When you’re in pain, the last thing you want is a two-hour drive to the nearest ER. But for millions of Americans, that’s not a worst-case scenario—it’s just reality. Maternity wards are vanishing. Emergency rooms are overwhelmed. And in some parts of the country, finding a nearby hospital feels like hunting for a needle in a haystack.
It’s a healthcare system that often leaves the most vulnerable—rural communities, the elderly, and expectant mothers—without a lifeline. Because when access depends on your zip code, it’s not just inconvenient. It’s dangerous.
That’s why health experts from ConciergeMD mapped out the state of hospital access across the U.S., using up-to-date population data to rank all 50 states by the number of hospitals per 100,000 residents. Beyond pure hospital numbers, this study not only examines overall access but also shines a light on individual states’ specific struggles, including ER overcrowding, gaps in maternity care, and an impending shortage of hospital beds by 2032¹.
The findings are a wake-up call. Some states are holding the line with strong hospital networks. Others? They’re on the verge of collapse. And for millions of Americans, the question isn’t when care will arrive—but if it will at all. As both a certified family medicine doctor and the CEO and founder of Concierge MD, Dr. Abe Malkin, M.D., M.B.A.,understands the life-threatening consequences of inaccessible care:
“We are watching rural hospitals disappear in real time. These closures don’t just affect emergency care—they gut entire communities, leaving patients without maternity services, cancer screenings, or even routine check-ups. When the nearest hospital is two hours away, people delay care until it becomes life-threatening. It’s a public health crisis hiding in plain sight.”
South Dakota Leads in Hospital Access, but Rural Gaps Remain
South Dakota ranks first nationwide for hospital availability, with six hospitals per 100,000 residents. It’s also one of the best states for doctors, with top-tier hospitals like Sanford USD Medical Center in Sioux Falls and Avera St. Luke’s in Aberdeen getting national recognition.2, 3
Yet, despite these strong numbers, ensuring reliable healthcare access remains a complex challenge—largely due to the states’ rural makeup and low population densities: Roughly 42.3% of South Dakota’s residents live in rural areas—more than double the U.S. average4. This dispersed population demands a greater number of hospitals across wide distances to ensure timely access, especially in emergencies. To meet the needs of dispersed, rural communities, Critical Access Hospitals (CAHs) play a vital role in South Dakota’s hospital landscape—small, rural hospitals supported by Medicare.
🏥 The state has 40 CAHs, which make up nearly half of its 61 hospitals5
🛏️ South Dakota also offers 4.6 hospital beds per 1,000 residents, well above the national average of 2.46
🕐These conditions contribute to relatively short emergency room (ER) wait times, averaging just 113 minutes compared to the national average of 163 minutes7
⚡However, nearly 28% of South Dakota’s hospitals are considered vulnerable to closure due to chronic staffing shortages, aging infrastructure, and limited funding8
As federal and state policies increasingly focus on fewer, larger medical centers, rural hospitals in South Dakota are struggling to stay afloat, threatening access for thousands of residents.
North Dakota: Small State, Strong Access—but at Risk
North Dakota ranks second in the nation with 5.4 hospitals per 100,000 residents, serving a largely rural population. Like its southern neighbor, North Dakota’s geography demands a broad distribution of healthcare facilities. A significant portion of its population lives in remote areas, requiring hospitals to be spread across vast distances to ensure timely emergency care.
🏥 The state maintains 37 Critical Access Hospitals (CAHs), nearly half of its total facilities5
🛏️ North Dakota also offers 4.3 hospital beds per 1,000 residents. This is substantially higher than the national average of 2.46
🕐 North Dakota ER patients wait just 110 minutes on average — well below the U.S. average of 163 minutes7
⚡ As of 2025, 11 rural hospitals in North Dakota are at risk of closing9
Like their counterparts in South Dakota, hospitals in North Dakota are under enormous pressure. Aging infrastructure, workforce shortages, and funding limitations put many of these rural hospitals at risk. Federal healthcare strategies often prioritize centralized, urban-based systems. Without continued investment and targeted policy support, these critical access points could disappear, leaving remote communities dangerously underserved.
Maryland falls on the last spot, leaving residents vulnerable to a lack of proper health care
Maryland has the lowest hospital density in the United States, with only 0.75 hospitals per 100,000 residents. This limited infrastructure significantly impacts the state’s ability to provide timely and adequate care, especially in emergency situations.
🕐 While the average ER wait time in Maryland exceeds four hours, there have been numerous reports of patients waiting up to 24 hours to receive necessary emergency care. In some cases, patients have even chosen to seek emergency services in neighboring states like Virginia due to prolonged wait times in Maryland10
👩🏻⚕️As of 2022, Maryland hospitals faced the most critical staffing shortage in recent history, with one in every four hospital nursing positions vacant11. This shortage is attributed to high staff turnover and an insufficient talent pipeline. Additionally, Maryland ranks among the bottom states for nurse-to-population ratio, with just over eight nurses per 1,000 residents12
🛏️ Maryland ranks as the fifth lowest in beds per capita, with 1.8 beds per 1,000 people, significantly lower than the national average of 2.4 beds per 1,000 people13
These factors—limited hospital availability, extended ER wait times, staffing shortages, and low bed capacity—underscore the pressing need for systemic improvements in Maryland’s healthcare infrastructure.
Despite Leading in Medical Schools, New York Ranks 49th in Hospital Access
With just 0.8 hospitals per 100,000 residents, New York ranks 49th in hospital accessibility — despite being one of the most densely populated states and home to 18 medical schools, the highest number in the country. The state’s prominent role in medical education hasn’t translated into adequate infrastructure, as New Yorkers still face a shortage of hospitals and some of the longest emergency room wait times nationwide.14
🕐 Patients typically wait over three hours to be admitted, and at Albany Medical Center, the average ER visit lasts more than six hours from arrival to discharge15
🏥 Nearly 40 hospitals have closed across New York state since the 2000s16
The disconnect between medical education and healthcare infrastructure highlights a critical gap in patient access and care.
Florida’s Hospital Access Under Strain: Aging Population Meets Staffing Gaps
With just 0.94 hospitals per 100,000 residents, Florida ranks 45th nationwide in hospital accessibility. This is a concerning statistic for one of the most populous states in the U.S. However, the challenge goes beyond the number of hospitals alone.
👴🏻 Florida is home to a significant aging population, with 22% of residents aged 65 and older as of 2023, the third-highest share in the country17. This number is predicted to rise to 30% in the next twenty years18
🛏️ Florida has just 2.5 hospital beds per 1,000 people, placing it just above the national average — a ratio that leaves little room for surges in patient demand19
👩🏻⚕️ Staffing shortages further aggravate the situation. While the state’s nurse vacancy rate dropped to 13% in 2023, down from 21% the year before, the outlook remains bleak: by 2035, Florida is projected to face a shortfall of nearly 60,000 nurses as both the population and demand for care rise sharply20
With too few hospitals, too few beds, and a shrinking workforce, Florida’s healthcare system may soon be overwhelmed by its aging population.
California’s Training Capacity Falls Short While Demand for Nurses Soars
California has over 39 million residents but ranks just 47th in the nation for hospital access, with only 0.90 hospitals per 100,000 people. This shortage is particularly concerning given the state’s vast and diverse population.
🏥 Since 2012, at least 46 hospitals in California have permanently closed or suspended their labor and delivery services, with approximately 60% of these closures occurring in the last few years. These closures have left 12 counties without any hospitals to deliver babies, exacerbating maternal health challenges across the state21
🤰🏻 This is especially concerning as maternal mortality rates have worsened in San Diego County and throughout California, with pregnancy-related deaths hitting a 10-year peak in 202022
👩🏻⚕️ Staffing shortages further strain California’s healthcare system. Some hospitals in Southern California report nurse vacancy rates exceeding 30%. For comparison, the average pre-pandemic vacancy rate was 6%23. This shortage has led to overworked staff and increased burnout, prompting many nurses to consider leaving the profession
🎓 Compounding the issue, California faces a critical paradox: while there’s an overwhelming demand for skilled nurses, the state lacks the capacity to train them24
Despite thousands of qualified applicants, nursing programs in California can admit only a fraction due to funding and resource constraints. This stark disparity underscores the urgent need for effective solutions to improve healthcare access across the Golden State.
Hospital Deserts in Texas: 64 Counties Without a Single Facility
With 1.6 hospitals per 100,000 residents, Texas ranks 25th nationwide in hospital accessibility. Yet the healthcare system of the second-largest state in the U.S. faces significant challenges, particularly in rural areas.
🏥 Since 2010, the state has experienced 26 rural hospital closures—the highest number in the country—leaving many communities without immediate access to care25
‼️ 64 out of all 254 Texas counties don’t have a hospital at all 26
🛏️ Additionally, 64% of Texas hospitals report operating with fewer beds and reduced services due to nurse staffing shortages27
This combination of hospital closures, provider shortages and an insufficient coverage of hospitals in many counties underscores the pressing need for systemic improvements in Texas’s healthcare infrastructure.
Shrinking Access: Illinois’s Maternity and Medical Staff Shortages
Illinois, the most populous state in the Midwest, ranks 31st nationwide in hospital accessibility, with 1.46 hospitals per 100,000 residents. Despite its urban centers, the state faces significant healthcare challenges, particularly in rural areas.
🤰🏻Between 2016 and 2023, Illinois saw a decline in birthing hospitals from 118 to 86. This reduction disproportionately affected rural women, with only 65.4% living within a 30-minute drive to a birthing hospital in 2023, down from 76.5% in 201628. While Illinois continues to see a decline in birth rates, the state still recorded nearly 125,000 births in 202329
👩🏻⚕️ Staffing shortages exacerbate these issues. Illinois is projected to face a shortfall of nearly 15,000 registered nurses by 2025, with fewer than 8,000 nurses graduating annually30. Additionally, the state anticipates a deficit of 6,200 physicians by 203031
These challenges underscore the need for systemic improvements in Illinois’s healthcare infrastructure to ensure equitable access to care across the state.
A Hospital Shortage is Threatening the Nation
The shortage of hospitals is only part of the challenge. Since the pandemic, the number of staffed hospital beds in the U.S. has declined by 16% — not due to a drop in need, but largely because of ongoing staffing shortages and limited resources32. As federal support fluctuates and public healthcare infrastructure struggles to keep pace, patients across the country are increasingly facing uncertainty in accessing timely and reliable care. This analysis underscores a critical shift: private healthcare providers are becoming an essential pillar in delivering consistent, long-term care. Services like mobile clinics, telemedicine, at-home care, specialist consultations, urgent care centers, and preventive health screenings are helping to bridge the gap, offering flexible and accessible solutions where traditional hospital infrastructure falls short.
Sources
The full list of sources used for the research can be found in the overview provided here.
Methodology
How the analysis was conducted:
The dataset used for the hospital accessibility ranking includes all nonfederal, short-term general and specialty hospitals open to the public, as defined by the American Hospital Association and consistent with national health reporting standards. These facilities represent the core of the U.S. healthcare system, providing a broad range of services—from emergency care and surgical procedures to specialized treatment centers such as cardiac and oncology units. They are typically accessible to the general population, regardless of background, and encompass nonprofit, for-profit, and community-governed institutions that deliver acute, short-term care.
Hospital numbers: The most recent data available was utilized in this analysis, including data from the American Hospital Association (AHA), the American Hospital Directory (AHD) and the Kaiser Family Foundation (KFF).
Population data: The state population data for the year June 2024 has been acquired through the United States Census Bureau.
To ensure that the analysis uses data that is comparable between states and reflect the needs of the majority of the nation, the following institutions have been excluded from the dataset:
🏥 Federal hospitals, such as those operated by the Department of Veterans Affairs, the Department of Defense, or the Indian Health Service, which serve specific populations and are not generally open to the public;
🏥 Long-term care and specialty facilities, including psychiatric hospitals, rehabilitation centers, and chronic care institutions;
🏥 Closed-access or restricted hospitals, such as those located in correctional facilities or operated by private organizations serving limited groups (e.g., religious orders or corporate employees).
This focused definition ensures consistency in tracking and comparing hospital infrastructure across states.
