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Jigsaw Puzzle of Health Reform

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Title: Jigsaw Puzzle of Health Reform


1
Retention and Recruitment Issues Brock Slabach,
FACHE Sr. Vice-PresidentNational Rural Health
Associationbslabach_at_nrharural.org 816-756-3140
x14
2
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.

3
  • Improving the health of the 62 million who
    call rural America home.
  • NRHA is non-profit and non-partisan.

4
Why rural is different
  • 1) The challenges of rural
  • 2) The importance of rural
  • health care (both for
  • rural Americans and the
  • rural economy)

5
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.

6
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.

7
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.

8
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)

9
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.

10
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)

11
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.

12
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.

13
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.

14
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

15
Surgeons Top 10 Reasons for Changing Jobs
  • Higher Compensation 38
  • Better Work Environment 25
  • Other 17
  • Better Community 13
  • Malpractice in State 7

16
Surgeons Top 3 Frustrations
  • Reimbursement Issues
  • Medical Liability Issues
  • Administrative and Business Agendas that
    interfere w/ Clinical Decisions
  • Recruitment Strategy must address these factors.

17
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

18
Rural Recruitment Resource
  • 3RNet
  • Partly funded by Office Rural Health Policy
    (ORHP)
  • www.3rnet.org/
  • 1-800-787-2512
  • NRHA Partner for Rural Workforce

19
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

20
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