written 11/96
The state continues to have shortages of physician workforce. Psychiatry, rural physicians, and rural general surgeons lead the list. With more attention directed in these areas, it is not a time to sit back and wait for developments. Just a few items of note:
In recent years the legislature has made inquiries regarding what UNMC is doing to meet the state’s need for workforce. The legislature has also shown their willingness to act in this area by requesting reports from UNMC, approving legislation assisting Clarkson and Creighton residency training, and funding loan programs.
Recent reports in the media have noted shortages and they have interviewed UNMC and state health department personnel regarding the steps that UNMC and the state have taken. There may be more stories coming in this area.
It is clear that UNMC is in some degree of competition for the public and practitioner eye. The recent changes by Creighton to allow preceptors to have CME credit in exchange for their teaching will not be their only response that will attract the state’s attention. We can meet this, but Creighton grabbed the initiative that could have been ours.
A final item that will certainly be a cause of some controversy is recent UNMC initiatives in rural Nebraska. Some hospital and physician representatives have asked if this signals a change from the previous neutrality of the institution.
It is not hard to predict that increasingly UNMC will be called to account for any funding. If there is an increasing perception that we are not doing all that we can to meet the state’s needs, this may be difficult. The question becomes, therefore, do we want UNMC to wait for proposals to come from outside of UNMC, or from inside?
There are some opportunities available to us with minimal investment and some significant return. These proposals would act to increase the workforce within the state, retain Nebraska-trained students within the state, and improve the image of UNMC across the state with health care providers.
The Annual Recruitment Fair
One proposal that could assist UNMC in the area of meeting state needs is the Annual Rural Recruitment Fair. This has been a low key item for UNMC for many years. Although appreciated by rural communities, it has received little other attention. The recruitment fair represents much of what we have to offer: workforce to meet the state’s needs.
For those who have not attended in recent years, the fair has been revised. It has changed from a fun event for students with prizes and drawings, to a more serious recruitment effort. The fair takes advantage of teaching days for physician assistants and family practice residents to boost attendance. The fair begins with breakfast and morning sessions that include both family practice residents and community members so that they can meet each other and begin to interact even before the booths open. The 11:30 to 1:30 PM slot is reserved for booth interactions between communities, residents, physician assistants, nurse practitioners, and their spouses. Students come in the afternoon.
Despite these changes that have resulted in increased attendance by those most in demand by the communities, the recruitment effort of the fair still faces barriers:
The lack of floor space for adequate interactions between communities and recruits.
The low attendance of spouses, critical to a serious recruitment effort
The low attendance of rural practitioners, the future colleagues of those being recruited.
Although a few Lincoln family practice residents have attended in recent years, more could come and more Clarkson and Creighton family practice residents would come to more "neutral" territory where they could bring their spouses.
Efforts to call, phone, and mail information to physicians coupled with CME credit vouchers have increased physician attendance from 1 in 1995 to 5 in 1996. To address these needs and continue to keep the fair a more serious courtship event, the fair will move to Kearney in conjunction with the Nebraska Rural Health Association meeting in September of 1997. The Kearney area has more booth space, a location more favorable for many rural communities especially those in most need of practitioners, and the Rural Health Association meeting attracts the interest of many rural hospital administrators, practitioners, and community members. UNMC already supports this event in a major way with funding for the conference, support of speakers, and the contributions of rural faculty and staff, but it could do more.
There are enough resources to do the fair. It would be an unprecedented opportunity for 25-30 rural communities to interact with nearly the entire state supply of potential rural primary care practitioners for the next 2-3 years. UNMC has choices regarding this event. It can continue to support it or it can act to enhance the fair.
Recommendations:
UNMC should continue to support this fair at the continued level of $3000. Previously this came from hospital funds to cover food and administrative costs (for continuing education’s superb work in this area). UNMC should continue this level of support, but the change in location presents a change in allocation of funds. Basically the funds would pay for the travel of trainees (primary care residents, physician assistant students, nurse practitioner students, rural interested medical students, and their spouses) to Kearney. The Nebraska Rural Health Association has agreed to pay for registration and hotel for the day of the recruitment fair. The benefit of this event is more serious recruitment. The Kearney site already has many of the personnel that have attended past recruitment fairs. The location is more likely to attract the rural practitioners and the spouses of the trainees that are so crucial to considering and choosing rural practice. The people at the conference will remind trainees of why they were interested in rural practice in the first place and it will help others to develop a significant interest. The choice of rural practice is a courtship and the major players must be in place for serious interactions to develop.
The recruitment fair should have the full support of all UNMC training directors and UNMC administrators. Verbal support for this effort has already been obtained from most primary care training directors. They have long been aware of the need for improved recruitment. This year training program support of the fair should include one day’s educational time away from rotations so that interested trainees could attend this training seminar.
Extra funds could enhance the potential of the fair. Each year we export various students to primary care residencies in locations outside of the state. Many of these have an interest in rural practice and families back in Nebraska. Many of these will choose rural practice in other states without some reminders or incentives. This recruitment fair is a good reminder about these areas as well as the state’s loan repayment and other practice incentives.UNMC could certainly benefit from sponsoring 2 or 3 medical school graduates a year to return to Nebraska to the recruitment fair.
A critical need for the recruitment fair is to attract rural practitioners to participate in recruitment in booths, at lunch, and at dinner. UNMC could sponsor a weekend of locum tenens as an award for physicians who attend the fair and assist their communities with recruiting. This would be matched by a similar award from the state’s locum tenens program.Time off is a most critical need for rural physicians and this would be very supportive of their efforts.It would also be a political plus to supplement the efforts of state committees active in rural health support efforts.
UNMC could also offer $100 in CME credits to physicians who did not win the locums prizes, but who attended the booths and recruited for their communities.
The result would be more visibility of UNMC as a supporter of rural physicians and rural health efforts, more rural physician attendance, improved career training of students and residents, and more serious recruitment. Potential future benefits include more UNMC graduates staying in the state. The rural association meeting also needs more physician participation. Physicians and communities attending the fair would also learn much about recruitment. They would learn from experts at the fair as well as from the attendees themselves. This interaction is a key to improving their recruitment techniques. Improved recruitment efforts are a critical need for the state.
Optimal public relations opportunities exist at the fair.
Usually the governor attends the opening of the rural health association meeting and this is covered by the local and state media. This appearance would occur at the same time that the recruitment fair was being held.
The chancellor would also have an opportunity to meet rural folks at their booths and could participate in the drawing for the locums coverage.
Both Kearney and Grand Island Rural Training Track locations are near enough for visits by officials and the media. This is an effective and successful workforce intervention and also a source of rural workforce as well.
The governor could proclaim a rural primary care day. Indiana has a similar day.
Currently representatives of the training programs meet once a month to administrate another rural program. We then move to discussions regarding the recruitment fair. We would like to continue these planning meetings and add representatives from the chancellor’s office and public relations. We hope that you will agree that this is an opportunity that UNMC cannot afford to pass up.