Northern Inyo Healthcare District Board of Directors were updated on physician recruitment efforts during the board’s recent monthly meeting. Setting the discussion stage, Chief Executive Officer Kevin S. Flanigan, MD MBA, stood in the shoes of many current and former area leaders, frustrated by unsuccessful specialty recruitment efforts.
National polls and surveys predict large shortfalls in physicians by 2030. With only seven percent of all current graduating physicians willing to consider living and working in rural America, the challenge for NIHD and all similar healthcare facilities is more significant than most people want to believe.
“We are competing with large swaths of America, trying to bring in physicians to live and work in a very rural and isolated area,” Dr. Flanigan said. “It’s not an easy task.”
Consistently recruiting for one physician or another since Dr. Flanigan’s 2015 arrival, NIHD has turned to temporary physicians to preserve patient access while recruitment continues. Every once a while, this approach results in an unexpected, one-time solution.
NIHD’s new pediatrician is an example. “Following three years of recruitment effort, she was a temporary replacement, brought in to provide coverage and relief for Dr. (Charlotte) Helvie,” Dr. Flanigan explained. “It turns out that she loves what she’s doing, loves where she is living, and has agreed to sign on. Our commitment to preserve access for pediatric patients resulted in a win, but that doesn’t always happen.”
Other recruitment efforts can be a struggle. The most obvious case is the effort to fill a vacancy left following the retirement of Internist Dr. James Engelsby more than a year ago. Three temporary physicians rotated through the Internal Medicine office to maintain access for Dr. Engelsby’s former patients, and while recruitment continues, there is no immediate solution in sight.
Using both internal efforts and professional recruitment firms, Dr. Flanigan and NIHD leadership remain frustrated. “Some of it stems from our naiveté thinking that we could do this internally, and some of it is realizing we are dealing with a national problem that’s projected only to increase,” Dr. Flanigan told the board. “The recruiting firm was able to identify 70 possible connections for us, but once screened, only one person was willing to interview. One.”
Dr. Flanigan defended the use of a national recruitment firm, despite the results. Such firms have larger staffs capable of connecting with more professionals across the country. Their physician databases are unique and unavailable without contracting for service.
So what does that mean for the future?
Dr. Flanigan assured the board that recruitment efforts would continue, including more outside-of-the-box approaches, but that comes with little comfort for those left without a primary care provider. Data shows Dr. Engelsby handled more than 3,800 clinical visits per year. Since his departure, NIHD has seen a reduction in visits by nearly 2000in the course of the last year. The Rural Health Clinic, Toiyabe Indian Health Project and remaining private providers in the region absorbed some of the patients.
Still, NIHD has identified approximately 450 Dr. Engelsby’s patients who will need to establish care with a new provider. Dr. Flanigan acknowledged there are very few places they can turn, and there are other physicians who will retire at some point in the next decade.
NIHD Board members encouraged Dr. Flanigan to pursue regional partnerships with the City of Bishop, County of Inyo, and other employers faced with the same challenges, and to explore possible avenues should the proposed air service expansion at Bishop Airport gain traction.
“It is a very difficult issue, one that we share with other employers here,” said board member Jean Turner. “I do hope that the new airport plans will help some, but at the end of the day, it’s still very much a niche lifestyle that’s not for everybody. It’s always going to be an uphill battle for all of us here.”
Dr. Flanigan noted other complicating factors, such as jobs for spouses and housing availability. “You have doctors with partners, who in many instances are professionals as well, so you have to have an economy that allows them to work,” he stressed. “We are also looking for people who accept a team-based approach to healthcare delivery. We want people who will partner with all the services we provide, so patients get the best possible outcome and have the most number of avenues to achieve that outcome.”
Drs. Stacey Brown and Robbin Cromer-Tyler also encouraged NIHD leadership to look to the next generation by developing a rural medicine rotation for medical students. “We need to catch them early and begin building relationships,” Dr. Brown said. “If we do, maybe they will see what rural health care can offer.”