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Providers, states act to attract primary care docs to rural areas

Geisinger Health System is among healthcare organizations and states that are taking steps to attract more primary care providers to their rural areas. Physicians entering the workforce now seek a career where they can be home for dinner, have job security, an attractive salary and live in a thriving area with opportunities.

That may make it more difficult for hospitals and practices to attract primary care providers who treat the increasing number of Medicare beneficiaries in rural areas, said Jennifer Grebenschikoff, president of the Physician Executive Leadership Center.

Traditionally, physicians were focused on getting a loan and opening a practice, according to clinical talent experts.

“Physicians want to be home at night for dinner, and they don’t want to take calls at night and weekends. They want regular schedules. They also want to move to places where they have connections,” Grebenschikoff said at a Sept. 22 meeting of the Institute of Medicine’s committee on Geographic Adjustment in Medicare Payment.

Geisinger serves a primarily rural region in Pennsylvania. Of the 120 physicians it recruited last year, just one third were primary care providers, said Cynthia Bagwell, vice president of talent acquisition at Geisinger.

“It can take six months to three years to find the right physician who wants to practice in a rural environment,” she said.

“For the majority of physicians, a rural-based practice won’t even garner a second look. They want to go where their friends and colleagues are going,” she said. 

Geisinger promotes what’s great about living there, lifestyle, work balance and beautiful surroundings. “Physicians don’t have a long commute anymore. They can get to their children’s soccer games and go back to the office later,” she said. 

Geisinger relies on electronic health records (EHRs), including its 37 community practices, which are tied into the main hospital’s system. “A doctor who is in a practice in a tiny town has the same access to information and the PAC system for radiology as they do if they were working in a larger community or at the main center,” she said.

Besides offering competitive benefits, compensation and relocation payments, Geisinger helps with loan repayment and loan forgiveness, she said. “We also try to attract people who have ties to our area and to a rural environment, who already know that lifestyle and they enjoy it,” Bagwell said.

She believes public policies that would make it financially feasible for physicians to go into primary care and help them with their loan repayment would ease the imbalance. Also federal and state agencies should have more consistent and broader definitions of what it means to be “underserved” and “health professional shortage area” for loan repayment programs, she said.

Michigan has focused on making it easier for students to move into clinical rotations with the Alliance for Clinical Experience. ACE works with 20 nursing programs and 35 hospitals in a collaborative effort to develop common clinical placement standards and processes, said Anne Rosewarne, president of the Michigan Health Council.

The group uses a clinical placement system that is a product of the Oregon Center for Nursing and added a module that helps a student with the administrative details needed to move from an academic institution into a clinical rotation.

Michigan’s latest effort works with federal grant programs to place student nurses, nurse practitioners and physician assistants in clinical rotations in underserved communities. It can be difficult to get undergraduate medical students into rural communities to have a different experience. “If you’re going to look at living in a rural area, you have to be in one, go to one, understand the richness of that life and like that,” Rosewarne said.

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