Recruiting and Retraining in Rural Health
Accessing quality healthcare can be difficult in a large urban city, but it can be impossible if you live in a remote area. Consider the following obstacles:
1. Many rural community residents (regions having ninety-nine or fewer people per square mile) cannot get to an emergency department quickly enough given distance. Others often cannot or do not want to travel long distances to get annual exams, checkups and required screenings, putting them at risk.
2. Many remote areas are susceptible to environmental dangers from industry and farming, putting populations at a higher risk for certain types of cancers.
3. While 20 percent of Americans live rurally, only 9 percent of the nation’s physicians practice there. There is a nursing shortage in rural areas as well.According to the Colorado Health Institute, there are more than 13,000 doctors in Colorado, but our 16 rural counties have three or fewer doctors. Provider shortages are exacerbated by the difficult task of recruiting providers to work in small towns and keep them there. Recruitment and retention also become more complicated with local health care employers’ inability to compete with urban-based employers in terms of salaries, benefits and bonus incentives, creating increased disparities between urban and rural providers.So how can we address the dire need for providers in rural areas?An article in Medicine and Society had these ideas:
1. Increase the number of medical students from rural areas.
2. Increase rural undergraduate medical education and rural-focused postgraduate training.
3. Enhance return-of-service programs.
4. Improve financial incentives for rural practice.
5. Stabilize rural group practices with appropriate facilities and health care teams.
6. Increase community involvement and support.
7. Increase functional referral networks.
.Of these ideas, loan repayment programs, as well as other payment incentives, have become increasingly popular. These programs are designed to entice physicians – especially residents — to practice in rural areas. Given the tremendous amount of medical school debt, these programs are compelling (and effective) for residents who admit that the financial help makes a difference.
Beyond finances though, there is the issue of the community itself. Reports from the American Academy of Family Physicians suggest that opportunities for spouses, schools, peers, and family close by also influence physician recruitment and retention in rural areas. As a result, rural health researchers suggest rural clinics and communities place a high priority on practice scheduling, the spouse-partner and interpersonal issues during recruitment. Changing the ways in which physicians are recruited and selected for fit in rural communities will ultimately change retention outcomes, they argue.
At the same time, others are starting to ask a different question: If you live in a rural area, would you consider seeing your doctor by video? Telemedicine, a different kind of care practice, is one way of attempting to alleviate the overwhelming demand of providers. Researchers at Mayo Clinic have found that using two way audio-video telemedicine to deliver stroke care, otherwise known as “telestroke,” appears to be cost-effective for rural hospitals that don’t have an attending neurologist at all times. Care is delivered through a robot so that stroke patients can be seen in real time by a neurology specialist elsewhere, who then consults with an emergency room doctor via computer in the rural clinic.
It is clear that the complexity of recruitment and retention in rural areas demands multidimensional strategies and collaborations in order to meet the needs of rural residents and those who choose to practice there. How does your rural clinic or hospital recruit and retain healthcare providers?