»PROACTIVE APPROACHES TO WORKFORCE CHALLENGES CREATE STRONGER COMMUNITIES
By Russ Johnson
The health care workforce once was a simple equation of supply and demand. Many doctors practiced medicine for 20, 30 years or more in Alamosa, making it their home. Their relationship to the hospital was one of practical convenience and necessity in terms of caring for their patients. In a span of 15 years or so, this scene has changed dramatically.
I don't believe physicians, primary care or specialty, will move into rural communities and join a practice or start their own again as they once did. That is a bygone era. The risk is too high and the debt to get through medical school has become too great. Additionally, provider temperaments have changed. Today physicians emerging from training seek balance in their lives and are less inclined to embrace the whole package: private practice, being on call, working in both hospital and clinic settings, and managing patients and administration.
With a population of 47,000, the San Luis Valley has about 55 physicians in active, full-time practice. Of those, all but four or so are employed by hospitals or the community health clinic. This trend marks a major shift in who employs the provider workforce.
Four years ago, the San Luis Valley Regional Medical Center employed four physicians: Emergency Room doctors who provided 24/7 coverage in the trauma center. Now, we employ more than 40 providers and are actively recruiting more. If 10 physicians in the right specialty areas walked into my office and said, "We'd like to work here," I would hire them all. Providers and hospitals are no longer autonomous in our community. We recognize our interdependence and thus the hospital is willing to make a commitment to these providers and share in more of the risk related to providing operating infrastructure, recruitment, training, overhead and, ultimately, revenue.
By and large, rural providers serve patients covered by Medicare and Medicaid, with a modest number of privately insured patients and many people who have no coverage at all. The uninsured rates for people under age 65 in rural areas is more than 60% higher than in suburban areas, according to the U.S. Census. While suburban providers have some flexibility in determining how many uninsured and publicly insured patients they will see, rural providers simply do not have this option as there are not enough privately insured patients to sustain most of their practices. Also, I would argue, many of us feel compelled by ties to our small communities to avoid turning patients away. The fact is, huge disparities exist between hospitals and providers based on where they are locatedand, consequently, who pays the medical bills.
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