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Dr. who? Providing stability to recruiting and retaining health care professionals in West Virginia.

Introduction

In the United States, 66 million people live in areas, both rural and urban, that the United States government recognizes as underserved, according to the Department of Health and Human Services. The agency estimates that about 7,438 primary care physicians are needed to bridge this health care provider shortage. (5) Health care leaders predict that this scarcity will worsen dramatically in the next 15 years.

Recruitment and retention of primary care providers in rural areas has been a national concern for several years. Strategies undertaken to recruit rural physicians include initiatives that decrease educational debt and those that provide flexible practice opportunities such as salaried and part-time positions; group practice positions; and increasing communities' attractiveness and recruiting abilities.

The recruitment of health care providers to practice in West Virginia is a very complex and detailed endeavor. West Virginia is the second most rural state in the nation, and the only state that is located entirely within Appalachia. Eighty percent of West Virginia contains miles of hardwood forests, wind-swept mountains, and photo perfect valley landscapes. West Virginia covers 24,078 square miles, with the 2011-estimated population of 1,855,364 people, of which 819,193 citizens live in rural areas. (6)

In many instances, there is a lack of public transportation and other basic amenities in rural communities throughout West Virginia. As a result of these deficiencies, it is often difficult to find health care providers willing to relocate and practice in rural areas, causing many small, rural communities throughout the state to continuously recruit health care providers.

Forty-four (44) percent of the State's population resides in these rural areas, usually in communities of 2,500 or less, living at or below 200% of the Federal poverty level. Twenty-six (26) West Virginia counties are federally designated as whole- or partial-county Primary Care Health Professional Shortage Areas (HPSAs). Fifty-one (51) counties have whole- or partial-county Medically Underserved Area or Medically Underserved Population (MUA/MUP) designations. (7)

Over the past ten years, the number of people receiving emergency care annually has increased 32% from 90.3 million to 119.2 million. (8) A significant contributing factor for this increase is that more and more patients are turning to emergency departments for care because of lack of insurance, for after-hours care, or due to limited options in rural communities.

In a national survey conducted in 2011 by the American College of Emergency Physicians, 97% of Emergency Room physicians reported treating insured patients (both Medicaid and private insurance) daily for non-emergency conditions. (9) The physicians reported that individuals with Medicaid stated they were unable to find a physician who accepted Medicaid patients.

The recruitment of health care providers, specifically for rural areas, and that accept Medicaid patients, is a perplexing task. The Division of Rural Health and Recruitment (DRHR) works to improve access to care for West Virginia's underserved populations.

The DRHR manages a health care provider placement service and maintains a clearinghouse for matching providers with practice opportunities throughout the state. Typically, the DRHR has approximately 300 openings statewide for primary care physicians; sub-specialists; specialists; physician assistants; family nurse practitioners and dentists. This service is offered at no cost for the health professional.

The DRHR administers three financial incentive programs and participates in the J-1 Visa Waiver program. Each requires that the provider practice in a designated shortage area and see all patients regardless of their ability to pay; including Medicaid, Medicare, and Children's Health Insurance Program (CHIP).

The following are a list of health care provider recruitment programs that the DRHR administers and/or oversees:

* The National Health Service Corps (NHSC)

The NHSC loan repayment program extends to primary care physicians, physician assistants, nurse practitioners, certified nurse midwives, general and pediatric dentists, dental hygienists, behavioral health care providers, nursing faculty, and practicing nurses. The NHSC awards up to $60,000.00 for the initial funding in exchange for a two-year service obligation at an NHSC-approved site with HPSA status. Awards are highly competitive.

* State Loan Repayment (SLRP)

The SLRP, initiated in 1987, is a federally funded program with matching dollars paid from the State General Revenue Fund. The total budget of $300,000.00 provides loan repayment to approximately ten (10) providers (physicians, nurse practitioners, dentists, physician assistants, pharmacists) per year in return for their obligation to work in rural West Virginia. The initial award is usually for $40,000.00, requiring the recipient to work for a period of two (2) years. At the end of the initial obligation, the recipient is eligible to reapply for an additional commitment period of two (2) years.

* Recruitment & Retention Community Project (RRCP)

The RRCP, which began in 1987, mirrors the SLRP and is supported entirely by State General Revenue Funds. Unlike the SLRP, the RRCP only requires that the facility be located in a federally designated MUA/MUP. The initial award can be up to $10,000.00 for a one-year commitment, with the employer matching the award, for a total of $20,000.00. The recipient may apply for and receive this award for a total of four years.

* J-1 Visa Waiver Program

The J-1 Visa Waiver Program, initiated in 1987, offers a means of increasing the availability of physicians in areas of West Virginia designated as either a HPSA or an MUA/MUP. Communities unable to recruit a United States citizen to provide health care are allowed to recruit a foreign physician trained (residency or fellowship) in the United States. The DRHR supports and recommends assignment through the Department of State and the Appalachian Regional Commission.

** Department of State Conrad 30 Program (DOS)

The DOS allows the placement of primary care specialists and sub-specialists who are licensed to practice medicine in West Virginia, and agree to provide health care for at least forty (40) hours per week in an underserved area for a minimum of three years. The DOS allows for placement in either rural or urban areas. Ten (10) flexible slots are available each year that require the physician to serve patients that reside in a HPSA or MUA.

** Appalachian Regional Commission (ARC) J-1 Visa Waiver Requirements:

The ARC requires the physician to have completed a residency within the United States in one of the following specialties: pediatrics, family practice, obstetrics/gynecology, internal medicine, internal medicine/ pediatrics, or psychiatry. The physician must be licensed to practice medicine in West Virginia, and agree to provide clinical care forty (40) hours per week in a designated HPSA for a minimum of three years, In addition to the physician recruitment programs, DRHR administers an innovative community program created to encourage community participation in the recruitment and retention of rural providers.

* Recruitable Community Program (RCP)

The Recruitable Community Program, initiated in 1998, is a collaborative effort between the DRHR and the West Virginia University Extension Service (WVU), to promote community engagement and volunteerism and enhance a community's ability to attract providers to rural underserved areas. The program utilizes the services of the WVU First Impressions Team (FIT) and the Community Design Team (CDT). The First Impressions Team offers an objective analysis of the community from the perspective of a first time visitor, and assesses the local health care system, business opportunities and educational system, as well as accessibility to those services. The Community Design Team typically consists of health care professionals, public administrators and economic specialists who work with community members during a three-day visit, to lay a course for future development and health care provider recruitment. The result is a detailed plan of action presented during the visit and, a comprehensive written report which details CDT recommendations, and which is often used by the community during grant applications. The professional services provided by the teams yield approximately $25,000.00 worth of expertise to the selected community. The primary goal of the RCP is to educate and share best practice procedures with community stakeholders, health care centers, hospitals, and the general population in the field of recruitment and retention. The RCP has assisted eighteen (18) communities and provided feedback for community improvement and health care provider recruitment.

The DRHR continues to develop and implement new approaches to recruitment and retention with collaborative partnerships between federal and state agencies that strengthen the health care safety net, and is involved with the National Rural Health Association, the National Organization of State Offices of Rural Health, the Rural Recruitment & Retention Network (3R Net), the West Virginia Primary Care Association, and the West Virginia Rural Health Association. The Division coordinates our placement services with each of the state's medical schools, and maintains an active participation with the Recruitment & Retention Committee as led by the West Virginia Higher Education Policy Commission.

Through these various programs, the Division of Rural Health and Recruitment has placed a total of 154 NHSC providers; 52 SLRP providers; 47 RRCP providers and 94 J-Visa physicians since 2008. Currently, 80% of these providers have remained at their initial placement site upon completion of their obligation.

The Division of Rural Health & Recruitment receives a $150,000 per year grant funding from the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), Bureau of Clinician Recruitment and Services "Grants to States for Loan Repayment", for the State Loan Repayment Program. Additional funding for the State Loan Repayment Program is provided by the State Legislative Primary Care Support budget in the amount of $150,000 per year.

The National Health Service Corp (NHSC) loan repayment and scholarship programs awards are made by United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), Bureau of Clinician Recruitment and Services. During the past four years, NHSC has awarded $9.2 million dollars in loan repayment to West Virginia clinicians. Administrative costs are covered by funding through the United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), Office of Rural Health Policy, "State Offices of Rural Health Grant Program (SORH)", and State Legislative Appropriations for Primary Care Support. Funds are received by HRSA totaling $200,000 per year, with a state match of $400,000 for primary care support. The State Legislative Appropriations also provide funding the Recruitment & Retention Community Project (RRCP) in the amount of $268,000 per year.

The cost of placing these providers is $568,000 in loan repayment provided by the State and the Federal Government per year, and administrative costs also provided by the State and Federal Government.

National Health Service Corps loan repayment funding is handled directly by the Federal Government. The cost of those placements is $9.2 million dollars. Each placement receives $60,000 for a two-year commitment.

For more information about these initiatives, or if you need assistance in securing a practice opportunity in West Virginia, please contact the Division of Rural Health and Recruitment at 304-558-4382.

Objectives

This article provides recent data regarding the shortage of primary care providers nationwide and documents shortage areas in West Virginia. Information is provided regarding healthcare provider recruitment and retention initiatives that are active in West Virginia. These programs increase access to healthcare in underserved areas of West Virginia, especially in rural areas.

Melissa Wheeler

Director, West Virginia Division of Rural Health & Recruitment

Martha Endres

National Health Service Corps Ambassador, West Virginia Division of Rural Health & Recruitment

Karen Pauley

Loan and Grant Coordinator, West Virginia Division of Rural Health & Recruitment

Monique Mahone

J-1 Visa Waiver Coordinator, West Virginia Division of Rural Health & Recruitment

Nancy Melton

Recruitable Community Coordinator, West Virginia Division of Rural Health & Recruitment

Corresponding author: Melissa Wheeler, Director, Div. of Rural Health and Recruitment, 350 Capitol St., Rm 515, Charleston, WV 25301-3716; Melissa.S.Wheeler@wv.gov.
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Article Details
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Title Annotation:Special Informational Article
Author:Wheeler, Melissa; Endres, Martha; Pauley, Karen; Mahone, Monique; Melton, Nancy
Publication:West Virginia Medical Journal
Article Type:Report
Geographic Code:1U5WV
Date:Jul 1, 2013
Words:1939
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