basic principles: retaining health professionals in rural and underserved areas and practices don...
DESCRIPTION
Why Believe Me? From Los Angeles Studied philosophy and medicine in PhiladelphiaTRANSCRIPT
![Page 1: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/1.jpg)
Basic Principles:
Retaining Health Professionals in Rural and Underserved Areas and Practices
Don Pathman, MD MPHUNC Chapel Hill
NC Primary Care ConferenceAshevilleJune 22, 2012
![Page 2: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/2.jpg)
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
![Page 3: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/3.jpg)
Why Believe Me?
• From Los Angeles• Studied philosophy and medicine in Philadelphia
![Page 4: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/4.jpg)
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
![Page 5: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/5.jpg)
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
![Page 6: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/6.jpg)
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.
![Page 7: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/7.jpg)
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.
![Page 8: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/8.jpg)
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.
![Page 9: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/9.jpg)
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
![Page 10: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/10.jpg)
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.
![Page 11: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/11.jpg)
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.
![Page 12: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/12.jpg)
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.
![Page 13: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/13.jpg)
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.
![Page 14: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/14.jpg)
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
![Page 15: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/15.jpg)
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.
![Page 16: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/16.jpg)
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.
![Page 17: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/17.jpg)
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).
![Page 18: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/18.jpg)
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.
![Page 19: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/19.jpg)
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
![Page 20: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/20.jpg)
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
![Page 21: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/21.jpg)
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.
![Page 22: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/22.jpg)
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
![Page 23: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/23.jpg)
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.
![Page 24: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/24.jpg)
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.
![Page 25: Basic Principles: Retaining Health Professionals in Rural and Underserved Areas and Practices Don Pathman, MD MPH UNC Chapel Hill NC Primary Care Conference](https://reader035.vdocuments.us/reader035/viewer/2022062413/5a4d1b287f8b9ab0599983ac/html5/thumbnails/25.jpg)
Do not use the phrase “recruitment and retention”.
It misleads people to think they are the same thing.
recruitment and retention