NORTHEASTERLY: Spotlight on the New Hampshire Healthcare Sector
Northeasterly, April 9, 2026
A Blog about Prosperity and Opportunity in Northern New England
Healthcare in New Hampshire and across the region faces a shortage of workers (both in health care support and health care practitioners). In fact, 29% of the state’s healthcare workers are nearing retirement, according to an assessment of the State’s workforce development needs.
Analyses of future demand for healthcare workers in New Hampshire indicate that current labor supply will be insufficient to meet future needs. For example, according the Economic and Labor Market Information Bureau:
Healthcare practitioners and healthcare support occupations, two separate major occupational groups, account for 7,725 of all new projected jobs by 2032, 18.5 percent of all new jobs in the ten-year period.
Per the state’s “high demand occupations” data from 2024, there were 2,382 job openings in health care occupations in June of 2024 and New Hampshire will need 3,461 additional workers in healthcare occupations by 2032. See also projections by industry for rural and urban areas in New Hampshire.
Filling those positions with qualified local workers will require boosting New Hampshire’s workforce development efforts generally and specifically adding to the capacity of local colleges and universities to educate and train future healthcare workers in both degree and non-degree programs. But filling these positions also requires some fundamental economic infrastructure: housing.
Focus: Critical Access Hospitals in NH
According to the New Hampshire Hospital Association, Critical Access Hospitals employ roughly 5,300 people in the state. Critical Access Hospitals are hospitals that meet certain criteria established by the Center for Medicare Services based on the size of the community, its rural status, distance from other hospitals, and limited size of the facility.
Did you know that, in New Hampshire, each dollar of hospital payroll generates an additional $0.7750 in earnings across all other industries? Each hospital job generates 0.9130 additional jobs across all other industries.
–U.S. Bureau of Economic Analysis, RIMS-II Multipliers
Several factors contribute to the financial struggles of critical access hospitals in New Hampshire and across the region. Rural patients are more likely than their urban counterparts to be on Medicare or Medicaid and are also more likely than their urban counterparts to be over age 60. Also, the cost structures of rural hospitals have higher fixed cost ratios: for example, according to one study, the median ratio of fixed costs to total costs for hospitals in metropolitan areas is 73.3%; for micropolitan areas the median ratio is 84.7%; for “noncore” areas with a town of at least 2,500 residents, the median fixed cost ratio is 90.1%; for noncore areas with no town of at least 2,500 residents, the median fixed cost ratio is 93.3%. Put simply, the more rural the hospital, the less financial flexibility the hospital has to cut costs.[1] The less financial flexibility these providers have, the more financial strain they will experience. Without the economies of scale and flexibility to increase prices or reduce costs, these providers are very much in peril.
Talent Attraction and Retention: A Common Problem for the Region’s Hospitals
Beyond the funding and regulatory environment for Critical Access Hospitals, one of the biggest challenges facing rural hospitals is talent attraction. In fact, according to a survey by AMN Healthcare, an advanced practitioner search and consulting organization, practitioners have a strong preference for mid-size and larger metropolitan areas. Many of the reasons for these preferences are difficult for local communities to address – for example, a young doctor with a spouse who is pursuing their own career may not want to live in a rural community with limited job options for the “trailing spouse.”
| Final-Year Medical Resident Practice Location Preferences by Community Size | |
| Community Size | % |
| 10,000 or less | 0% |
| 10,001 to 25,000 | 3% |
| 25,001 to 50,000 | 5% |
| 50,001 to 100,000 | 14% |
| 100,001 to 250,000 | 16% |
| 250,001 to 500,000 | 15% |
| 500,001 to 1,000,000 | 17% |
| 1,000,001 or more | 30% |
| Source: AMN Healthcare 2023 Survey of Final-Year Medical Residents | |
One increasingly common barrier to talent attraction and retention is housing availability. This is especially true in rural communities, in which there is both a general housing shortage and a specific shortage in the market for new and/or high-quality rental housing.
An increasing number of critical access hospitals have elected to address this one specific barrier to talent attraction and retention by providing employer-owned housing. One such hospital is Speare Memorial Hospital in Plymouth, NH.
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CASE STUDY: SPEARE MEMORIAL HOSPITAL PLYMOUTH, NH
Speare Memorial Hospital owns a small portfolio of five units to support their efforts to attract and retain staff in a very tight Plymouth housing market. These properties — three standalone houses and two apartments within hospital office buildings — are all easily accessible on foot from the hospital, and are directly managed by the hospital admin.
As we own all of the units, the Hospital can set a rental fee that is affordable — and as we manage the units ourselves, we can address any issues in a timely manner.
Cheryl Callnan, Director of Development, Speare Hospital
Directly owned units are the core of Speare’s workforce housing strategy. Hospital-owned properties allow Speare to successfully house and retain staff in a market constrained by vacation rentals and college housing. However, Speare also maintains relationships with local rental property owners if excess need arises.
One house owned by Speare is shared specifically by on-call nurses, and all the units are available only to hospital staff. Since these units are typically only rented for a few weeks to months at a time, they are the most flexible, convenient, and affordable option for new hospital staff. Based on past experience, the units will likely turn over 4 times per unit per year – put differently, each unit can facilitate up to 4 new hires per year. The cost of recruiting for key positions can be substantial, so each new hire facilitated by employer-owned housing also represents significant savings when it comes to advertising, recruitment, travel reimbursements for interviewed candidates, et cetera.
Speare is now expanding its housing footprint with three more apartments – the latest units were financed in part through a $500,000 catalyst grant from the Northern Border Regional Commission. NBRC’s grant programs are among the only sources of federal grant funding that can be used to finance employer-owned housing.
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Keep an eye out for more from Northeasterly! We’ll be back on the blog in a couple of weeks.
Northeasterly is published by Harpswell Strategies, LLC, a Maine-based economic development and public policy consultancy. This content is researched and written by @Jacob Sesker (Principal), with help from two talented young analysts: @Addison Davis and @Oscar Herrera. To contact Northeasterly, e-mail jacob@harpswellstrategies.com and reference Northeasterly in the subject line.
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[1] Abigail Barker, PhD; Eliot Jost, MBA, MPH; Timothy McBride, PhD; and Keith Mueller, PhD. The Impact of High Hospital Fixed-Cost Ratios on Rural Populations. RUPRI Center for Rural Health Policy Analysis, Brief No, 2025-3.
