Cost-Benefit of Rural Programs
FINANCING RURAL PROGRAMS
Rural areas that are Medically Underserved (MUA) can have Rural Health Clinics, Community Health Centers, or Federally Qualified Health Centers. Rural Health Clinics and FQHCs involve capitated reimbursement that often exceeds RBRVS rates. CHCs receive grants for operations and indigent care, have a sliding scale, and a community board. Special grants to CHCs or rural hospitals can finance graduate medical education, in addition to the traditional Medicare GME sources.
Rural medical education can be less costly than the traditional urban-based programs. The Jefferson PSAP program ran for years will little funding. Spokane's Rural Training Track costs $60,000 per resident per year compared with their usual resident cost of $120,000. RPAP students may generate $20,000 - $70,000 in increased billings for their preceptor's practice. This more than offsets the $9000 each preceptor pays to support each student.
Those developing rural programs should be wary as there is a danger when "using" the desperation of rural communities (for physicians) to finance rural programs. The expectations of the programs, the communities, and the state must be realistic. Faculty should attempt, whenever possible, to accommodate the needs of communities. This means longer rotations with less need for orientation, consistent supplies of residents so that communities can gear up with staff, etc.
Setting up new programs and hiring extra faculty and staff can make startup of new programs costly. Travel and housing costs for students and faculty, faculty development, site development, and other specialized training costs can eat into ever tightening budgets. Rural practice revenues are not as lucrative as the usual medical school practice base; however, rural programs can be very valuable in funneling patients into regional medical centers and financing can be negotiated from this strength. One way of looking at rural programs is to examine the financial impact on a site. The addition of one or two residents or a faculty line can add $300,000 and more than ten jobs to the local economy.
The investment cost is high in terms of time, dollars, and the stress of effecting change, but the need for rural physicians is higher. Rural communities often foot the bill for many rural medical education programs. Most rural preceptors across the nation volunteer their time for teaching and in some cases housing and living costs as well. Rural communities are realizing the value of long term recruiting as these few thousand dollars compared to the $35,000 or more expended in recruiting a single physician.
The states often balk at supporting rural medical education. This is short-sighted. Even programs such as the RPAP program in Minnesota, costing $800,000 of state tax dollars each year, reaps major dividends when the graduates choose rural practice with an economic impact of $360,000 per year and 17 jobs. Of the 800 RPAP graduates, the 60 who returned to the rural community of the preceptorship alone paid for the program. The other 300 plus rural RPAP graduates were the icing on the cake.
RPAP - The Rural Physician Associate Program in Minnesota - economic analysis demonstrated that ...
The 22 million dollars invested in RPAP by the state since 1971 has resulted in an economic impact of one billion dollars and the addition of 5000 jobs for Greater Minnesota.
With additional physicians also comes improved hospital finance and services, and better opportunities for job recruitment for the area