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Assuring an Adequate Number of Rural Primary Care Providers

A new report finds no single approach is effective to recruit and retain health professionals in rural areas. Only when combined do interventions have a positive effect on both recruitment and retention.

All communities need quality health care, and yet the supply of healthcare workers to meet these needs has been disproportionately thin in rural areas.  Now, with changes in population density and declines in the supply of primary care physicians, the disparity is likely to grow with consequences for the health of rural communities.

According to Kaiser Health News, California’s growing need for primary care doctors, particularly in its rural areas, has compelled the state to pursue strategies that will ease the burden on patients who currently must travel far for expensive treatment. Jeff Oxendine from the University of California Berkeley’s School of Public Health suggests that “informing young people from underserved areas about health careers and providing opportunities to pursue them could help with recruitment and retention of a more diverse workforce.” A new advisory group in the state, the California Future Health Workforce Commission, will convene over the course of 2018 to generate possible solutions.

Understanding what strategies have been shown to not only recruit but also keep health professionals in rural areas is critical for policymakers like those in California. A new rapid evidence review conducted by AcademyHealth with support from the Colorado Health Foundation analyzes the body of research underlying various strategies to assure a stable supply of rural primary care providers. The review suggests that no single approach is as effective as combining interventions into a bundle. Specific interventions shown to have a positive effect on both recruitment and retention in rural settings include:

  1. targeting recruitment of groups with existing ties to rural communities (a strategy that mirrors Oxendine’s proposal),
  2. providing professional development and training opportunities for rural practitioners, and
  3. establishing a stable, well-resourced work environment.

Several additional interventions have been shown to be effective approaches to recruitment, but not necessarily for retention. These include:

  1. educational scholarships, loans and post-graduate loan repayment, salary increases and other direct payments,
  2. short-term rural placements for students, and
  3. curricula tailored to rural practice.

One difficulty noted in the report is that researchers do not use a common definition or time period for measuring the concept of retention, making it difficult to draw conclusions about how long providers remain in rural practice.

For policymakers trying to assure a stable rural primary care workforce, the effectiveness of recruiting trainees who already have ties to a rural area, and of efforts to bolster the professional work environment, underscores the importance of providers seeing rural areas as rewarding places to both live and practice.

As part of its commitment to reducing the gap between research findings and evidence-informed decision-making, AcademyHealth’s Translation and Dissemination Institute (TDI) regularly explores innovative approaches to quickly, but rigorously identify and communicate evidence to inform public and private decision-making. Learn more about it here.

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