Rural communities are facing a monumental challenge: residents often exhibit poorer health in multiple categories and there are roadblocks to maintaining an adequate medical workforce in those areas.
Nearly one-fifth of the U.S. population resides outside metropolitan areas. But rural communities struggle with recruiting – and retaining – healthcare providers (HCP), reporting higher shortages and long-term vacancies. In fact, researchers have found that less than 12% of US physicians practice in rural areas.
The lure of small-town living isn’t attractive to many physicians. They may think facilities are out of date, workload is heavier, or a lack of specialists will impact outcomes.
However, there are benefits to working in rural settings. For example, rural HCPs can examine local population health and provide insight to providers in other regions. They are able to work locally to look at how disease is affected by area environments, socioeconomic factors, healthy behaviors, and so on.
So, how does the medical community address this challenge? Are there effective solutions to this problem?
Key Factor in Choosing Rural Practice
A big issue is recruiting HCPs from urban areas. Growing up in a rural community is a primary, consistent determinant for choosing a rural practice. A comprehensive analysis of medical school graduates suggested that a physician’s hometown was a significant predictor of practicing in rural settings.
National Rural Recruitment and Retention Network
One helpful solution is the National Rural Recruitment and Retention Network (3RNET), a nonprofit network funded by the U.S. Federal Office of Rural Health Policy and member dues. More than 2,000 HCP placements are achieved annually through 3RNET’s recruitment tools, with 90% of these in “designated shortage areas”.
Its main focus is to connect health care professionals seeking jobs in rural or underserved communities with health care employers known as “safety net providers.” These include:
- Critical Access Hospitals
- Federally Qualified Health Centers/Community health centers
- Free clinics
- State prisons
- Substance use disorder treatment facilities
Incentives and Benefits for Rural HCPs
For many rural facilities, it may take significant benefits and/or incentives to attract non-rural HCPs to their areas. Some of the typical “carrots” offered include:
- Payments for professional expenses such as
- Malpractice insurance
- Licensure fees
- Association dues
- Continuing education
- Benefits that include
- Retirement packages
- Leave for volunteer work
- Sabbaticals for research, education, or mission work
- Other incentives like
- Low-interest home loans
- Practice set-up costs
- Assistance with finding spousal employment
- Assistance with locating daycare
Recruiting International HCPs
Some communities may recruit international medical graduates to fill vacancies. The Conrad State 30 Program allows each state’s health department to request J-1 visa waivers for up to 30 foreign physicians per year. In addition, non-immigrant H-1B visas can sometimes be used to fill employment gaps.
Medical Educators Offer Rural HCP Solutions
Medical educators have sounded the alarm and provided insight into overcoming this tremendous challenge. In the spring of 2020, prominent medical educators were invited to respond to rural staffing questions. Their responses revealed what many believe must be done:
- Create opportunities for rural youth to envision the possibility of becoming a doctor
- Cultivate rural community partnerships with medical schools and residencies
- Expose medical learners to practicing rural physicians
- Establish mentoring programs to support and maintain rural interest
- Provide rural training opportunities during residency
You can read their commentary here.
One thing is certain: the shortage of rural HCPs is not going away soon. To fully address the issue, U.S. policy makers and the healthcare community will have to solve the growing HCP shortage throughout the country.
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