Recruitment and retention have become increasingly important for community health centers and rural health facilities across the nation as tens of thousands of doctor and nurse positions remain vacant.
Recruiting and health care professionals is particularly important in rural areas and community health centers, where the loss of even one clinician can affect health care delivery for an entire community. Ineffective recruitment and retention can limit access to basic health care services for thousands of patients spread out over hundreds of miles or who cannot travel outside of their community for care.
A physician shortage looms over the nation, particularly for community and rural health settings. The Council on Graduate Medical Education projects a shortage of 85,000 physicians in 2020. The Association of American Medical Colleges (AAMC) predicts this shortage will grow to 124,000 physicians by 2025.
The average age of registered nurses (RNs) is rising, with more than half of all RNs are at least 40 years old and 40 percent are over the age of 50. Large numbers of nurses will retire over the next 20 years, causing the RN workforce to level off.
Rural Health Facilities and Gaps in Health Care
Gaps in the health care workforce caused by doctor and nurse shortages disproportionate affect residents in rural areas. About 55 percent of health centers are located in rural communities, where they serve about 13 million patients. In many cases, these rural health facilities are the only health care provider for hundreds of miles. The loss of a provider can force patients to travel hundreds of miles just to see a doctor or nurse.
While 20 percent of the U.S. population lives in rural areas, only 11.4 percent of all physicians practice there. Rural areas have a disproportionately smaller share of doctors than urban areas, and distribution within rural areas is more inconsistent too. Stagnation in the proportion of minority students enrolled in public medical institutions will likely add to physician shortages in underserved areas.
Barriers to Recruitment and Retention
A number of barriers prohibit recruitment and retention of health care professionals in both rural and community health centers, including geographic isolation, understaffed facilities, overworked medical staff, and even boom-and-bust economic cycles that complicate planning for these areas. These barriers often discourage medical professionals looking for a long-term position.
Health care providers in community and rural health centers frequently care for patients that are sicker than patients at other facilities. Patients living in rural areas experience several disparities when it comes to health status, such as a higher incidence of disease and disability, lower life expectancies, increased mortality rates, and higher rates of pain and suffering. Compared with those living in urban areas, patients in rural settings have higher rates of chronic illness and poor overall health. They are also older, poorer, and have fewer clinicians to care for them.
Certain risk factors contribute to these disparities, including geographic isolation, higher rates of health risk behaviors, limited job opportunities and lower socio-economic status. These same disparities can also make a community seem less attractive to health care professionals.
These recruitment challenges underscore the need for robust retention strategies.
Recruiting and Retention
Despite stiff competition for a limited supply of health care professionals in other communities, few rural health centers and community health facilities use a long-term view when it comes to recruitment and retention of caregivers. Desperate to provide care to needy patients, many organizations jump right into the recruitment process without giving much thought to current retention rates, cost of staff turnover and benefits of staff retention.
Recruiting is a short-term solution, one that involves identifying the workforce need, identifying key attributes required for the open position, and finding potential employees that fit the need. Retention requires a long-term view focusing on how an employee relates to his or her work and to the people in the organization.
Community health centers and rural health facilities face special challenges when it comes to maintaining an adequate work force. Many find it difficult to meet staffing requirements or provide the level of patient care needed.
Recruitment attracts health professionals and student to current and future openings within a health care organization. Retention keeps health care professionals working within these facilities and communities. Successful recruitment and retention minimizes the number and duration of vacancies, thereby saving money, improving quality of care, and ensuring the provision of health care services in the community.
There is a strong link between recruitment and retention, in that strong retention rates reduce the need for frequent recruitment and properly planned recruitment strategies can improve retention rates. A proactive and strategic approach can help community health centers and rural health facilities recruit and retain the personnel they need to provide adequate patient care.
Recruiting qualified and interested health care providers, and helping them acclimate to a community and facility, are costly endeavors. Finding a provider suited to the community in which they will work can also be a lengthy process. Leaving a position unfilled for any length of time can cause tremendous gaps in the health care provided to a community.
Efficient recruitment and robust retention are therefore essential for rural health facilities and community health centers, but many of these health care organizations are at a loss when it comes to retention. Team activities, staff satisfaction surveys, performance reviews, and mentoring opportunities can help improve the retention of qualified health care professionals in community health centers and rural health facilities.