What Attracts Providers to Rural and Underserved Communities? Five Themes from 3RNet Academy Session #2

3RNet’s second Academy session, Finding your Unique Selling Points, took place last week. Over 250 participants from across the country joined the session to hear from Family Medicine Physician/Medical Educator Dr. Dave Schmitz and North Dakota 3RNet Member Stacy Kusler. Dr. Schmitz and Stacy examined 50 factors related to recruitment/retention of healthcare providers to rural and underserved areas. Those 50 factors were spilt into five groups, each with their own set of potential advantages and challenges:

Geographic Factors:

Rural and underserved communities often struggle with geography when recruiting. Access to things like specialty dining, shopping, and entertainment are often much more limited than they are in urban areas. However, with every challenge comes a possible solution. Examples from around the country were shared with the common theme of breaking down geographic barriers through technology, collaboration, and creativity. Here is the full list of Geographic factors discussed:

1. Access to larger community
2. Demographics/ patient mix
3. Social networking
4. Recreational opportunities
5. Spousal satisfaction (education, work, general)
6. Schools
7. Shopping and other services
8. Religious/cultural opportunities
9. Climate
10. Perception of community

Economic Factors:

While not everyone practices solely for economic considerations, it certainly plays a large role in almost every offer acceptance. But there is more to the Economic factors than simply take home pay. Communities may offer great incentives like loan repayment, signing bonuses, or flexible contracting to potential providers. In addition, a key consideration for Economic factors is the demographic of provider a community is trying to hire. For example, a contract may have to look significantly different if a community is recruiting a newly trained provider as opposed to a pre-retirement provider. The Economic factors examined were:

1. Employment status
2. Part-time opportunities
3. Loan repayment
4. Income guarantee
5. Signing bonus
6. Moving allowance
7. Start-up/marketing costs
8. Revenue flow
9. Payor mix
10. Competition

Scope of Practice Factors

A key part of any job, is the duties required for performance. What are we asking the providers in our rural/underserved communities to do? Many providers love working in rural and underserved communities for the large scope of practice they have, but too much of a good thing can become overwhelming. For example, do we expect a provider to cover the clinic, emergency room, nursing home, inpatient care, while still participating in the administration of the facility? Are our providers getting burnt out from providing too much mental health assistance that they may not feel qualified for? These issues and many others were examined through our Scope of Practice factors:

1. Obstetrics
2. C-section
3. Emergency room coverage
4. Endoscopy/surgery
5. Nursing home
6. Inpatient care
7. Mental health
8. Mid-level supervision
9. Teaching
10. Administration

Medical Support Factors

All providers want to do their job well, but everyone needs assistance. Providers feel more confident and supported when they have a quality team of other professionals around them. Isolation in rural areas can often feel overwhelming for a new provider, but having adequate support can ensure that a provider doesn’t feel all the pressure of the world solely on his or her shoulders. Session #2 talked about supporting providers through the following Medical Support factors:

1. Perception of quality
2. Stability of physician workforce
3. Specialist availability
4. Transfer arrangements
5. Nursing workforce
6. Allied mental health workforce
7. Mid-level provider workforce
8. Ancillary staff workforce
9. Emergency medical services
10. Call/practice coverage

Hospital and Community Support Factors

Many providers that are drawn to rural and underserved areas have a great desire to serve. Providers in rural areas are often pillars of the community, and get a sense of job satisfaction that cannot be replicated in urban areas. For some providers, hospital and community support is more important than any salary or call schedule. Hospital and Community Support factors include:

1. Physical plant and equipment
2. Plans for capital investment
3. Electronic medical records (EMR)
4. Hospital leadership
5. Internet access
6. Televideo support
7. Hospital sponsored CME
8. Community need/support of physician
9. Community volunteer opportunities
10. Welcome and recruitment program