Want More Doctors in Rural Delaware? Train Them Here.
A simplistic view says, graduate more Delaware doctors and you will get more doctors practicing in Delaware.
IT DOES NOT WORK THAT WAY.
Delaware wants more doctors, particularly in Kent and Sussex counties. But getting more Delaware students into medical school does not necessarily mean getting more doctors practicing in Delaware. The real bottleneck comes next: residency training.
Whether or not the medical students are Delaware natives, they don’t stay here. They stay where they did their post-medical-school training, internships, and residencies. That is where their mentors and colleagues are, which usually coincides with where they started their families.
I came back to Delaware after medical school at the University of Virginia and internship
and residency at Yale, not because I was a Delaware native. I came back because my mentor and colleague was my father, who was practicing Orthopedics in Delaware.
Delaware understood decades ago that building its own medical school was not necessarily the most economical way to educate Delaware doctors. In 1969, after feasibility studies examined the cost of a state medical school, the General Assembly created the Delaware Institute of Medical Education and Research (DIMER) instead. The original legislation said the partnership could provide Delaware “most of the advantages of a State medical school at a fraction of the capital and operating costs.” The medical-school question was revisited roughly every decade, but DIMER remained the practical alternative. When lawmakers formally revisited DIMER in 1996, they concluded that the model was “sound and should be continued and strengthened.” Today, DIMER reserves seats for Delaware residents at Sidney Kimmel Medical College at Thomas Jefferson University—formerly Jefferson Medical College—and the Philadelphia College of Osteopathic Medicine (PCOM). Delaware has long had a cost-effective way to provide medical-school opportunities for its residents without owning and operating a medical school itself.
Even though a Delaware medical school might make more Delaware natives into doctors, it does not necessarily make more Delaware doctors.
The next step in the physician pipeline—residency training—is where Delaware has a real opportunity to get more doctors practicing here. After medical school, physicians must complete residency training before practicing independently in their specialties. A residency position is not simply a training slot. A resident is a physician working and caring for patients in a Delaware hospital while completing that training. Teaching hospitals employ and train these physicians, and Medicare has historically provided a major source of funding to help hospitals cover that cost. In 1997, however, Medicare generally capped the number of residency positions it would support at each hospital based on that hospital’s 1996 resident levels. Hospitals could still train additional residents, but they generally had to find other money to pay for positions above the cap.
The 1997 funding cap put downstate Delaware at a particular disadvantage.
ChristianaCare already had a long-established residency program when the federal cap was set. Bayhealth and Beebe did not. Bayhealth welcomed its first classes of residents in 2021, and Beebe welcomed its first in 2023. In effect, Medicare support was largely locked in based on where residency programs already existed in 1996. And residency is not just training—it is physician recruitment. Residents trained at ChristianaCare, Beebe, or Bayhealth do tend to stay in Delaware.
Federal funding helped Delaware’s downstate hospitals begin building residency programs. In 2019, the federal Health Resources and Services Administration awarded Beebe and Bayhealth $750,000 each to develop new rural family-medicine residency programs. Delaware health officials understood exactly why. “Clinicians who train in rural settings are more likely to continue to practice there after they complete their residencies,” said Dr. Karyl Rattay, then director of Delaware’s Division of Public Health.
Since then, Delaware hospitals have built a substantial residency pipeline—much of it with their own resources. By 2026, Delaware’s six acute-care hospital systems filled more than 250 residency and fellowship positions. According to the Delaware Healthcare Association, hospitals now support more than 100 GME programs and provide nearly $70 million annually for graduate medical education, including positions beyond federal funding caps.
Other states put state dollars directly into the residency bottleneck. States including Texas, Indiana, Missouri, and Montana use state funding to expand graduate medical education. Montana is particularly instructive: with a population similar to Delaware’s, it directly supports residency training. Delaware should ask whether its healthcare dollars are targeting the point in the pipeline most likely to produce practicing physicians.
But getting more doctors here is only part of expanding Delaware’s healthcare capacity. The state’s Certificate of Public Review (CPR) law still requires approval for certain new healthcare facilities, major capital investments, and changes in bed capacity. Delaware eliminated major medical equipment as a stand-alone CPR trigger in 2026; CRI believes the next step should be full repeal.
As Delaware moves forward with plans for a new medical school, we should not lose sight of where the real physician bottleneck lies. If the goal is more doctors practicing in Delaware, we would be far better off investing more resources in residency training slots in Kent and Sussex counties. Doctors training here are already caring for Delaware patients while developing local networks, becoming part of the community, and hopefully developing a fondness for the Kent and Sussex County lifestyle. Do that, and we might just get some more licensed doctors practicing in rural Delaware.
If Delaware wants more doctors in rural Delaware, train more doctors in rural Delaware.
TAKE ACTION
Delaware patients deserve greater access to healthcare—and greater transparency about the care they receive. CRI is working to remove barriers that limit healthcare expansion while giving patients the information they need to make informed decisions about their care. You can help by taking action on two important healthcare issues facing Delaware.
Patient Transparency
Tell Delaware Lawmakers: Patients Deserve Transparency
Delaware patients deserve to know whether the healthcare professional diagnosing and treating them is a physician, nurse practitioner, physician assistant, or another licensed healthcare professional. Add your name and urge Delaware lawmakers to bring back and strengthen the Healthcare Professional Transparency Act.
Why Healthcare Access Matters
Tell Delaware Lawmakers: Patients Deserve Transparency
Delaware patients deserve to know whether the healthcare professional diagnosing and treating them is a physician, nurse practitioner, physician assistant, or another licensed healthcare professional. Add your name and urge Delaware lawmakers to bring back and strengthen the Healthcare Professional Transparency Act.
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