Rural Recruitment for Retention
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5/18/2016 1 Rural Recruitment for Retention Providing Physicians a Road Map for Rural North Dakota Dave Schmitz, MD, FAAFP Stacy Kusler, Center for Rural Health History of Partnerships that work for rural ND: UND SMHS, AHEC, CRH and our communities! Began CAP Partnership with CRH • 2011 16 ND CAH’s participated in Y1 & Y2 • Sept 2011- March 2013 8 ND CAH’s participated in Y3 & Y4 • Nov 2014- late 2016 RHEN feasibility studies • September 2015 RHEN/ Future Projects • Ongoing
Transcript of Rural Recruitment for Retention
5/18/2016
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Rural Recruitment for RetentionProviding Physicians a Road Map for Rural North Dakota
Dave Schmitz, MD, FAAFPStacy Kusler, Center for Rural Health
History of Partnerships that work for rural ND:UND SMHS, AHEC, CRH and our communities!
Began CAP Partnership with CRH
• 2011
16 ND CAH’s participated in Y1 & Y2
• Sept 2011-March 2013
8 ND CAH’s participated in Y3 & Y4
• Nov 2014- late 2016
RHEN feasibility studies
• September 2015
RHEN/ Future Projects
• Ongoing
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Health Workforce Stats-2015 Biennial Report▪ Most of ND’s population is located within a federal designated primary
care HPSA. 1 in 20 people live in a county that does not have a primary care physician.
▪ 14 of ND’s 53 counties, with a combined population of 35, 752 (approx. 4% of the population) have no primary care physicians.
▪ More than half of all primary care physicians (57%) in ND graduated from UND SMHS or completed a residency here.
▪ North Dakota is a net physician “exporter” (more ND SMHS graduates practice in other states than other states’ graduates practicing in ND).
▪ One important predictor of eventual practice location is where physicians obtain their residency training, since many physicians start practicing in the general vicinity of where they completed post-medical school residency training.
Source: 2015 biennial report
Presentation Overview▪ The Community Apgar Project
▪ Use of the Community Apgar Program
▪ Development of Community Apgar Solutions
▪ The Rural Health Education Network (Proposed)
▪ Medical student tracks (ROME)
▪ Rural Training Track (RTT) residency program development
▪ Rural rotation and rural continuity training experiences for residents
▪ Community engagement, including learner service projects
▪ Where do we go from here?
▪ Your ideas that will allow us to work most effectively together
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Community Apgar
Program
A Tool for Improving the Recruitment
and Retention of Critical Access
Hospital and Community Health
Center Physicians
•States Participating in the CAP •States Interested in Implementing the CAP
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Geographic
•Schools, Climate, Perception of Community, Spousal Satisfaction
Economic
•Loan Repayment, Competition, Part-time Opportunities, Signing Bonus
Scope of Practice
•Emergent Care, Mental Health, Obstetrics, Administration Duties
Medical support
•Nursing Workforce, Call/practice Coverage, Perception of Quality, Specialist Availability
Hospital and Community Support
•EMR, Welcome & Recruitment Program, Televideo Support, Plan for Capital Investment
Top Apgar Factors
2016 North Dakota Comparative Database
North Dakota (2016)
Top Apgar
•Transfer arrangements
•Ancillary staff workforce
•Competition
• Income guarantee
•Community need/physician support
•C-section
•Emergency medical services
•Obstetrics
•Perception of quality
•Schools (Tie)
•Mid-level provider workforce (Tie)
North Dakota (2016)
Bottom Apgar
•Spousal satisfaction
•Mental Health
•Electronic medical records
•Shopping/Other Services
•Access to larger community
•Allied mental health workforce
•Climate
•Emergency room coverage
•Specialist availability
•Payor Mix
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Examples from Hospital Level
Report
Comparative Cumulative Apgar Score
Hospital X
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Community Apgar Class
Baseline Mean Oakes Community Hospital
Overall Apgar Geographic Economic Scope of Practice Medical Support Hospital and Community Support
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Comparative Cumulative Apgar Score
Hospital X
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0.00
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100.00
150.00
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250.00
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Community Apgar Class
Baseline Mean McKenzie County Memorial Hospital
Overall Apgar Geographic Economic Scope of Practice Medical Support Hospital and Community Support
Comparative Cumulative Apgar Score for Geographic Class
Hospital X
-20.00
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-10.00
-5.00
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Geographic Factors
Baseline Mean Nelson County Health System
Access to larger community
Demographic, patient mix
Social networking
Recreational opportunities
Spousal satisfaction
Schools Shopping and other services
Religious, cultural opportunities
Climate Perception of community
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Comparative Cumulative Apgar Score for Economic Class
Hospital X
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Economic Factors
Baseline Mean Cavalier County Memorial Hospital
Employment status
Part-time opportunities
Loan repayment Income guarantee
Signing bonus Moving allowance
Start-up, marketing costs
Revenue flow Payor mix Competition
Comparative Cumulative Apgar Score for Scope of Practice Class
Hospital X
-20.00
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Scope of Practice Factors
Baseline Mean Mercy Medical Center
Obstetrics C-section Emergency room coverage
Endoscopy, surgery
Nursing home Inpatient care Mental health Mid-level supervision
Teaching Administration
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Comparative Cumulative Apgar Score for Medical Support Class
Hospital X
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Medical Support Factors
Baseline Mean Cooperstown Medical Center
Perception of quality
Physician workforce stability
Specialist availability
Transfer arrangements
Nursing workforce
Allied mental health workforce
Mid-level provider workforce
Ancillary staff workforce
Emergency medical services
Call, practice coverage
Comparative Cumulative Apgar Score for Hospital and Community Support Class
Hospital X
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Hospital and Community Support Factors
Baseline Mean Southwest Healthcare Services
Physical plant and equipment
Plans for capital investment
Electronic medical records
Hospital leadership
Internet access Televideo support
Hospital sponsored CME
Community need, physician support
Community volunteer opportunities
Welcome and recruitment
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Top 10 Apgar Factors across All 50 Factors
Hospital X
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Top 10 Apgar
Overall
Emergency medical services
Transfer arrangements
Hospital sponsored CME
Perception of quality
Ancillary staff workforce
Competition Schools Internet access Teaching Welcome and recruitment
Bottom 10 Apgar Factors across All 50 Factors
Hospital X
-6.00
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Bottom 10 Apgar
Overall
Electronic medical records
Transfer arrangements
Allied mental health workforce
Mental health Emergency medical services
Mid-level provider workforce
Perception of community
Nursing workforce
Demographic, patient mix
Schools
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Top 10 Cumulative Apgar Variance Factors across All 50 Factors
Hospital X
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Top 10 Apgar Variance Factors
Physical plant and equipment
Access to larger community
Demographic, patient mix
Nursing workforce
Emergency medical services
Schools Physician workforce stability
Inpatient care Transfer arrangements
Endoscopy, surgery
Bottom 10 Cumulative Apgar Variance Factors across All 50 Factors
Hospital X
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Bottom 10 Apgar Variance Factors
Call, practice coverage
Climate Allied mental health workforce
Schools Televideo support
Community volunteer opportunities
Ancillary staff workforce
Employment status
Welcome and recruitment
Mid-level supervision
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We’re all in this together!
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Rural Health Education Network
▪ The Rural Health Education Network (RHEN) is:
▪ Training of both graduate (residents) and the undergraduate (medical students) medical professional students
▪ Utilizing an interprofessional health education model
▪ In the context of providing a team-based approach in health care delivery
▪ Targeted to deliver a competent and confident rural physician workforce to fit rural community recruitment and retention
RHEN for North Dakota
RHEN for ND will:
– Make the most of North Dakota’s education resources
while further providing an efficient model for learner
placement and workforce retention
Examples of similar work:
• Completed feasibility studies
– McKenzie County Healthcare System
– Coal Country Community Health
– Sakakawea Medical Center
– Standing Rock Indian Hospital
– CHI St. Joseph’s Health Center
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Time for your input and suggestions!
Thank you!
David Schmitz, MD FAAFP
Chief Rural Officer and Program Director for Rural Training Tracks
Family Medicine Residency of Idaho
Stacy Kusler
Workforce Specialist
Center for Rural Health
