I always feel a rush of focus when guiding a catheter through the heart into the pulmonary artery. It’s a delicate task, like steering a small vessel through unseen waters. Each movement matters as I find the right path. Once I have my lane, it feels almost effortless. The catheter locks into place, and then the real work begins.
In comparison, the actual procedure is calm. Using a wire to hold my position, I switch to a specialized catheter that essentially acts as a vacuum. This tool allows me to safely remove the clot obstructing blood flow to the lungs. Moments later, my patient’s racing heart slows back to normal, and he’s ready to go home in just a couple of days.
Yet, the excitement of the operation isn’t the heart of the matter. It’s the quiet moments leading up to it that make a real difference in patient care.
Just two hours before the procedure, my patient arrived at a nearby emergency room in North Georgia, experiencing chest pain and trouble breathing. An urgent scan revealed a significant clot in the main pulmonary artery. Thanks to swift action from the emergency physician, who started blood thinners and called me, we could move forward with the procedure later that evening.
However, this door to advanced treatment is closing for many rural communities as local hospitals are shutting down.
Pulmonary embolism is often overlooked, yet it’s the third leading cause of cardiovascular death. In 2018, the FDA approved a device to remove clots, shifting the landscape of treatments. A recent study from late 2025 showed that mechanical clot removal can outperform blood thinners in high-risk situations. This progress is promising, but it highlights a concern: amazing technologies won’t help if they aren’t accessible to those in need.
In my patient’s case, the local hospital was unable to perform the suction procedure. It was fortunate they could quickly diagnose and administer blood thinners. Starting treatment early is vital, significantly impacting survival rates. If the local hospital had been closed, my patient would have faced a long, risky 90-mile drive for care—potentially life-threatening.
A report from the Center for Healthcare Quality and Payment Reform indicates that 756 rural hospitals across the U.S. are at risk of closing due to financial instability—over a third of such facilities. Of these, 323 could shut down within three years.
Even with limited resources, these hospitals are crucial for emergency care in rural areas. They serve as essential gateways, but their survival is now threatened.
There is a glimmer of hope, thanks to funding from the Rural Health Transformation Program. Announced in late December by Centers for Medicare and Medicaid Services Administrator Mehmet Oz, this initiative aims to bolster rural healthcare.
Skepticism is warranted, however. While the program allocates $50 billion over five years, it accompanies Medicaid cuts totaling $58 billion. That bond could result in an $87 billion revenue loss for rural hospitals in a decade, chiefly due to a high number of uninsured patients.
The Rural Health Transformation Program responds to predicted harm from these Medicaid cuts. States must outline plans focusing on five areas: improving chronic disease management, ensuring sustainable access, developing a skilled workforce, encouraging innovative care models, and expanding technology.
There are promising aspects. Enhanced management of chronic diseases could reduce expensive emergency visits, and technology investments might improve access to care. However, these benefits could be short-lived if the program funding dries up.
During my surgical training in rural North Carolina and my early career in Virginia, I witnessed the challenges firsthand. Providing equitable healthcare, regardless of economic background or geography, is a moral obligation. The ability to safely remove a clot through a minor incision is a remarkable advancement. Yet, all this progress means little if patients can’t access these essential treatments.
Each step toward better healthcare matters, but access must remain a priority if we want to genuinely improve patient outcomes.
Daniel Torrent is a vascular surgeon with the Longstreet Clinic at Northeast Georgia Health Systems.
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