Overcoming the Odds to Recruit During the Doctor Shortage
Mendocino Community Health Clinic (MCHC), which owns and operates three local health centers in Lake and Mendocino Counties, has been beating the odds when it comes to physician recruitment.
“There’s a major shortage of primary care doctors in rural communities all over the country, and we’re no exception,” said MCHC CEO Linnea Hunter, “So we’re doing everything we can to bring doctors in. So far, it seems to be working.”
Many factors have contributed to the shortage: a surge in the number of government-insured patients paired with an almost 20-year freeze on the number of graduate medical (residency) program slots in the United States has led to far fewer doctors available than are needed.
According to the American Medical Association President Jeremy Lazarus, M.D., "Residency training gives new physicians hands-on experience and provides high-quality care to patients. Limiting the slots available to train physicians as they leave medical school creates a bottleneck in the system and prevents the physician workforce from growing to meet the needs of our nation’s patients."
The Association of American Medical Colleges (AAMC) estimates that 10,000 Americans a day turn 65 years old—becoming eligible for Medicare and increasing their utilization of healthcare services—and this will continue for the next two decades; and millions of people have purchased health insurance as a result of the Affordable Care Act (ACA), making them more likely to seek treatment. According to Partnership HealthPlan of California, the insurance company that manages Medi-Cal in much of Northern California, the Affordable Care Act has led to 20,000 additional patients being added to Medi-Cal’s roster in Lake and Mendocino Counties alone.
Both nationally and locally, the number of new doctors is not keeping up with demand. In fact, the AAMC projects that the United States will have a shortage of approximately 100,000 doctors by the year 2020.
MCHC Recruiter Kelly Kesey said, “In addition to the lack of residency slots, we don’t have enough people going into medicine to keep up with population growth. The government does not permit enough foreign medical graduates to enter the workforce, and those who do pursue medicine tend to specialize. Primary care doctors are getting harder and harder to find.
“Right now the United States has the same number of internists [primary care doctors who treat adults] as we’ve had for years, but the vast majority of internists coming out of residency are becoming hospitalists (who only take care of hospitalized patients) or sub-specialists such as cardiologists. This trend significantly limits the number of newly trained physicians available for clinics like ours.”
Kesey also mentioned the difficulty of drawing physicians to a rural community. According to the National Rural Health Association, only ten percent of physicians choose to practice in rural areas, even though almost a fourth of the population lives there. When competing in a national market, recruiting to Lake and Mendocino Counties is especially challenging because of the high cost of housing and the lack of professional jobs for spouses/partners.
Clearly, some of the causes of the physician shortage cannot be addressed locally; however, MCHC has been proactive in its recruitment efforts to try to assure that local patients do not have to travel for care or go without it. MCHC accepts patients with all types of health insurance, including Medicare, Medi-Cal, and CMSP, as well as patients without insurance who cannot afford to pay for care. Typically, it is these patients who feel shortages first, but not in this case.
In the past year or so, MCHC has recruited more than a dozen providers—either doctors or midlevel providers. (Midlevel providers treat patients with physician oversight.) According to Partnership HealthPlan Regional Manager Andy Jensen, MCHC’s recruitment efforts are impressive.
“Kelly [Kesey] has done an extraordinary job. The success she has had is remarkable given the provider shortage. MCHC must have a good grasp on what it takes to recruit here. Recruiting providers and physicians is complicated. It’s a layered process, so when I say they’ve done a remarkable job, I don’t say it lightly. Your community can be very proud of the work there,” he said.
Oftentimes, insurance companies and medical clinics are on opposite sides of healthcare finance issues, but locally, this is not the case when it comes to physician recruitment. Partnership HealthPlan’s mission is to help their members and the communities they serve to be healthy. To that end, they created a pilot program to provide additional recruitment funding for rural practices in several high-need counties.
Jensen explained, “We recognize that one of the crucial things about managed care is that our members must have access to primary care, so we took unusual step to help partner clinics recruit physicians—because we want to make sure our members are as healthy as possible. The great thing about successful recruitment is that, whether the patients are our members or not, we’re improving health in the communities we serve.”
Kesey believes MCHC has been successful in its recruitment for several reasons, one of which is the recent financial support from Partnership HealthPlan. Being a part of this innovative pilot project enabled MCHC to be more competitive in the recruitment process. Kesey explained that new physicians interview at an average of 5-10 locations in several different states, and typically receive many employment offers. Money is not the only factor doctors consider when choosing where to start their career, but it is a significant factor and Partnership has helped MCHC compete in the national market.
“To meet our community’s healthcare needs, we employ physicians and midlevel providers with varied experience and cultural backgrounds. New providers have cutting-edge medical training, and they share it with the more experienced members of their team. Experienced providers mentor new physicians as they develop their own approach to medicine. It’s a mutually beneficial relationship, and it increases the quality of care,” she said.
MCHC promotes team-based care and this supportive environment is appealing to many providers. Team include physicians, midlevel providers, nurses, behavioral health providers, health educators, support staff, and others.
The addition of more midlevel providers is one of MCHC’s key strategies as they consider the next 20 years in health care. “I believe these masters level providers will continue to fill the gap caused by the physician shortage, and I have found them to be competent, caring and professional,” Kesey said.
Recruitment strategies are as varied as the physicians they are intended to attract, from online ads and postings to job fairs to old fashioned networking. Recently, Kesey signed contracts with several universities to allow medical students to complete part of their training at MCHC health centers: Hillside Health Center in Ukiah, Little Lake Health Center in Willits, and Lakeview Health Center in Lakeport. These rotations or shadow days expose physicians and midlevel providers to our communities, allow them meet patients and staff, and to learn more about how medicine is practiced in community clinics. If the providers are a good fit for MCHC, they may pursue a permanent position once their medical training is finished.
“It’s a very special provider who chooses to work in a community health center. These providers are what we call mission-driven. Many providers who want to work here grew up in rural areas and want to give back to a community like ours. Other times, new grads just like the pace and beauty of our area. When they interview, we always attempt to give them the best feel for the clinic, the patients and the challenges that go with health care in an economic depressed area,” Hunter said.
Because new physicians are hard to come by, another strategy to keep the number of doctors up is to maintain the ones we have. To that end, CEO Linnea Hunter has offered part-time employment to specialists who want to slow down, but are not ready to retire. While many physicians used to go into a private practice, the overhead now required to do so is cost-prohibitive for most. Existing practices require a busy, full-time physician to cover overhead and make a living: part-time work does not cover expenses.
“By employing specialists who want to work a few days a week rather than retire, we create a win-win situation. Our patients covered by Medicare and Medi-Cal have access to specialty care, and wonderful physicians who are not ready to give up medicine can continue to practice,” Hunter said.
“And it’s not just retiring specialists,” Kesey continued. Because of how health insurance works, specialists in private practice who want to serve Medi-Cal patients can do so at MCHC on a limited basis, from several hours a week to just a day a month. At MCHC, Medi-Cal patients have access specialists in nephrology, orthopedics, dermatology, HIV, gastroenterology and more.
“If they see Medi-Cal patients in their office, they’ll lose money, but our payment structure is different. As a federally qualified health center, we receive federal grants to care for the uninsured and under-insured, and we receive adequate reimbursement for treating Medi-Cal patients. Since we’re a medical home for Medi-Cal patients, we want to provide them with as many services as we can. Setting up this collaborative relationship with specialists allows us to take excellent care of our patients.” Kesey said.
Kesey says she will keep working on creative ways to attract physicians to our area. She said if you or someone you know is interested in a career in medicine, visit www.mchcinc.org/careers/.