“Exploring Options:

Recruitment & Retention

of the primary care
workforce issue?”
Gerry D. Stover, MS
Executive Vice President
West Virginia Academy of Family
Physicians
304.562.4433
Family Medicine
• Patients with a family physician as source
of care…
– Receive more preventive services
– Use emergency rooms less often
– Spend less on care
• $51.15 versus $116.41 per visit
• $340 versus $506 per month

Green L, Fryer. “The Ecology of Medical Care.” The New England

Journal of Medicine 344 (2001): 2021-5.
 US Primary Care Health Professional Shortage Areas
By County (2006)

>750 vacancies for PCPs at Community Health Centers (2004)

Legend
A Full PC HPSA (n=1381, 44.0%)
A Partial PC HPSA (n=667, 21.2%)
Not A PC HPSA (n=1093, 34.8%)

Data Source: HRSA (08/03/2006) Prepared by The Robert Graham Center

 The Widening Physician Payment Gap
$450,000 Diagnostic Radiology
$400,000 Orthopedic
Surgery
$350,000
Annual Income

$300,000

$250,000 Primary
Care
$200,000

$150,000

$100,000 Family Medicine

$50,000

$0Graham Center
Source: Robert
89

99
79

81

83

85

87

91

93

95

97

01

03
 Percent of US Medical School Graduates Working at
a Community Health Center According to Whether
School Was Title VII Grant Funded

Percent of Physicians Working in CHCs

(2001-2003)

3.0%
3.0%

1.9%
2.0%

1.0%

0.0%
Title VII Graduates Non Title VII Graduates

Source: D Rittenhouse et al, Ann Fam Med, 2008

 Incentivizing Primary Care
Through the National Health
Service Corps
• 6000 sites seeking NHSC placements in 2008

• In 2008:
– 950 applicants for 76 NHSC scholarship awards
– 2713 applicants for 867 NHSC loan repayment awards

• Good evidence that NHSC participants tend to remain in

practice in underserved areas, even if not at initial service site

• Legislative proposals under consideration:

– Fund at least a doubling of NHSC scholarships and loan repayment
positions (from current $155M to >$300M)

Source: Office of NHSC Director

 The Rural Health Workforce Pipeline
Med School Experiences:
Student Selection: Rural mentors, clinical rotations,
Rural origin, career interest incentives to med schools

Residency Training:
Debt management,
Rural Tracks,
OB/procedural training,
Practice Support: Etc.
Loans, reimbursement, peer support,
family issues, rural economy

Rabinowitz,1998 NEJM. LONG-TERM SOLUTION TO

Rosenblatt et al,1992 JAMA.
RURAL MEDICAL WORKFORCE
MALDISTRIBUTION
 Residency Training (Rural): “Etc”
Factors found to encourage rural practice among residency graduates:

Defined Rural Mission: [11.1]

Required rural ambulatory clinic [6.7]
Program Director [6.5]
OB Track Available [6.0]
Rural Track Available [5.1]

R. Bowman
U. of Nebraska
 Sufficient State FP
Workforce Depends on:

Sufficient
Recruitment Appropriate Continued
Training Retention

A practical approach to workforce: The Three-Legged Stool

Amy L. McGaha, MD, Assistant Division Director, AAFP
 Rural Graduate Medical
Education: Value

Graduates tend to practice in proximity

to their residency sites (>70%). This
has held true for
rural residency grads.
 Chancellor’s WVA Physician Workforce Study

 Over past 25 years, the number of WVA physicians

who are WVA medical school grads increased by
360%.
 WVA retains 40% of its medical school graduates in
state practice, which is approximately equal to the
national retention rate.
 However, although the number of WVA medical school
graduates has increased, the % who practice in state
has remained almost flat at 40%.
 Chancellor’s WVA Physician Workforce Study

 WVA ranks 38th nationally in retention of physicians who complete

allopathic residency programs in state, (38% WVA retention rate vs.
50% national retention rate).

 The capacity of the state’s allopathic residency programs has

remained essentially flat over the past decade.

 West Virginia’s allopathic and osteopathic residency fill rates are

significantly below national average fill rates.

 The number of WVA med. school grads completing West Virginia

primary care residencies has declined 65% over the past 4 years,
despite the availability of positions in state residency programs.
 Chancellor’s WVA Physician Workforce Study

 The number of WVA M.D. medical school grads who

subsequently practice primary care in the state has
increased.

 However, the percent who are in primary care practice

has declined from approx. 55% in 1981 to approx.
45% in 2006.

 The percent practicing primary care in rural areas of

WVA has also declined from approx. 20% in 1981 to
approx. 9% in 2006.
“Medical educators and policy makers can
have the greatest impact on the supply
and retention of rural primary care
physicians by designing programs that
increase the number of qualified medical
school matriculants with background and
career plans that are independently
related to career goals.”

Rabinowitz,2001 JAMA