said, characterizing the school’s multi-faceted educational approach as “trying to make a difference” in expanding the workforce.
Upon transitioning from interim dean to dean, she tasked Curtis Donaldson, the school’s executive director for rural medicine, with an ambitious goal: “Build us up to over 50 counties by the 50th anniversary of the college in 2027.”
As of this writing, the school serves 54 Texas counties, largely thanks to its clinical partners, vital to the program as it does not have its own centralized teaching hospital.
The program requires medical students to do two-week rotations in rural communities throughout the state, with 71 physician preceptors available to support patient care in an increasing number of locations as A&M expands that outreach via the mandatory rural rotations.
One novel program, in conjunction with the Texas Tech University Health Sciences Center School of Medicine Lubbock, places medical students into fully functional clinics constructed from shipping containers.
Mr. Donaldson notes treating patients in outlying communities helps medical students understand the value of rural medicine, with some saying upon finishing rotations, “I could see myself living there.”
The first student in the program who did a rotation in Mr. Donaldson’s hometown of Mason, upon finishing his residency this summer, will become that city’s next doctor, partnering with a primary care physician in his late 50s who is contemplating retirement.
“Curtis knew, ‘If we don’t do something about this, I’m not going to have a physician in my town,’” Dr. Waer recalled. “[The community members] were personally and professionally invested in it.”
The program is also inspiring the next generation of health care professionals through education programs. A&M partners with more than 70 rural school districts – which Mr. Donaldson expects could surpass 90 by May – to reach K-12 students. Its latest initiative, launched in February, circulates digital and printable career exploration guides intended to, per Dr. Waer, “spark awareness, interest, and empowerment” for those considering health care careers.
As A&M develops its rural medicine outreach – which now includes a hub operating from the A&M system’s Kingsville campus in partnership with Christus Health – Dr. Waer believes its growing reputation will attract aspiring physicians who will want to practice in rural settings.
“Getting our medical students into these rural communities and seeing the lack of access to health care and the need is huge,” she said. “I believe our Aggie doctors to be a notch above … they can go into those community and truly be leaders from day one.”
Institute of Telehealth and Digital Innovation
Lubbock internist Cynthia Jumper, MD, believes Texas needs to be “creative” to address its lack of rural health care access – a challenge that she and her colleagues at the Texas Tech University Health Sciences Center (TTUHSC) believe is solvable, in part, by employing technology to connect physicians and patients across the state.
“We have communities in Texas without primary care, where patients have to drive 80 miles to the next largest town to see a doctor,” said Dr. Jumper, who serves as executive vice president for health policy and strategic initiatives at TTUHSC. “Patient access is one of the mission statements of the university ... and we are setting up ways to support that mission with the help of technology.”
For example, in 2025, the university’s Institute of Telehealth and Digital Innovation (ITDI) partnered with the Texas A&M University Health Science Center (Texas A&M Health) and the student-led organization, Texas A&M BUILD, to bring a state-of-the-art medical care facility to the rural community of Fort Davis.
In retrofitting a 40-foot shipping container, the partners equipped it with telehealth and telecounseling capabilities, offering local patients access to telemedicine services provided by TTUHSC Lubbock family medicine physicians and residents, and telecounseling services provided by Texas A&M Health licensed professionals, respectively.
Housed under the university’s Division of Rural Affairs, ITDI was established in 2023 after TTUHSC received funds from the state to establish the technology hub. The legislative investment allowed TTUHSC to launch the telehealth institute to expand access to care in rural and underserved communities in West Texas, including by developing infrastructure for telehealth primary care access sites and training the next generation of health care professionals to leverage telehealth and emerging technologies.
Coleman Johnson, senior vice president of TTUHSC’s Division of Rural Affairs, sees some of the most “transformative uses of technology happening in the most remote corners of Texas.”
Mr. Johnson said without the “generous state funds,” ITDI would not have been able to bring telehealth initiatives like those in Fort Davis.
With additional funds provided by the state last year, TTUHSC plans to continue ITDI’s momentum in 2026.
Mr. Johnson said the university’s telehealth institute is uniquely suited to “drive change and innovation that supports rural communities with what they need most: access to care.”
“When most people think of cutting-edge technology adoption, they picture urban hubs like Austin with autonomous vehicles and smart infrastructure,” Mr. Johnson said in email correspondence with Texas Medicine. “Yet frontier communities, where access to health care has historically been limited, are now embracing advanced telehealth platforms to connect with [physicians] hundreds of miles away.”
- Expand telehealth access sites and integrate specialty care options for rural communities;
- Build telehealth clinics in rural areas, including more retrofitted shipping containers outfitted with telehealth screening technology;
- Invest in telepsychiatry initiatives that allow psychiatrists and other behavioral health professionals to deliver psychiatric care online;
- Enhance technology platforms, including digital devices and remote patient monitoring;
- Develop opportunities for breast cancer screening and prevention, expanding from the university’s Access to Breast Health for Texans project; and
- Improve academic education related to telehealth through supporting initiatives such as the TTUHSC School of Medicine’s Telehealth Club and Project ECHO elective, and the deployment of telehealth training carts for the School of Nursing.
“Innovation isn’t confined to metropolitan areas,” Mr. Johnson said. “In fact, necessity is driving rural regions to become early adopters of digital health solutions, proving that technology can bridge geographic gaps.”
Mental Health Workforce Training for Underserved Areas
East Texas has generally lacked access to mental health care, according to John Pogue, MD, chair for the Robert M. Rogers Department of Psychiatry at The University of Texas at Tyler School of Medicine. But some of its residents, including those in more remote, rural parts of the region, have acute needs for that care.
“We do have some not unique problems, but the prevalence of some things that are higher in the region than maybe in other parts of the state and other parts of the country,” Dr. Pogue said. “One is opioid use disorder; we have a relatively high incidence of that. And then we also have, compared to the rest of Texas, a much higher than average rate of suicide, and Texas tends to run higher than the rest of the country on average.”
UT Tyler has been able to address these issues with its residency programs. A continued allotment from the state budget for 2026-27 will help continue to fund psychiatry residency training in underserved areas of East Texas, and at Rusk and Terrell State Hospitals.
“One of the big aims, of course, is to recruit and retain graduates, [psychiatrists] in the area, either private practice or recently what we’ve been doing is essentially adding them to our faculty, so that they become [psychiatrists] within our own system ... more services and more [psychiatrists] are what we need,” Dr. Pogue said.
“We’ve been very impressed by the response that our programs have gotten,” added Emmanuel Elueze, MD, PhD, associate dean for GME and Professional Development for UT Tyler.
Drs. Pogue and Elueze both note students applying to UT Tyler’s mental health program generally embrace the challenges of caring for rural and underserved populations, and the culture the faculty has created, combined with Tyler’s ongoing evolution as a regional hub, provides a sense of community.
“It’s a good place for younger people,” Dr. Pogue said. “We have a number of residents who are starting families, and so the community is a draw itself.”
The school’s psychiatry residency programs fully match each year, Dr. Elueze adds, and its psychiatric residency program gets upward of 500 applicants for six positions in Tyler and four in a clinic in Pittsburg, about 55 miles northeast of the main campus.
“The clinic is located in the middle of the city,” the chair of the Texas Medical Association’s Committee on Continuing Education said. “I can tell you that probably one of my happiest days here was the day I visited that clinic on a Friday afternoon and saw the number of patients waiting in the waiting room.”
The experience allowed him to realize the importance of the program, providing mental health care to a community that otherwise might not have it.
“We already need a bigger facility, and it’s a good problem to have,” Dr. Pogue added.