The Membership Organization of State Offices of Rural Health
In a recent NOSORH Member survey, more than 50% of SORHs reported a focus on recruitment and retention and more than 70% previously reported they have need for resources to address recruitment and retention. With this in mind, NOSORH contracted with Boise State University Center for Health Policy to prepare a comprehensive resource for SORHs: The Toolkit for Recruitment and Retention of Primary Care Physicians in Rural Areas is designed to offer valuable resources for physician recruitment and retention to recognize best practices, identify critical need and challenge areas for recruitment and retention, and also to illustrate Federal resources, state programs, current policy issues, and other important resources.
NOSORH will offer a webinar on March 18th at 3 pm ET to review the toolkit.
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Back to March Branch
Access to surgery in rural areas is becoming more limited as rural surgeons age out faster than they are being replaced, according to Jonathan C. Sprague, president of Rocky Coast Consulting. Sprague, who facilitates a national Rural General Surgery Coalition (RGSC), likens this to a ticking time bomb.
“While not technically primary care, general surgery is a fundamental health service,” Sprague said. “Yet there are very few physicians coming out of surgery residencies who want to go into general surgery—most want to go into specialty surgery. And of those who want to be general surgeons, few are going out to rural areas.” Sprague added, “Not only is access to surgery clinically important, but most small hospitals are dependent on income they receive from general surgery programs.”
Sprague said that even with rural-sensitive initiatives, such as improving residency programs, developing rural rotations, and starting transition-to-practice programs, it’s still not going to be possible to train enough surgeons over the next decade to meet projected needs. Therefore, hospitals must look at restructuring their delivery systems so that multiple hospitals can work together to provide adequate access to general surgery services.
The National Rural Health Association is the host organization for the coalition. Teryl Eisinger represents NOSORH on the RGSC.
RGSC and NRHA are looking for six to 10 hospital systems/clusters around the country to participate in a project that will identify models for regional collaboration and best practices. In addition to on-site discussions, participants will connect with each other periodically during the study via conference calls to discuss strategies that are working or not working. The coalition will then create a composite report—looking at the strengths and weaknesses of the models, which the hospitals can use as a workbook. Each hospital will also get an analysis looking at their issues, with specific recommendations on how to strengthen their programs.
Although hospitals would have to fund their participation in the study, Sprague said that the outcome could reap big savings. “If you could retain your physicians and tame your turnover, improve scheduling and staffing, or work with other hospitals so you don’t need quite so many surgeons, there could be substantial cost savings,” Sprague said. “For example, if five hospitals in a cluster were able to save one general surgeon FTE that could save $400,000 or more per year.”
Sprague suggested that interested NOSORH members review NOSORH’s 2011 study, Summary of Discussions, Recommendations and Tactics Related to Rural General Surgery. RGSC would also welcome an additional representative from a State Office of Rural Health to work with Eisinger to foster communications with SORHs. The workgroup is not highly demanding, Sprague said, because it only involves some exchanges by email and a couple of conference calls a year that will serve as a forum where people come together and exchange ideas.
For more information on the challenges of assuring access to general surgery and RGSC, or to share thoughts on SORH involvement or to volunteer, contact Jonathan Sprague.
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Back to April Branch
Two Recruitment and Retention (R&R) programs sponsored by the South Dakota State Office of Rural Health (SD SORH) have been so successful that they were recently revised and expanded. The programs are designed to help rural facilities— including hospitals and long-term care facilities—recruit physicians and other health professionals.
“We have great support from the executive and legislative branches in the state—both programs are funded by the state government,” said Sandra Durick, Administrator of the SD SORH. “Our governor has been supportive of rural health care including R&R programs.”
The Recruitment Assistance Program (RAP), which has been in existence in various forms since 1988, was expanded in the state’s last legislative session to encompass more levels of practice. Whereas in the past only family medicine physicians, general practice dentists, physician assistants and nurse practitioners were included in the program, it now also includes pediatricians, internists, ob/gyns, pediatric dentists and nurse midwives, said Josie Petersen, who coordinates the RAP program.
The Rural Healthcare Facility Recruitment Assistance Program (RHFRAP) was enhanced and approved by the2012legislature, with the incentive amount increasing from $5,000 to $10,000, along with the service obligation expanding from two to three years. The program recruits health professionals from a variety of fields including dietitians, LPN or RN nurses, occupational, physical and respiratory therapists, pharmacists and laboratory technologists. “With the legislative changes, all 60 spots for the 2012 program were filled and we anticipate filling all spots in the 2013 program as well,” said Karen Cudmore, RHFRAP program coordinator.
“The retention rates have been excellent,” Durick said. When a facility finds someone they want to recruit, they apply to the SD SORH for the funding. Communities of 10,000 people or less are eligible to participate in either program. Communities will pay a portion of the incentive payment based on their population size. Health professionals receive the full amount of the incentive after they have worked the required three years.
A Health Professional Workforce Summit, held on April 12 in Albuquerque, NM, gave participants an opportunity to meet in person and develop strategies for retention of clinicians in the state. The one-day event sparked discussions based upon real data, as opposed to supposition and/or anecdote, according to Britt Catron, Director of the New Mexico Office of Primary Care and Rural Health (NM SORH). Summit participants included non-profit employers, health care providers, members of the NM legislature, Residency Program Directors, and representatives from institutions of higher education and other state government agencies.
New workforce data from the Findings of the First Year Retention Survey of the Multi-State/NHSC Retention Collaborative, conducted by the Cecil B. Sheps Center for Workforce Research of the University of North Carolina, was presented by Jerry Harrison and Kim Kinsley from New Mexico Health Resources (NMHR), and Harvey Licht from Varela Consulting, who was the meeting facilitator. The survey polled National Health Service Corps loan repayers and scholars, in addition to those obligated through the New Mexico Higher Education Loan Repayment Program. [Some of the survey findings also will be presented in a session at the NRHA Annual Meeting this month.] Summit participants reviewed survey results, and made comments and recommendations for future action. Catron said that the Summit additionally included a review of the literature on health professional retention, bringing information up-to date in light of generational, discipline, and health system delivery system changes (since much of the earlier literature was published in the 1990s). “I think everyone added to the development of strategies for the retention of health care professionals, and provided very rich discussions about the issue of retaining health care providers in our rural, frontier and underserved communities throughout the state,” Catron said. “After the event there were discussions about holding another Summit so that the work does not stop.”
“The Summit was a great example of SORH coordination and leveraging of resources by the NM SORH,” said Stephanie Hansen, NOSORH Education and Services Director, who attended the meeting. “It provided an opportunity for all of the partners to get together and discuss the past, present, and future of the health care workforce in the state.”
The NM SORH contracted with NMHR to coordinate health professional workforce research through the Sheps Center, in conjunction with 11 other states, and to organize the Summit. The NM SORH applied for funding through the Retention and Evaluation Activities Initiative of the American Recovery and Reinvestment Act (ARRA), which aims to coordinate activities to increase retention of health care providers and to evaluate the efficacy of specific retention models and the impact of ARRA funding on communities.
With a new recruitment and retention team and a relatively new field director, the Oregon Office of Rural Health (OR SORH) wanted some expert advice—so this past January they hosted an Educational Exchange with the North Dakota Center for Rural Health (ND SORH).
“We wanted to look at how to integrate our work and how to track our data, to see what effects we were having on recruitment and retention (R&R) and placement outcome on our rural communities,” said Robert Duehmig, OR SORH Director of Communications. “As programs change, and expectations from the feds change, it’s important to show what we’re doing and better understand what we’re not doing well.”
The OR SORH chose the ND SORH, Duehmig said, because “North Dakota always seemed to have this great program, and great relationships working with their clinics and hospitals.” Mark Barclay from the ND SORH attended. In addition, Kelly Quigley from TruServe was able to attend at the same time (with her visit paid by TruServe training funds).
Barclay met with all OR SORH staff at the start of the day and talked about ND SORH R&R efforts. Then the staff broke into teams. Barclay met with R&R staff to discuss sites, how to put together R&R plans, how to track data for candidates and how to extract data. Quigley met with small groups to talk about inputting TruServe data. “I thought the two of them coming out together, showing those two pieces together, was very helpful for us,” Duehmig said.
Duehmig rated the EE a success. “It’s important for our staff to have this professional interaction, to see how other states are doing R&R,” Duehmig said. “It was our first EE, but I hope not the last—either as a recipient of the program or offering our services.”
The Educational Exchange program supports leadership and partnership efforts of SORHs by offering and/or facilitating mentoring, education,information exchanges and training assistance. (NOSORH paid the travel costs for Barclay’s visit to the OR SORH.)
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Rural Training Tracks New Approaches to a Proven Strategy (R. Longenecker-D. Schmitz)