montana rural recruitment and retention roadshow! · health professional shortage areas a health...

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Montana Rural Recruitment

and Retention Roadshow!

Mike Shimmens

Executive Director, 3RNet

shimmens@3RNet.org

Mark Barclay

Director of Member Services, 3RNet

barclay@3RNet.org

www.3RNet.org

Introductions

• Name

• Facility

• Background

© 2015 3RNet April 2015 | 3

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Basics of Recruitment and

Retention Planning

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What is Recruitment?Is this your definition of recruitment?

• The process of finding and hiring the best-qualified candidate

• Timely and cost effective manner

• Process includes– Analyzing the requirements of a job

– Attracting employees to that job

– Screening and selecting applicants

– Hiring

– Integrating the new employee to the organization.

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What is Retention?Is this your definition of retention?

• An effort by a business to maintain a working environment which supports

current staff in remaining with the company.

• Many employee retention policies are aimed at addressing the various

needs of employees to enhance their job satisfaction and reduce the

substantial costs involved in hiring and training new staff.

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Or is this?

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“Recruitment and retention are not

separate events – they are part of a

process.” Tim Skinner, ex-officio ED 3RNet

RECRUITENTIONRetentionRecruitment

www.3RNet.org

• “Recruiting for Retention” The Recruitment and

Retention Manual of the 3RNet updated in 2009,

2013, 2015

• “Recruitment and Retention of Clinicians” NACHC

Manual by Illinois, Mississippi, Arizona and Virginia

PCA’s completed in 2005 and updated in 2010

• “Midwest Retention Toolkit” 2012

• Association of Staff Physician Recruiters (ASPR)

www.aspr.org

Basic Science

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R & R Plan Action Steps

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For me, it’s all about the team!

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Form a Recruitment and Retention

Committee

• No matter what the size of your organization this needs

to be thought out and roles assigned

• Some members may wear more the one hat in the

process, but it is a team effort

• Your efforts will be hard pressed to succeed if you skip

this step!

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How long do these steps take?• According to the Advisory Board, a typical recruitment timeline from initial

candidate response to signing averages 19 weeks – but best practice is six

weeks.*

• A compressed recruitment timeframe reduces chances that a candidate will

be lured away before signing, and should look something like this: – Initial candidate contact

– 24 hours: follow up with candidate’s initial contact

– 1 week: schedule and conduct pre-screen interview

– 3 weeks: arrange a site visit

– 48 hours: extend an offer

– 2 weeks: receive signed offer

• IS THIS REALISTIC? Should it be?

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Part I Planning and

Preparation

Planning and preparation are the

most important ingredients for

ensuring a successful recruitment

effort. They are also the most often

neglected.

‐ 3RNet

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1. Assess the Need

2. Gain support of key stakeholders

3. Form a recruitment and retention committee

4. Define your opportunity

5. Define the ideal candidate

6. Develop a recruitment budget

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People want to practice where

they are needed and welcome.

Show them they are supported

by as many members of the

community as possible.

‐ 3RNet

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Part II Searching for

candidates

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Step 7 Generate Candidates

• Use your unique selling points (USPs) in a creative way

with graphics, pictures, quotes, etc.

• Create many different types of ads:– Short profile

– Classified ad

– Internet version

– Promotional packages, maybe video?

– “Elevator speech”

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Step 7 Continued

• Use multiple methods of sourcing to have greatest impact– On line job boards and advertising like 3RNet

Montana 3RNet contact is: Crystal Bridges

crystal@mtha.org 406-457-8047

– Journals and print media

– Direct mail and email blasts

– Databases like PracticeMatch, PracticeLink and Profiles

– Social media – Facebook, LinkedIn, Twitter

– Search firms – Understand the different types and your

responsibilities (contingency, retained and hybrid)

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Part III Screening candidates

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8. Interview Candidates by phone or video conferencing

9. Conduct credential check

10. Interview the spouse/significant other

11. Check references

12. Conduct site visit

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Part IV Follow up and Follow

Through

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13. Follow up communication

14. Negotiations

15. Retention plan implementation

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Key Players in Rural

Recruitment and Retention

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Collaboration

• 3RNet Member

– “One stop shop”, Trusted Resource

– https://www.3RNet.org/locations

• Primary Care Office

– Loan repayment, J-1 Visa Waiver, HPSA designations

– http://bhpr.hrsa.gov/shortage/hpsas/primarycareoffices.html

• Area Health Education Centers (AHEC)

– Rotations, CE, Pipeline

– http://www.nationalahec.org/AHECDirectory.taf

• State Office of Rural Health - NOSORH

– http://nosorh.org/nosorh-members/nosorh-members-browse-by-state/

• Primary Care Association

– http://www.nachc.com/nachc-pca-listing.cfm

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3RNet.org• Non profit membership

association

• Each member in unique

• Celebrating 20 years

• Post any job

• In 2014, there were:– Over 45,000 active candidates

– 9,566 job postings

– 3,101 new candidate

registrations

– 1,718 professionals placed

Montana Primary Care OfficeRoadshow April, 2015

What do we do? HPSA Designations

HEALTH PROFESSIONAL SHORTAGE AREAS

A Health Professional Shortage Area (HPSA) is a designation, determined by the HHS Secretary, of a health workforce or provider shortage. A HPSA designation can be made for a geographic area, population group or health care facility. There are 3 types of HPSA designations:

Primary Care Dental Mental Health

Determining Factors of HPSA Scores Primary Care Dental Health Mental Health

Population to Provider Ratio X X X

% Below Poverty X X X

Travel Time/Distance to Care X X X

Infant Mortality/Low Birth Weight X

Access to Flouridated Water X

Youth and Elderly Population X

Substance and/or Alcohol Abuse X

• Many Federal and State programs use HPSA designations in

determining eligibility

• HPSAs determine funding priorities

› NHSC makes awards by descending HPSA score

o Awardees working in sites with HPSA scores of 14 and higher receive higher

funding than other awardees

o The State Loan Repayment Program (SLRP) requires participants to work in a

HPSA. Montana also uses HPSA scores to prioritize funding.

• HPSAs guide placement opportunities

› Scholars have a limited number of placement opportunities and the statute

directs them to serve in areas of greatest shortage

› J1 Visa Waiver participants are required to work in HPSA designated areas

WHY ARE HPSAs IMPORTANT?

BCRS chart

BHW

NHHSP

Native Hawaiian Health

Scholarship Program

NHSCSP

National Health Service Corps Scholarship Program

NHSCLRP

National Health

Service Corps

Loan Repayment

Program

NHSCS2S

National Health

Service Corps

Student to Service

Loan Repayment

Pilot Program

NHSCSLRP State Loan

Repayment

Program

FLRPFaculty Loan

Repayment

Program

NCLRPNURSE Corp

Loan Repayment

Program

NCSPNURSE Corps

Scholarship

Program

ScholarshipProgram

Students pursuing careers in primary care can

receive a scholarship now and serve later.

The scholarship* includes:

Payment of tuition and required fees (tax-free)

Some other tax-free educational costs (books,

etc.)

A monthly living stipend (taxable)

*available for up to 4 years

support

YEARS OF

SUPPORT = YEARS OF

SERVICE

Scholars commit to serve in the Corps upon

completion of their training — one year for

each year of support (at least 2 years).

Loan Repayment Program

UP TO

$50,0002 YEARS MINIMUM

With continued service beyond 5 years, health care

providers may be able to pay off all their student loans.

UP TO

$30,0002 YEARS MINIMUM

Federal NHSC Program Montana NHSC Program

NHSC Loan Repayment Programs

The State Loan Repayment Program provides cost-sharing grants to states to operate their own educational loan repayment programs for primary care providers working in Health Professional Shortage Areas (HPSAs) within their state

State grantees have the option to expand eligible disciplines in their programs to include registered nurses and pharmacists, and expand eligible site types to include critical access hospitals, long-term care facilities, and state mental facilities, providing greater flexibility than is available through the NHSC loan repayment program

• SLRP varies state to state as compared to the NHSC in:

Approved disciplines

Length of service commitment

Amount of contract offered

Ability to utilize alternative funding sources

Physicians24%

Nurse Practitioners 10%

Physician Assistants18%

Certified Nurse Midwives 1%

Dentists3%

Dental Hygienists3%

Mental Health Providers41%

Montana National Health Service CorpsAs of 9/30/2014

Loan Repayment Program81%

Scholarship Program4%

State Loan Repayment Program

15%

National Health Service Corps Programs in Montana

National Health Service Corps

17

22

76

92

55

75

Why do NHSC providers choose Montana?• Beautiful outdoors• Broad scope of practice • Community need/support

National Health Service Corps Eligibility

Site Eligibility

Provider Eligibility

NHSC Sites

Benefits

Recruit

providers and

residents dedicated

to working

where they are needed most

Post clinical job

openings on the

NHSC Jobs Center

and participate in Virtual Job Fairs

Connect with

other NHSC-approved sites

Receive

community and

site development assistance

Establish

an integrated

system of care that

includes the

uninsured and underinsured

Develop linkages

with academic

institutions and

other organizations

Approved NHSC Sites in Montana

347357 366

416

Below is an abbreviated version of eligibility requirements. Sites must:• Be located in and treat patients from a federally-designated HPSA;• Not discriminate based on the individual’s ability to pay, race gender, age, or sexual

orientation;• Accept Medicare, Medicaid, or Healthy Montana Kids;• Post and honor a sliding fee scale according to current federal poverty guidelines; and• Have been in operation for a minimum of 12 months prior to site approval.

The application cycle for to become an approved site is open from March 30- June 2, 2015. Sites have to be approved before providers can apply for loan repayment.

Other Considerations• Site approval does not guarantee loan

repayment

• Need to update point of contact as staff changes

• Need to recertify every 3 years, recertification opens in the fall (Sept-Nov)

https://programportal.hrsa.gov/cas/login?service=https%3A%2F%2Fprogramportal.hrsa.gov%2Fshared%2Fj_spring_cas_security_check

How to apply

1Determine HPSA

Status; enlist

State Primary

Care Office

2Complete and

submit the Site

Application

3Complete and

submit the Site

Profile Form

Learn more at:

http://www.nhsc.hrsa.gov/sites/

Must be licensed in

one of the following

Eligible disciplines

Diciplines

• Physician (MD or DO)

• Nurse practitioner

(primary care)

• Certified nurse-midwife

• Physician assistant

Dentist

• Dentist

(general or pediatric)

• Dental hygienist

• Psychiatrist

• Psychologist (health service)

• Licensed clinical social worker

• Psychiatric nurse specialist

• Marriage and family therapist

• Licensed professional counselor

Eligibility U.S. citizen or national

Currently work, or applying to

work, at an NHSC-approved site

Have unpaid government or

commercial loans for school

tuition, reasonable educational

expenses, and reasonable living

expenses, segregated from all

other debts

Licensed to practice in state

where employer site is located

Eligibility Provide direct patient care services in the outpatient setting

Minimum direct patient care in the outpatient setting requirements

Discipline specific

Special allowances for Teaching Health Centers, and Critical Access Hospitals

Can work at multiple approved sites to meet hour requirements

How to apply?

1Review the

Application and

Program Guidance

2Find a job at an

NHSC-approved

site or find out if

your current job

is at an NHSC-

approved site

3Apply online at

NHSC.hrsa.gov/

loanrepayment

nhscjobs.hrsa.gov

After receiving the award? • Site Considerations:

– Verify participants are fulfilling service obligation, notify NHSC of changes

– Afford providers the opportunity to fulfill service obligation

– Allow for site visits

– Ensure practice policies continue to align with NHSC eligibility requirements

• Provider Considerations:– Fulfill service commitment at approved site

– Can change between full-time and part-time

– Waivers and suspensions are offered in extreme situations

– Can transfer to different NHSC-approved site, with prior approval

– Hefty default provisions

J1 Physician Visa Program in Montana

• Underutilized: 30 J1 slots total, 10 of which are flexible

0

5

10

15

20

25

30

35

2009 2010 2011 2012 2013 2014 2015

Montana J1 Visa Physiciansapproved per year

Potential J1 Visa Physicians

MT PCO Role: J1 Visa Program

• Interpretation of Policy– Found at: http://dphhs.mt.gov/publichealth/primarycare/J1-Visa-Program

• Process applications/ Provide recommendation

• Provide technical assistance

Service Site/Employer Eligibility

• Be located in a federally designated HPSA or federally designated MUA, or in a federally designated MUP;

• Be currently in operation or ready to operate when J1 commences employment; • Have attempted to recruit a U.S. citizen physician for at least 6 months prior to the

application submission and must be able to document recruitment efforts/dates;• Agree to charge patients at the usual and customary prevailing rate in the area, unless

the; • Accept Mediciad/Medicare; • Use a sliding-discount-to-fee scale based on ability to pay for all patients at the facility

who are uninsured and at or below 200% of current Federal Poverty Guidelines (FPL). The current FPL is available at http://aspe.hhs.gov/poverty/index.shtml#latest ;

• Agree to sponsor the J1 Physician’s H1B visa for 3 years; • Agree to notify the MT PCO, in writing, of physician start date within 30 days of the

start date;• Agree to submit semiannual reports to the MT PCO;• Agree to notify the MT PCO, in writing, of any change in the employment contract

within 30 days;• Agree to site visits by the MT PCO staff

Application process

1.STEP ONE: A J-1Physician must apply for a case number (DS-3035 online application form) from the U.S. Department of State (DOS) website and must secure a bona fide offer of employment.

2.STEP TWO: The health care facility applies to the State Department of Health to request a waiver on the J-1 Physician’s behalf.

•Application Period : Begins October 1 each year. Applications are accepted on a rolling basis- goal is 2 WEEK processing once the application is received

3.STEP THREE: State Department of Health reviews and processes the J1 Visa Waiver Application (8 to 12 weeks). When requirements are met, State recommends the J-1 waiver to the DOS.

4.STEP FOUR: U.S. DEPARTMENT OF STATE (4-6 WEEKS) •U.S. Department of State reviews the J-1 waiver applications

•U.S. Department of State reviews and considers state recommendation with other policy considerations

•Generally, U.S. Department of State signs off on state recommendations and forwards the recommendation to the U.S. CITIZENSHIP AND IMMIGRATION SERVICES

5.STEP FIVE: U.S. CITIZENSHIP AND IMMIGRATION SERVICES (2-6 WEEKS) •Makes final waiver approval •Approves waiver recommendations

Name Title Business Address CityStat

eZip

Code Phone Email

Ann Badmus Attorney Cowles & Thompson 901 Main St Suite 400 Dallas TX 75202214-672-2000

ajohnson@soundphysicians.com

Christopher Flann AttorneyImmigration Law of Montana, P.C. 8400 Clark Rd Shepherd MT 59079

406-373-9828

flann@immigrationlawofmt.com

Benita Adams Paralegal Cowles & Thompson 901 Main St Dallas TX 75202214-672-2260

badams@cowlesthompson.com

Kyle Clauseen Attorney Morgan Theeler LLP 1718 N Sanborn Blvd Mitchell SD 57301605-996-5588

kclaussen@morgantheeler.com

Brian Bruner Attorney Bruner Law Group 6609 Horseshoe Curve Chanhassen MN 55317612-205-5494

bbruner@brunerlawgroup.com

Robert AronsonManaging Attorney

Aronson & Associates, PA 1221 Nicollet Mall Minneapolis MN 55403

612-339-0517

raronson@aronsonimmigration.com

Kelli Stout Attorney Husch Bleackwell LLP4801 Main St, Suite 1000 Kansas City MO 64112

816-983-8309

Kelli.Stout@huschblackwell.com

Ellie NajfabadiAttorney at Law Law Offices of Carl

Shusterman600 Wilshire Blvd. Suite 1550 Los Angeles CA 90017

213-623-4592x107 enajfabadi@shusterman

.com

Cameron Halladay

Immigration Legal Assistant

Miller Mayer Attorneys at Law

P.O. Box 6435

Ithaca NY 14851607.273.4200 clh@millermayer.com

Otieno B. Ombok Attorney Jackson Lewis P.C.44 South Broadway, 14th Floor

White Plains

NY 10601914-872-6895

omboko@jacksonlewis.com

Bringing it altogether in Havre, MT

A Glance at the Numbers 7 Mental Health Providers 1 Dentist, 1 Dental Hygienist 1 Primary Care Physician (possible 3 more) 1 Pharmacist 1 Oncologist/Hemotologist $530,000 in loan repayment

Bullhook Community Health Center Alone: Grant Expenditures: $892,304 Over 3,000 patients served

76% below 200% poverty line About 20% American Indian 1,422 Medical 1,637 Dental 1,637 Mental Health

Increase in Cervical Cancer Screening from 31-63% Adolescent Weight Screening from 5.1-34.3% Tobacco Cessation Counseling from 61.2-88.1% Childhood Immunization from 34.8-77.8% Diabetes Control from 64.4-70.8%

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Factors to Market Your Rural Community: Accessing Strengths/Challenges, Community Marketing, and Finding Solutions

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How do we market for rural providers?

• High Salaries?

• Loan Repayment?

• Hunting and fishing?

• Is an advantage, still an advantage, when most everyone

offers it?

• What factors make ourselves stand out from our

competitors?

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What factors matter in rural?

78

Geographic

• Schools

• Climate

• Perception of Community

• Spousal Satisfaction

Economic

• Loan Repayment

• Competition

• Part-time Opportunities

• Signing Bonus

Scope of Practice

• Emergency Care

• Mental Health

• Obstetrics

• Administration Duties

Medical support

• Nursing Workforce

• Call/practice Coverage

• Perception of Quality

• Specialist Availability

Hospital and Community Support

• EMR

• Welcome & Recruitment

• TelevideoSupport

• Plan for Capital Investment

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Where did these factors come from?

• Idaho Family Medicine Residency – Dr. Dave Schmitz

– dave.Schmitz@FMRIdaho.org

• Boise State University– Dr. Ed Baker

– ebaker@boisestate.edu

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Geographic Factors

• How does geography make rural recruiting different?– Have you ever used “town has a grocery store” as a selling

point in an urban area?

• Sample factors: schools, religious/cultural opportunities,

spousal satisfaction

• What types of candidates do strengths in these factors

matter to?

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Example – Geographic Factors

• Access to a larger community– Advantage: Loan repayment, outdoors, and 40 miles to a

large city.

– Challenge: No specialty shopping/restaurants, 2 hours to

large city on tough roads

– Solutions: shared transportation, weekend scheduling,

online options, bring services to you

• Despite geography, how can we get rural providers what

they need?

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Economic Factors

• How does compensation make rural different?– Its all about quality of life/compensation balance

• Sample factors: loan repayment, income guarantee,

competition

• What advantages does rural have economically?

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Example – Economic Factors

• Part-time Opportunities– Advantage – flexible, offer part time

– Challenge – need full time

– Solutions – job sharing, multiple recruits

• Can rural offer the flexibility newly trained physicians are

looking for?

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Scope of Practice Factors

• What are we asking rural physicians to do?– Clinic, ER, nursing home, impatient, mental health,

supervise NPs/PAs, and administration?

• Sample factors: OB/C-section, endoscopy, teaching

• Offer, but don’t require

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Example – Scope of Practice Factors

• Mental Health– Advantage – not required, specialists available

– Disadvantage – isolated, lack of referral options

– Solutions – telehealth, allied providers, psych NPs

• What do rural physicians want to do?

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Medical Support Factors

• How is a physician’s practice supported in rural?– Team based care? I’m the only provider here!

• Sample factors: transfer arrangements, EMS, ancillary

staff

• Trained in urban, practicing in rural

• Onsite, virtual, traveling

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Example – Medical Support Factors

• Specialist availability– Advantage: onsite, visiting, or virtual access

– Disadvantage: no access

– Solutions: telemed, partner relationships, professional

contacts

• How can we make sure physicians don’t feel isolated in

rural?

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Hospital and Community Support Factors

• How does the community support the physician?– Cookies at the doorstep, urban vs rural

• Sample factors: hospital leadership, EMR, internet

access, welcome and recruitment program

• Something urban usually can’t offer

• A rural physician is greatly appreciated, and often a pillar

of the community

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Example: Hospital and Community

Support Factors

• Physical plant and equipment– Advantage: nice facility, good technology

– Disadvantage: older facility, lack equipment

– Solutions: plans for capitol investment, fundraising,

candidate as champion

• Why is it important for candidates to feel valued in rural?

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Montana advantages

-8.00

-6.00

-4.00

-2.00

0.00

2.00

4.00

6.00

8.00

Mea

n S

core

Top 10 Factors- Apgar

Overall

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Montana challenges

-8.00

-6.00

-4.00

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2.00

4.00

6.00

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core

Bottom 10 Factors- Apgar

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So what does this mean?

101

• What do physicians want?

• It depends.

• By knowing your strengths, you can target

specific groups of physicians those

strengths are desirable to

• If your strengths don’t align with your

ideal, changes must be made

Scope of

Practice

Salary Outdoors Call

Schedule

Loan

Repayment

Services Physical

Plant

Part

Time

Telemed

Hospital 1 X X X X X X X

Hospital 2 X X X X X X

Hospital 3 X X X X X X

Hospital 4 X X X X X X X

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Takeaways:

• Recruitment is a process

• Leverage collaboration– 3RNet, SORH, PCO, PCA

• Identify and communicate strengths

• Invest in challenges

• 3RNet Manual/Factors book

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Thanks for coming…

• 3RNet Manual

• Why Rural is Different Factors Book

• Available for viewing until October 15th, 2015

• 3RNet.org/MTRS– Password: montana15

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Questions?

– Mike Shimmens, Executive Director• shimmens@3RNet.org

• 1-800-787-2512 ex 2

– Mark Barclay, Director of Member Services• barclay@3RNet.org

• 1-800-787-2512 ex 1