basic principles: retaining health professionals in rural and underserved areas and practices don...
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Why Believe Me? From Los Angeles Studied philosophy and medicine in PhiladelphiaTRANSCRIPT
Basic Principles:
Retaining Health Professionals in Rural and Underserved Areas and Practices
Don Pathman, MD MPHUNC Chapel Hill
NC Primary Care ConferenceAshevilleJune 22, 2012
Goal
• Review general concepts of retaining rural and urban underserved area health care professionals
• Data are on physicians in underserved settingsand mostly rural, but apply (with some variation) to other health professionals and urban
• I call on your expertise:
I ask; you predict; then I present data from our studies of the past 20+ years
Why Believe Me?
• From Los Angeles• Studied philosophy and medicine in Philadelphia
Why Believe Me?
• From Los Angeles• Studied philosophy and medicine in Philadelphia • Practiced in rural Maine (NHSC), Colorado and
North Carolina• Published 50+ papers over 22 years on rural and
underserved health workforce issues• Worked with the NC Office of Rural Health• Serve on NHSC NAC
Fundamental R & R Principles
1. Retention success is achievable in any community.
2. Underserved-area physicians are humans first, professionals second:• Relationships are key• They are atypical among physicians
3. Rural and underserved practice is a marriage between a community and physician:• The match is key• The outward characteristics of the physician are
not important; what is in their heart is• The work situation needn’t be perfect, just not
bad
4. Rural physicians are locals at heart
5. What physicians encounter in their practices and communities is key to retention:• They need to feel satisfied, valued, invested and
fulfilled• They need a viable, long-term employment situation
6. Retaining and recruiting differ in important ways.
Principle: Retention success is quite achievable in any community.
Retention: Rural vs. Urban Location
Years
86420
Prop
ortio
n Re
mai
ning
1.0.9.8.7.6.5.4.3.2.1
0.0
urban site
rural site
355 rural and urban generalists
p = n.s.
587 rural generalists
Years
1086420
Pro
porti
on R
emai
ning
1.0
.8
.6
.4
.2
0.0
non-HPSA
HPSA
p = n.s.
Rural HPSA vs. Non-HPSA Location
Principles: Retention success is quite achievable in any community. Retaining and recruiting differ.
1086420
1.0
.8
.6
.4
.2
.0
Years
1086420
Cum
Sur
viva
l
1.0
.8
.6
.4
.2
.0
Retention: Community Characteristics
Urban Adjacent
Non adjacent>10K 2.5K - 10K< 2.5K
Town Pop
Principles: Retention success is quite achievable in any community. Retaining and recruiting differ.
587 rural generalists
Rural vs. Urban Raised587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning 1.0
.8
.6
.4
.2
0.0
rural raised
urban raised
p = n.s.
Principles: Characteristics aren’t important, only what is in their heart. Retaining and recruiting differ.
Rural vs. Urban Raised Spouse466 married rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning
1.0
.8
.6
.4
.2
0.0p = n.s.
rural raised
urban raised
Principles: Characteristics aren’t important, only what is in their heart. Retaining and recruiting differ.
587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning 1.0
.8
.6
.4
.2
0.0
preparedneutral
not prepared
Preparation for the Community
p < .001
Principle: Rural practice is a marriage between a physician and a community.
Work and Community Preparation
CommunityWork
1086420
1.0
.8
.6
.4
.2
0.0
1086420
Cum
Sur
viva
l
1.0
.8
.6
.4
.2
0.0
Work
Community
PreparedNeutralNot prepared
Principles: Rural practice is a marriage between a physician and community. Rural physicians are human first, professionals second.
587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning 1.0
.8
.6
.4
.2
0.0
Principle: Rural practice is a marriage between a community and a physician.
very satsatisfiedneutraldissatvery dissat
Satisfaction with the Community
p < .001
Satisfaction vs. Dissatisfaction w/ the Community611 urban and rural subspecialists
0102030405060
Ver
yD
issa
tifie
d
Dis
satis
fied
Neu
tral
Satis
fied
Ver
ySa
tisfie
d
% leaving within 2 years
Principles: Rural practice is a marriage between a community and physician.
Things needn’t be perfect, just not bad.
Owners vs. Employees587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning
1.0
.8
.6
.4
.2
0.0
owners
employees
p < .001
Principle: Physicians need to feel invested.
587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning
1.0
.8
.6
.4
.2
0.0
$60-80K
p < .05
Income: < $60K vs. $60-80K vs. > $80K
< $60K
> $80K
Principles: Physicians need a viable employment situation. Things needn’t be perfect, just not bad. Rural physicians are atypical ($$ isn’t everything).
1086420
1.0
.8
.6
.4
.2
.01086420
1.0
.8
.6
.4
.2
0.0
1086420
1.0
.8
.6
.4
.2
0.0
call < 2x/wk
call > 3x/wk
Years
> 25 pts/day
< 24 pts/day
> 50 hrs/wk
< 49 hrs/wk
Principles:
Physicians need to feel valued and invested.
Physicians need a viable long-term employment opportunity.
Areas of Satisfaction—Assoc. w/ 2 year retention499 Clinicians Completing Service Obligations
• Strong personal connection to my patients
• Had good clinical back-up from senior/supervising clinicians
• Relationship with administrator
• Support from other clinicians
• Felt work did not encroach on personal time
• Agrees administrator is effective
• Agrees s/he is doing important work
• Financial stability of the practice
• Satisfied with salary/income
• Mission and goals of practice
• Access to specialist consultants
• Able to practice full scope of services
Areas of Satisfaction—Assoc. w/ 2 year retention499 Clinicians Completing Service Obligations
• Strong personal connection to my patients
• Had good clinical back-up from senior/supervising clinicians
• Relationship with administrator
• Support from other clinicians
• Felt work did not encroach on personal time
• Agrees administrator is effective
• Agrees s/he is doing important work
• Financial stability of the practice
• Satisfied with salary/income
• Mission and goals of practice
• Access to specialist consultants
• Able to practice full scope of services
Red = statistically related to retention @ 2 years
Teachers vs. Non-Teachers587 rural generalists
Years
1086420
Prop
ortio
n Re
mai
ning
1.0
.8
.6
.4
.2
0.0
teachers
non-teachersp = .05
Principle: Rural physicians need to feel fulfilled.
Retention by Type of Service Program353 obligated generalists
Principles: Physicians need to feel satisfied. The physician-community match is key.
Years
6543210
Prop
ortio
n Re
mai
ning
1.0
.8
.6
.4
.2
0.0
Loan RepaymentLoanIncentive
ScholarshipResident Support
Key Points/Recommendations
1. Heed the fundamental principles presented earlier.
2. Develop separate retention and recruitment strategies.
3. Develop multiple strategies for retention and for recruitment.
4. Develop strategies in advance, not after problems arise.
5. The challenge should only be landing a physician (recruitment): once landed, any community is in good position to keep her/him.
Key Points (cont.)
6. Select a physician on their fit w/ practice and community.
7. Identify and remedy problems that trouble local physicians.
8. Sell yourselves and community. Warmly welcome attractive prospects. Embrace the entire family.
9. Create a job that fosters satisfaction, fulfillment, and investment, and is a viable long-term position.
Do not use the phrase “recruitment and retention”.
It misleads people to think they are the same thing.
recruitment and retention