Physicians are disappearing from the map of rural America. Twenty percent of the country’s population lives in a rural area, and the ratio of physicians to patients is 1 to 2,500, which means that 60 million people are dealing with the impact of this shortage.
If even one rural physician or nurse decides to move or retire, it can precipitate a health care coverage crisis in the community. Hospitals and clinics in rural areas work on thin margins, limiting their financial ability to entice new medical personnel, and each new shortage leaves them at a fresh crossroads.
As the gap in rural health care coverage grows, more people are finding ways to acknowledge and address the shortage.
Schools and programs are starting to address needs
More medical programs are recognizing this need and are moving to place residents in rural hospitals and clinics. This shift is an opportunity for more physicians and nurses to understand rural medicine and erase misconceptions.
Medical schools are also becoming sensitive to the rural shortage. Some institutions have begun accepting more candidates from rural areas to their programs in hopes that they will return home to practice and encourage more people to seek out rural positions. Several schools now have rural-specific training, like the Scholars in Rural Health program at the University of Kansas Medical Center’s KU School of Medicine. As the students advance in their schooling, they gain practical experience in rural areas at the side of a mentor.
Although the KU School of Medicine has been a leader in training rural physicians for many years, other institutions are also starting to put programs in place to prepare students for the unique challenges and opportunities of rural medicine. The Rural Training Track (RTT) Collaborative currently partners with schools of medicine in rural communities and residency training programs with a rural campus or rural pathway for select students. The RTT Collaborative has been influential in establishing medical training programs and placing residents in rural hospitals.
Another tool used in rural recruiting is the Community Apgar Program (CAP), a recruiting structure developed by researchers, educators and clinicians at Boise State University. The CAP identifies strengths and opportunities for improving rural medicine within specific communities, as well as identifying specific challenges that could hinder future growth. The CAP and related programs have enhanced the probability of attracting and placing a practitioner for many rural communities.
Hospitals are selling the rural lifestyle
The rural lifestyle has been an effective recruiting tool for many hospitals addressing shortages. Although it’s easy to shrug off as the stuff of Hollywood films, there is real appeal in rural living for the right person. Physicians can find wonderful community living among rural people, where deeply appreciative relationships can be built on for years.
The people appeal is not just with patients; working with rural practitioners is equally worthwhile. Other practitioners in the area are usually eager to help and will make the new professional’s stay a better one.
The pace of rural life can increase job satisfaction. Physicians do not deal with the same business pressures of urban practices and can focus on patient care. The lifestyle is less stressful, with more recreational possibilities, and often in beautiful parts of the country. Plus, a rural doctor almost never has traffic on the way to the clinic.
Finally, physicians concerned about upcoming changes to the Medicare Access and CHIP Reauthorization Act (MACRA) may also want to consider rural medicine. Clinicians practicing at a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) are exempted from certain reporting and adjustment requirements.
Using locum tenens physicians raises the profile of rural providers’ staff
Another solution to the rural healthcare shortage is the use of locum tenens physicians, where medical providers travel to work in underserved areas on temporary assignments. More than 90 percent of hospitals in the U.S. use locum tenens to supplement their full-time staff. These temporary assignments are especially important for hospitals in rural areas where it can take longer to recruit a full-time provider, and where staffing needs change regularly from one day to the next.
Along with filling in for full-time staff members, locum tenens providers give relief during busy seasons, assist in initiating new operations, and help meet the need for in-demand specialties. For example, an area of constant shortage for rural hospitals is in obstetrics and gynecology. In cases such as these, locum tenens physicians are able to step in and fill those gaps to provide relief. Rural hospitals can also use locum tenens physicians to test out new operations and make sure new personnel are a fit before investing in a full-time team member.
Locum tenens placements increase as healthcare providers and facility administrators understand the significant positive impact it can have on the quality of care for rural patients. For example, providers from Weatherby Healthcare, one of the largest locum tenens companies in the industry, delivered care to more than 5.3 million patients in 2017 alone.
These strategies of addressing the physician shortage in rural areas show promise of being effective in the medium to long term. Raising awareness of both the problem and the ways of addressing it can provide incentive to physicians to go rural.