In recent years, academic medical centers (AMCs) have emerged as key players in the healthcare landscape, particularly as many community and rural hospitals face crisis. With a growing number of these facilities closing or reducing their services, access to care is significantly threatened. AMCs are repositioning themselves from being solely centers for complex care, research, and education to becoming vital stabilizers of local healthcare. This transformation comes as a response not only from strategic business goals but also from a sense of civic responsibility.
The closure of community hospitals is a pressing issue, particularly in rural areas where over 700 hospitals, roughly one-third of all rural facilities, are at risk of shutting down. With such dramatic trends, patients increasingly find themselves without essential healthcare services. For instance, the data reveals that more than 500 hospitals in the U.S. ceased offering maternity services between 2010 and 2022, and currently, only 41% of rural hospitals provide labor and delivery capabilities. These closures correlate with diminished access to critical health services including maternal and surgical care, as well as mental health support.
In the United States, hospital acquisitions involve various types of buyers, including not-for-profit systems, investor-backed groups, and specialty hospitals. However, many historical buying entities are now facing financial strain, limiting their capacity to acquire distressed community hospitals. Not-for-profit hospitals and safety net facilities are increasingly positioning themselves as sellers as they seek relief through mergers or divestitures. Moreover, for-profit operators are focusing on optimizing existing assets rather than taking on new burdens.
Given this shifting landscape, AMCs represent one of the remaining types of buyers that possess the capital and mission-driven focus necessary to invest in these hospitals. Resources such as philanthropy, tax-exempt financing, and state support equip AMCs to not only upgrade facilities but also maintain essential local services while connecting patients to advanced academic care when necessary.
The need for AMCs to play a proactive role in preserving community hospitals is underscored by compelling data. Analysis indicates that patient admissions and observation stays at AMCs surged by 16% from 2020 to 2024 compared to just 2% for non-AMCs. By stabilizing community sites, AMCs enhance their capacity for complex care, thereby reducing overall care costs and keeping patients closer to home. Moreover, a study published in the JAMA Network indicates that markets with a significant AMC presence report lower mortality rates and higher counts of healthy days at home, illustrating the positive impact that effective integration of community and academic healthcare can have.
This is further illustrated by recent trends in acquisitions, with AMC involvement in community and regional hospital deals rising from 29% in 2021 to 50% in 2025. Notably, university-owned systems' share of the total deal volume also grew from 14% in 2019 to 21% in 2025. These figures highlight how AMCs are becoming critical players in the acquisition landscape as more community hospitals seek new ownership.
Despite their potential, many AMCs encounter execution issues due to their lack of a proven model for operating extensive networks. A poorly defined business strategy or governance structure could limit the benefits of acquisitions, risking the replication of costly flagship operations across new community assets. Thus, it is essential that AMC leaders formulate a clear growth strategy and expedite network design following acquisitions.
Key strategic considerations include:
Without addressing these governance issues, AMCs may risk inconsistent service delivery, which could undermine their integration efforts.
As the pressures facing community hospitals intensify, there is an urgent need for AMCs to act swiftly and strategically. The choices regarding which assets to acquire, the services to maintain locally, and the governance structures required to create effective networks must be made decisively. Delaying these actions may result in fewer options for AMCs and could diminish their ability to strengthen community healthcare infrastructure.
In closing, AMCs have a pivotal opportunity to stabilize access to healthcare in local communities. By becoming strategic and disciplined buyers, and recognizing their role as community stewards, AMCs can significantly influence the future of healthcare delivery in regions at risk of becoming deserts.
Contributors to this analysis include leaders from EY-Parthenon, underscoring the collaborative nature of addressing these ongoing challenges.
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