Jigsaw Puzzle of Health Reform

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Retention and Recruitment Issues Brock Slabach,
FACHE Sr. Vice-PresidentNational Rural Health
Associationbslabach_at_nrharural.org 816-756-3140
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NRHA Mission

• The National Rural Health Association is a
  national membership organization with more than
  18,000 members whose mission is to provide
  leadership on rural issues through advocacy,
  communications, education and research.

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• Improving the health of the 62 million who
  call rural America home.
• NRHA is non-profit and non-partisan.

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Why rural is different

• 1) The challenges of rural
• 2) The importance of rural
• health care (both for
• rural Americans and the
• rural economy)

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Operation Patient Access

• Health cannot be improved without access to
  health care.
• Access is remains the gravest concern for rural
  America.
• Operation Patient Access is Critical.

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State of Health Care in Rural America

• 25 of population over 90 of landmass
• combination of factors make health care
  disparities much more acute in rural America
• economic, cultural, educational, demographic
  factors all play importance rolls
• great distances mean lack of preventative and
  follow-up care ( more chronic illness heart
  disease, diabetes)
• overall population is older, requiring more
  intensive care
• additionally - - rural mortality is 50 higher
  than the overall U.S. rate
• death rates for children - - 20 higher
• sedentary lifestyle is prevalent in rural America
• economic factors, low insurance (fewer
  employers), high poverty
• more dependency on Medicare and Medicaid
• inappropriate and unfair federal reimbursement
  rates
• 50 million Americans live in HPSA vast majority
  of those areas are in rural America
• Provider shortages 25 of population lives in
  rural America, yet only 9 of physicians practice
  in rural America.

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The Workforce Shortage Crisis

• In 20 years, 20 of population will be over 65
  years old.
• At the same time, physician shortages are
  predicted to be over 200,000 - - meaning some 84
  million could go without care.
• Number of graduates has remained virtually flat
  for 25 years. Tuition has skyrocketed - - 750
  (private) and 900 (public).
• One-third of physicians are 55 or older and soon
  will retire. More than half of rural general
  surgeons are older than 50, and a wave of
  retirements is expected in the coming decade.
• Decline in the numbers of Residents completing
  General Surgery programs
• Physician shortages in rural America is one a
  major intractable health policy problem of the
  last centurycrisis is inevitable.
• Recruitment and retention problems persist - -
  yet 50 million Americans live in areas where
  shortages exist.

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The General Surgeon Crisis

• In 1994, there were 7.1 general surgeons per
  100,000 people. Today there are five per 100,000.
  
• In rural America the problem is much graver.
• In rural America -- some places have only half
  as many surgeons per capita as cities -- that the
  problem is most acute. And it's likely to get
  worse.
• Population to support one General Surgeon ranges
  from 10,362 (GEMENAC) to 16,471 (Kaiser)

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Crisis Dimensions the implications

• Without general surgeon battle, primary care is
  crippled - - e.g., Family practitioners cannot
  deliver babies, emergency rooms cannot take
  trauma cases, and most internists will not do
  complicated procedures such as colonoscopies.
• Only 9,334 of the 211,908 rural physicians are
  general surgeons.

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Rural Challenges/Disparities

• Geographic
• Cultural
• Payment/Reimbursement
• Poverty/Sociological
• Lifestyle
• Aging (high chronic disease)
• Employment (hazards)
• Accidents
• April 2008 Harvard study
• Life expectancy actually declined in
• certain rural populations
• (Appalachia/Deep South)

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Heath care and the rural economy

• Over the last decade, cities and towns across
  nation lost manufacturing jobs, but gained heath
  care jobs.
• Last year the manufacturing industry lost 310,000
  and health care industry gained 363,000.
• Rural manufacturing jobs declined at double the
  rate of urban manufacturing jobs.
• Education and health care are the largest rural
  employers and added the most jobs to the rural
  economy in 2007.

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Recession Hits Rural America

• In December alone, 282,000 were lost in the
  nations 2,048 rural counties.
• December numbers indicate a 29 increase in job
  losses.
• Uninsured and Under-insured is rising at a faster
  rate in rural America than urban America.
• Healthcare is the fastest growing segment of
  rural economy.

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Healthcare Critical to Rural Economy

• Each rural physician generates 23 jobs in the
  local rural economy
• in most rural communities hospitals are the
  largest or second largest employer
• Health care often represent up to 20 percent of a
  rural community's employment and income.

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RecruentionPlan Ahead

• Recruitment cycle is 18-24 months
• Timing, Timing, Timing
• 2008 Survey
• --82 of Residents began searches over one year
  prior to graduation
• --78 desired salary w/ production bonus
• Tim Skinner, 3RNet

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Surgeons Top 10 Reasons for Changing Jobs

• Higher Compensation 38
• Better Work Environment 25
• Other 17
• Better Community 13
• Malpractice in State 7

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Surgeons Top 3 Frustrations

• Reimbursement Issues
• Medical Liability Issues
• Administrative and Business Agendas that
  interfere w/ Clinical Decisions
• Recruitment Strategy must address these factors.

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Sourcing General Surgeons

• Networking 44
• Other 23
• Recruiters 18
• Internet Search 11
• Journal (print) 4
• Other Military Commitment, Professional
  Society, locums to permanent
• Source Locumtenens.com

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Rural Recruitment Resource

• 3RNet
• Partly funded by Office Rural Health Policy
  (ORHP)
• www.3rnet.org/
• 1-800-787-2512
• NRHA Partner for Rural Workforce

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Solutions for Change

• Include general surgeons in National Health
  Service Corps - - 30 year success.
• Expand Residency Programs
• Create Equity in Reimbursements
• Creative Tax Incentives
• Improve Telemedicine Capabilities

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Questions?