Rural doc retention also needs attention

("Rural doc retention also needs attention" is the final installment in a three-part series on recruiting and retaining physicians for underserved communities.)

Physician retention has been just as much an issue as getting physicians to make an initial commitment to rural life.

Nationally, physicians stay in their first jobs for about only three years. The challenge in rural areas has been to find doctors who are willing to stay for five or more years since initial recruitment can so difficult.

“We can certainly help with recruiting, but we're really interested in helping those who we want to keep too,” says Joyce Grayson, director of Rural Health Education and Services at the University of Kansas Medical Center, Kansas City, which has developed innovative programs for recruiting and retaining physicians who want to serve in rural areas.

Kansas programs such as student-loan forgiveness have had an 80% retention rate during the past 23 years, Grayson says. The state also funds a program that provides temporary clinician coverage to underserved areas so that solo providers can have time off.

“You absolutely can have work-life balance out in the rural areas,” she says. “There has been a big change over the last few years.”

In Oregon, state senators have introduced a bill that would recreate a primary-care loan repayment program and establish a loan repayment fund—something the state discontinued in 2009. It would build upon Oregon's other incentive programs, such as its participation in the federally administered state loan-repayment program, a match-grant program intended for primary-care providers willing to spend at least two years practicing in an underserved area.

On the national level, two bills introduced this year in the Senate aim to help retain international medical graduates willing to serve in rural areas.

The Conrad State 30 and Physician Access Act, introduced in March by Sens. Jerry Moran (R-Kan.), Amy Klobuchar (D-Minn.), Susan Collins (R-Maine) and Heidi Heitkamp (D-N.D.), eliminates the sunset on the 1994 program of the same name that allows states to waive visa requirements for rural physicians.

And last month's Border Security, Economic Opportunity and Immigration Modernization Act has a number of provisions that could directly or indirectly boost physician immigration, such as doing away with per-country limits on green card holders and increasing the number of physician immigrants who stay after completing training here.

Then there are the hyper-local efforts.

In 2009, Douglas, Ariz., a town on the U.S.-Mexico border, received a visit from then-“American Idol” judge Simon Cowell as part of “Idol Gives Back.” Because of a donation from the show, the town was able to convert a former school into a pediatrician's office.

“It really united the whole community,” says Neil MacKinnon, director of the Center for Rural Health at the University of Arizona. “Sometimes it comes to thinking outside of the box.”

Ashland (Kan.) Health Center, a public hospital in a town of only 900 people, was another “pretty extreme case” when Benjamin Anderson arrived as CEO in 2009.

During the past 18 years, 11 physicians had come and gone. The 24-bed hospital was operating with only one physician assistant who was working around the clock and was overseen by a physician 30 miles away who came in for a half-day a week. “That's all that was keeping this place open,” Anderson says.

Anderson approached two faculty members in the rural health program at Via Christi Health in Wichita, Kan., which has a partnership with Ashland, to ask for their help.

He was given a list of directives. He was told to offer physician recruits four days of clinic with one day a week on-call, one weekend on call a month, a salary that met the national average, and eight weeks of paid time off for international missionary work.

“You show them they can be a missionary here for 44 weeks,” Anderson recalls. “The physician who's willing to practice medicine in a mud hut in Africa—they don't need a Nordstrom's or restaurants.”

Anderson was then asked if he'd be willing to go to Africa to see for himself, and ultimately traveled to Zimbabwe to build screens around missionary housing to prevent malaria. “It was a game-changer for me. And I've been back every year since,” he says. “I was surprised by the similarities between rural America and overseas.”

Ashland now has two family medicine physicians, two physician assistants and one nurse practitioner. “We've become a little medical hub,” Anderson says, noting that six communities now benefit from the additional coverage. “We share those providers with the surrounding areas.” <<

Follow Beth Kutscher on Twitter: @MHbkutscher