The wages of recruiting rural docs

"The wages of recruiting rural docs" is the first in a three-part series on recruiting and retaining physicians for underserved communities.

Bisbee, Ariz., is a former mining town of about 6,700 people, some 12 miles north of the Mexican border and nearly two hours southeast of Tucson. Built in the hills of the red rock Mule Mountains, it's now known as an enclave of sorts for artists and hippies and was even a one-time runner-up as the “quirkiest” town in America. But while it has attracted galleries and coffeehouses, it has struggled to find healthcare providers.

“We're having a harder time this year than last year,” says Jim Dickson, CEO of 14-bed Copper Queen Community Hospital in Bisbee. “I think there's a bidding war going on for physicians.”

The heightened demand means Copper Queen's starting salary for primary-care doctors has increased to $225,000, up from first $150,000, then $175,000, and it may need to rise to $250,000 to keep up with local competitors, Dickson says. But because the hospital can't bill enough to justify lucrative pay packages, it relies on assistance from the National Health Service Corps, an HHS agency that provides incentives including loan repayment for doctors willing to practice in underserved regions.

It also sponsors foreign doctors with J1 visas, though Dickson notes that they tend to have higher turnover rates.

The investments are critical to Copper Queen's survival. Less than a decade ago, “We had no private doctors left in town,” says Dickson, who since 2007 has grown the medical practice from four physicians to 11, as well as four midlevel providers. “The hospital would have imploded without these doctors.”

Copper Queen's challenges are not unique. The doctor shortage in rural America is widespread and projected to get worse. Medicaid expansion and insurance exchanges are expected to provide coverage to about 30 million Americans—but many in rural and underserved communities may have to drive hundreds of miles for care if it isn't available locally.

A 2009 policy brief from the federal Office of Rural Health Policy highlighted that 77% of rural counties are facing a shortage of primary-care providers, and 8% don't even have a single primary-care physician.

“It's pervasive,” says Brock Slabach, senior vice president for member services at the National Rural Health Association. “There's just a significant need for workforce.”

The number of general surgeons practicing in rural communities decreased 21% between 1981 and 2005, according to a study from the family medicine department at the University of Washington. In addition, more than half (52%) of surgeons were approaching retirement age, between 50 and 62 years old.

The Patient Protection and Affordable Care Act tries to address those issues by providing more resources to medical schools and the National Health Service Corps to help with training and recruitment.

Some areas of the country—those close to mountains or beaches—may be able to draw on their idyllic surroundings to attract physicians, especially those looking for a quieter lifestyle. Others, not so much.

Neil MacKinnon, director of the Center for Rural Health at the University of Arizona, recalls how not once, but twice, physicians landing in the desert town of Yuma—which has a population of 93,000 and average July temperatures of 106 degrees—refused to even get off the plane.

Recruiters now fly in physicians at night.

“Some places in this country have unique challenges,” MacKinnon says. “We try to look at what is the best fit. The real key is knowing your state and the attributes of the communities.”

In Arizona, smaller towns and isolated areas average only 70 physicians per 100,000 residents, compared with 270 per 100,000 in urban areas, and 250 per 100,000 statewide. “That's certainly a large, large gap,” MacKinnon says. “In some cases, it does mean scaling back services.”

Follow Beth Kutscher on Twitter: @MHbkutscher