Indian Health Special Interest Group Email Discussion Summary: Recruitment and Retention
Rural Recruitment
and Retention
IH-SIG and Rural Health SIG Joint Listserv Discussion Summary
September 2006
Discussion Facilitator: Lori Byron, MD
We had several dozen participants in an active discussion that attempted
to focus upon positive comments and suggestions in this challenging
area. Former and current IHS and Indian Clinic employees, Canadian
physicians, rural, retired, and CONACH Pediatricians all participated.
The synopsis from most participants is that allocated funds are decreasing
at the same time that numbers in Pediatrics and Primary Care are decreasing,
making recruitment more difficult. At the same time, there are several
innovative suggestions below to help.
I have divided up suggestions into various categories although there
is some overlap. Savvy physician recruiters caring for us would obviate
many of these, but many of us lack that position overseeing our areas.
RECRUITMENT
LOCAL LEVEL A) Finding Applicants
The brunt of recruitment seems to fall to the level of the local pediatrician,
although it obviously should lay elsewhere. To truly get doctors,
however, it appears that we are now to some degree required to assume
this additional duty.
Become a formal rotation site, or at least accept
as many residents and students as your area can handle. This provides
a continuous stream of potential future applicants. This is currently
done in many areas, and can be implemented in others. Treat these
people well when they are at your site; the IHS rotation is frequently
ranked as these students?/doctors? favorite month. They are publicity
for our lifestyle (see below for the significance of this!), even
if they do not return to our specific site.
Use advertising available through the AAP Web
site (http://www.pedjobs.org/) ? free to IHS sites, and some of
the ?throw-away? journals. Consider color and catchy advertisements.
Also, advertise on the Web site or in the newsletter of your respective
AAP Chapter. Some states, Washington for example, have a Web site
for recruiting to their rural areas; utilize these, if available.
Take any opportunity to advertise the quality
of life gained by working in rural and IHS sites: practicing the
full range of Pediatrics, clean air, open skies, outdoor activities,
relative safety from big-city-violence, the excitement of a cross
cultural experience, a salaried position, NOT running a business
office, and less emphasis on ?production?. Advertise this not only
to applicants but to other physicians, medical school and residency
colleagues, and your Christmas letter recipients! When asked to
write an article, speak, or be interviewed, DO IT! Many Americans,
including physicians, know nothing about Indian Health opportunities
and have never considered a rural site to practice.
Get your local site listed as a National Health
Service Corps site. Check www.nhsc.bhpr.hrsa.gov/, or contact Rick
Smith at 301/594-4130.
Arrange a visit with your medical school or residency,
when you return to visit those cities. This is usually allowed,
if you were a previous student or resident there.
Send a flyer (color, catchy!) to the private practice
pediatricians in your state and nearby states, advertising the uniqueness
of your practice style. Many of these doctors are fed up with the
system and are looking for a change.
Consider utilizing retired pediatricians, possibly
on a part-time basis.
B) Care of Applicants
Site visits require work. Enlisting assistance
from tribal members (Tribal Health Boards or IHS employees) works
at some sites.
The applicant?s needs must be addressed. They
should be contacted ahead of time, if possible, to improve their
visitation experience. Involve local realtors, families using the
available school systems (if applicable). Be aware of resources
for doctors belonging to minority religions and races, and attempt
to introduce them to these people, if possible. Have applicants
meet some people with similar interests, including non-physicians.
Allow them to meet as many (upbeat) doctors and others as possible.
Provide them with literature from Tribal and State tourism, the
IHS, and other appropriate organizations. Some IHS Area offices
and local hospitals auxiliary boards will assist with this, but
input from the doctors in the trenches will improve the chances
of a favorable outcome.
AREA OFFICE/STATE LEVEL All suggestions to the local sites apply to area offices that
still utilize physician recruiters in the Indian Health Service. A
recruiter with enthusiasm and longevity (ie, many distant contacts)
certainly is more successful. A bustling recruiter who sends out feelers
and constantly has their ear to the phone is helpful! Doctors on the
local level can make suggestions to their Area Office recruiters.
Recruiters should advocate for Physician Comparability Allowances
(PCAs), bonuses, and medical school paybacks.
For attracting rural physicians, legislation that encourages rural
providers ? tax reductions, financial assistance for coverage during
vacation time, bonuses, land donations ? would aid in recruitment
and retention. The AAP Chapters and other primary care organizations
(ACP/ACIM, AAFP, ACOG), and the health care/child health NGOs and
coalitions should assist with such lobbying; representatives serving
such districts may be willing to sponsor such bills. Local hospitals
and hospital systems can and sometimes do assist with this, and/or
provide similar incentives.
Most states are concerned about the crises in rural health care.
Recruiting Web sites and adding rural family practice residency programs
are some of the actions taken in recent years. Legislators usually
welcome and respect advice from physicians ?in the field?.
NATIONAL HEALTH SERVICE CORPS Advertise the program ? to incoming medical students and to
rural/frontier sites. Advocate for increased funding to provide for
more scholarships.
COMMISSIONED CORPS A suggestion was made that they collaborate with IHS regarding
recruitment. Dr Matthew Clark sits on the Surgeon General?s Physician
Professional Advisory Committee and will make this suggestion.
AMERICAN BOARD OF PEDIATRICS and AMERICAN ACADEMY OF PEDIATRICS (Some of these recommendations are specific to ABP or AAP,
some could apply to both)
Consider increasing the amount of time that residents
spend in primary care, especially rural primary care
Promote the rural medicine track. Consider requiring
or encouraging residency programs to provide incentives for choosing
this option.
Continue to support IHS pediatricians? free membership
in the Council on Community Pediatrics.
Continue to encourage increased reimbursement
of primary care and, specifically, for frontier/rural providers.
Be proactive in the rural health care crisis ?
encourage legislation such as that mentioned under local/state.
Continue free advertising on the AAP Ped Jobs
Web site for Native sites; but consider free advertising for rural/frontier
sites, as well as free advertising in the written publications.
TRIBAL HEALTH CLINICS
Like local IHS sites, it is difficult to
have connections for recruitment.
Collaborating with all THC?s nationally to hire
a recruiter would be logical.
Also, use advice as listed under ?local level?.
Advertise on the National IHS Web site, www.ihs.gov.
638 PROGRAMS Since these programs receive a percentage of Area Office funds
when health care is assumed by the tribes, there should be funding
to hire physician recruiters. Consider collaborating with other 638
programs in advertising, and utilize ?local level? recommendations.
(No one on the listserv identified themselves as employed in this
situation.)
NATIONAL IHS The IHS Headquarters needs to continue to improve upon physician
recruitment. The appropriate personnel should consider or attempt
flashy advertisements in Primary Care ?throw-away? journals, letters
to medical students, recruiters at as many job fair and medical school
events as possible. Advertise that the pay is comparable to non-governmental
salaries in primary care. Continue PCAs and incentives for working
in rural sites.
COMMITTEE ON NATIVE AMERICAN CHILD HEALTH (CONACH) CONCAH has been, and will continue to be, the allies of those
who work with Native children. They have recently initiated contact
with the National Indian Health Board. They do work in Washington,
DC, lobbying for money and issues that affect Native children and
those working with them. We are indebted to the current and past members
who continue to advocate and advertise!
We would appreciate their continuing to advocate in the following
ways, if they see fit:
Work with the AAP to continue free membership
in the Council on Community Pediatrics for IHS pediatricians, as
well as others working with 638 and Tribal Health Programs. Consider
free advertising in paper publications as well as the Web site.
Work with the most appropriate agency/agencies
to promote rural medicine tracks.
Work nationally with Congress to improve reimbursements
and provide incentives to rural/frontier health care providers.
Work with National IHS personnel to improve physician
recruiting efforts.
RETENTION
Very few suggestions were made regarding this very important aspect
of recruiting. It should go without saying, but it doesn?t, that recruiters
should be involved, doing follow-up with physicians that they help
to place.
Again, the local doctors end up doing most of this task. Taking the
time and effort to listen to our new colleagues and their issues is
necessary. Helping them find appropriate CME and interaction with
physicians of like specialty, helping them with housing/spouse employment/school
issues/outside interests will assist. It appeared that many of us
do no formal exit interviews with physicians who leave, and it appears
that we should. IHS recruiters could perhaps learn from other professional
recruiters and pass on useful advice to the local level, or do such
interviews from the Area Offices. Small local hospitals should perhaps
do the same. The following suggestions were made:
Local hospitals should appreciate and financially
support their providers. They should pay for non-clinical time spent
in QI, EMS-C, local committees, etc.
The local FP community should support the lone
rural pediatrician by sharing call coverage and ER duties when applicable
and possible.
Novel CME and peds specialty consultation from
tertiary care centers, including telemedicine and e-mail should
be available.
Local AAP chapters should consider a CATCH-sponsored
rural pediatrician professional support group, such as the Northern
New England Rural Pediatric Association in Maine.
Of note, Canada already does many of the suggestions mentioned above
with incentives, a rural relief program where locums can work part-time
in an underserved area and still maintain family/quarters in a non-remote
area, funds for CME and returning for specialty training, retention
funds, and practice establishment grants. It appears to be more standardized
and organized, probably due to the existence of National Health Care
System in their country. Our country could and should learn from their
ideas.
In summary, primary care is in a crisis in America today. Most of
us would be happy to just do our jobs (which are always more-than-full-time
in rural situations), but the onus falls on us to assist with recruitment
and retention. Let us reflect our enthusiasm, advocate as much as
possible, and hope for the best!
