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Published October 06, 2011, 12:00 AM

COVER STORY: Rural health care seeing change

Many health care organizations are finding that once a potential health care professional steps through their doors there is a pretty good chance they are hooked.

By: Alan Van Ormer, Prairie Business Magazine

Despite that optimism, many will also tell you that it is tough to bring health care professionals to rural America.

“It is a challenge to find professionals that want to relocate into rural areas,” explains Peter Jacobson, Senior Vice President of Clinic and Regional Operations for Essentia, Fargo, ND. Jacobson oversees the operations of 30 clinics within the west region of Essentia. “Some of our greatest opportunities are capturing those who want to live in a rural community. There is an opportunity for people to have a meaningful profession and live in a rural community.”

Todd Hudspeth, the new CEO of Jamestown Regional Medical Center, states the difficulty in finding health care professionals sometimes depends on what a health care system is looking for. For JRMC, Hudspeth, who took over the facility on Aug. 15, finds that difficult positions to fill for those in rural communities includes physical therapy, pharmacy, respiratory therapy, radiology, and sometimes nurses. JRMC works with Jamestown College’s nursing program to help fill that need.

The business impact on communities in the region is ‘tremendous.’ In most communities, the medical community is in the top two or three employers. “That has a huge impact,” Hudspeth says.

According to the membership of the Minnesota Rural Health Association, there is a current need for primary care physicians, surgeons, specialty care, and health information technology expertise. MRHA also recognizes workforce shortages in nursing pharmacy and clinical laboratories. MRHA strengthens the rural voice on health care issues through dialogue, education, and advocacy with a focus on enhancing the accessibility, affordability, and quality of health care in rural Minnesota.

“I believe some of the same concerns to workforce recruitment are being seen in the larger communities in our region. Not at the level as rural perhaps, but none –the-less some of the specialty’s, in particular, are very hard to recruit for even in the larger communities,” says Judith Neppel, Executive Director of the Minnesota Rural Health Association in Crookston, MN. “Again, well educated individuals are often married to well educated spouses who also need a challenging career so working together as a community to find the right position for both is critical. The spouse must be happy in the community, and in their work, or the retention of the healthcare professional is compromised.”

South Dakota Association of Health Care Organizations President and CEO Dave Hewett says that rural medical services have issues that often complicate recruitment and retention of qualified medical professionals, such as aging of current rural health professions, quality of life balance with call time, reimbursement and increase medical care needs of rural patients.

Keeping pace with physicians retiring is a concern

“The best strategy tries to get people to come back that have a tie to the area,” Hudspeth explains, adding that the two newest physicians in Jamestown came from within a 60 mile radius.

In addition, JRMC has developed a strategy to identify high school students who have some sort of inclination to get into medicine, “We get to know who they are and stay in touch with them,” Hudspeth says. “We can offer financial incentives as well and even provide stipend while in college with a promise to come back.”

Jacobson adds that there are many advantages of being part of a health care system. “We are able to bring some of the same technology that is going to be present throughout the region,” he explains. “That is a strength that we bring and is attractive to provider who wants to work in a rural area but has capabilities and backups of a larger system.”

Some consider a disparity of income for those who practice in a rural community versus those who practice in urban settings. “Besides the issues of income, the quality of life style issues is a concern,” Neppel says. “So often there is only a few physicians, if there are multiples, sharing emergency call, so that the life of a rural health physician is such that they work long hours with less income than their urban counterparts,” Neppel says. “The lack of collegial support for discussions on acute issues is also difficult. Being responsible to know everything about everything and not having the option of discussing a patient’s condition with a colleague present to offer an opinion in a litigious environment like will live in today, is not a desirable working environment.”

Neppel says the health care community is seeing large health care systems buying out smaller rural community hospitals and clinics. “The jury is still out on what that structure will do to rural, but for now it is critical to many rural communities health care services survival and the resulting rural patient care access,” she says. “Currently, most Critical Access Hospitals (those with 25 or fewer patient beds) are getting by. Many have facilities that are obsolete, falling apart, and they are unable to come up with the capital to do anything about it. The Long Term Care facilities, in most rural communities, are also in financial trouble and haven’t been able to give their employees a salary increase in over three years.”

Jacobson says the type of individual that wants to work wants in smaller facility has roots in smaller community. “The more specialized the health care provider comes the more likely they will want to work in larger facility more access to broader array of technology and specialties,” he says. “We must make sure they are using others to the capability that they have been trained,” he states. “This is a key to making the health care work and deliver effective care.”

Hewett believes that ensuring that everyone in America is covered by health insurance is a primary concern coupled by the fact that the current health care system is not sustainable. “Health care currently finds itself in a twilight zone,” he says. “On the one hand, health care is being asked to improve patient safety and quality measures and create organizations that are more patient-centric and focused on keeping people well. On the other hand, payment systems that reward volume, not value remain in place.”

Hewett does say the good news for South Dakota is that its health care provider community is well positioned to adapt to a reformed health care delivery system. “As a low cost/high quality state for the delivery of health care services and with integrated health care systems already in place, South Dakota’s transition should be relatively easy compared to many other states.” PB

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