Incentives for Recruitment and Retention of Rural Doctors

With the face of healthcare in America constantly changing, especially since we have an aging population, the shift to primary care is key in lowering healthcare costs and in improving access and quality. There is a shortage of primary care doctors in America. In addition, there is also some serious maldistribution of those doctors. The previous reform blog for our group suggested incentives for medical students to pursue primary care or family practitioner positions. This reform blog builds on that, but for the need of incentives, not only for all primary care, but also specifically for rural doctors, either to draw more healthcare workers, or to retain those employees and make sure their needs are met as professionals in those areas. There needs to be recruitment and retention of doctors in rural practice. This will require the removal of disincentives to rural practice, and the provision of incentives, which help to counteract the additional responsibility of isolated practice. Rural doctors have identified financial, work practice and professional issues that can be adapted to enhance the capacity of rural doctors to remain in rural practice. These strategies will also assist the recruitment of doctors to rural practice.
The first issue is finding strategies to enhance financial incentives. This is the part that we feel the government holds a bigger responsibility in. We feel that the government should be more of a major payer and regulator when it comes to incentives for rural doctors. Not necessarily should the government have to foot the whole bill, but there should be incentives for the facilities to help in retaining and recruiting doctors, such as grants and tax breaks. Adequate financial rewards that recognize the complexity and degree of clinical responsibility accepted by rural doctors are an important incentive.
Some strategies are:
• Funding models that provide security and flexibility for the doctor and recognize the physician as a community resource.
• Additional payments to rural practitioners in recognition of higher level of clinical responsibility, services provided and on call demands.
• Specific incentive payments for practicing in isolated/underserved areas.
• Financial assistance to maintain the economic viability of at least two doctors working together in a rural location.
• Funding for travel and other costs for the doctor to attend continuing medical education.
• Support and incentives for rural doctors' spouses and families.
As stated before, retention of rural doctors is just as important as recruiting. The retention of rural doctors is predicated on the satisfaction that they achieve in both their professional and personal life. The isolation of rural practice puts strains on both of these. There is a need to provide an adequate working environment for rural doctors to use the extended range of skills that they have required. Too often the rural doctor has to work in substandard facilities. The extended period of on-call, often single handed, is a source of stress to doctors and their families. Such conditions must be alleviated if doctors are to remain in rural areas.
The next issue in retaining and recruiting rural doctors is the fear of an unstructured career path. Many fear not being able to change their career path once in a rural setting. The opposite must be implemented.
Such as:
• Access to ongoing appropriate continuing medical education to enhance and maintain their skills.
• Development of clear and attractive career pathways for rural practitioners.
• Preferential access to specialist training for those rural doctors who choose to change career pathways.
• There should be no financial, career or regulatory barriers to doctors moving to practice in urban areas.
• Academic appointments and support for rural doctors.
These and other strategies could help with the shortage of rural doctors. Family practice, primary care, and rural care may not seem as flashy and precise as specialty medicine but it will be the key in changing America’s failing health and failing health care around. We need to instill more incentives in rural America because they deserve the same level of quality and access and also lower costs. These steps towards preventive care will be the turning point for access in this country.



Sources: (all of which are a good read too and provide more insight)
http://www.globalfamilydoctor.com/aboutWonca/working_groups/rural_training/practice/Practi07.htm
http://www.amavic.com.au/page/About_Us/AMA_Agenda/Current_Issues/Incentives_for_rural_doctors_needed
http://www.glgroup.com/News/Shortage-of-Rural-Doctors---The-U.S.-Can-Learn-From-Canada-14602.html