Rural Hospitals Face Doctor ShortagesRural Hospitals Face Increasing Docto

[Judi Lynn]

Rural Hospitals Face Doctor ShortagesRural Hospitals Face Increasing Doctor, Nurse Shortage, Especially in Arizona
The Associated Press

PHOENIX Dec 27, 2005 — Health care experts say physician recruitment and retention is a perennial problem in Arizona, but the stakes are much higher in rural areas as the state's population soars.

According to the Arizona Hospital and Healthcare Association, Arizona ranks among the states with the lowest number of working nurses and physicians per capita. Even more troubling is that according to the National Rural Health Association, one out of 10 of the nation's doctors practice in rural areas, where one-fourth of the nation's population lives.

"We have people out in the middle of nowhere come here and are on death's doorstep," said Jason Taylor, a medical resident at Kingman Regional Medical Center.

One of the challenges residents and physicians face in rural health care is the lack of specialists, placing the burden on rural doctors to fill in the gaps of knowledge and develop an eye for the subtle nature of life-threatening ailments.
(snip/...)

http://abcnews.go.com/US/wireStory?id=1444824

[WildClarySage]

1. But nobody cares when those underserved rural populations

haven't got an ob/gyn who will provide abortions. Go fig.

[cantstandbush]

19. Maybe they can ask Castro for some help? n/t

[jody]

2. Under NAFTA and CAFTA, can't nurses from Mexico, Costa Rica,

Dominican Republic, El Salvador, Guatemala, Honduras and Nicaragua come to Arizona to practice?

Apparently MDs are limited to teaching or research suggesting the AMA has a strong lobby.

NAFTA Professional Job Series List
MEDICAL/ALLIED PROFESSIONALS
Dentist
Dietitian
Medical Laboratory Technologist
Nutritionist
Occupational Therapist
Pharmacist
Physician (teaching or research only)
Physiotherapist/Physical Therapist
Psychologist
Recreational Therapist
Registered Nurse
Veterinarian

[rainbow4321]

21. Nurses are being brought into the US

for the hospitals to use as cheap labor.
One of the recent bills passed had a blurb in there that allowed 10's of thousands of nurses to be allowed in..it was sandwiched in a defense/war funding bill. Sounds wonderful til you realize it is equiv to outsourcing high tech jobs--just being done in reverse.
US nurses make $10-$15 more than the imported nurses, so the hospitals turn to the cheap help. There is one Asian nurse who was brought in to the US by my hospital, took a job for $10 less per hr than the American nurses but was thrilled that the hospital bought her bed linen and towels...plus her husband was getting to be a stay at home dad.
Anyone ask Frist lately how many cheap labor nurses his family's company has imported? Plus you have groups/lobbyists like the AHA who represent hospitals wanting to save $$ even though it is nurses who keep their facilities up and running.

[jody]

22. Thanks for the info. Do you have a source for stats re problem size?

:hi:

[rainbow4321]

34. Here are some articles

Couldn't find any straight out percentages but here is some info on how the hospitals are bringing in help from other countries..the last section has the info about the 50,000 visas for foreign nurses that the feds put in the military and tsunami bill this year. I'm thinking actual stats/percentages are probably well hidden in the hospitals' executives'
desk/office/computer.


http://www.bizjournals.com/bizfinance/2005/04/29/

Some countries export oil, others steel or manufactured goods. But for some nations, nurses have become an important export to fill under-staffed hospitals across the United States.

That trend is creating opportunities for HCCA International, a Nashville-based nurse staffing firm. Founded 30 years ago as HCA Inc.'s international operations, the company was spun off in 1990 and began operating as a staffing firm that provided nurses to foreign countries.

The Nashville company has recruited 155 nurses from 10 countries, with another 400 to 500 nurses in various stages of the recruitment and immigration process. Nurses are being drawn from India, the Philippines, the United Kingdom and the Middle East. In most of these countries, English is used heavily, so the transition isn't very difficult. Soon, HCCA plans to recruit workers from South Korea, China and Singapore. Officials at the privately held company won't disclose revenue.

Mark Dixon, president of health care staffing firm USResources, says federal statistics show a nurse staffing deficit hitting in 2008, but he's already seeing the impact today. HCCA officials believe the shortage could hit 1 million nurses over the next 15 years.


Their recruitment webpage: http://www.hccaintl.com/

--------------
(note:All About Stafffing is owned by HCA)

http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=4744

“We found we were experiencing the same nursing shortage as the hospitals, whose needs were tripling and quadrupling year after year,” says Liz Tonkin, RN, BSN, administrator for All About Staffing. “We simply couldn’t supply the needed resources. So now we’re recruiting all over the world.” Efforts are under way in Britain, China, Hong Kong, India, Ireland, Malaysia, Pakistan, the Philippines, Scotland, Singapore, and several Caribbean islands.


Recruiting generates tremendous excitement overseas. For example, says Tonkin, an advertising campaign in Karachi, Pakistan, drew 1,200 licensed nurses during two days. “Some even followed the recruiters back to the hotels hoping for an interview on the spot,” she says. “Their motivation to attain a better life inspires awe. It’s a good feeling helping them come to America.”

Looking beyond US borders seems a short-term approach to filling vacancies — the jury is out on whether recruiting foreign nurses should become part of the long-term fix. Still, Tonkin feels that her agency’s method of one-stop shopping to fill HCA vacancies — streamlining immigration and licensure, managing travel, and arranging for housing and training — is a win-win for everyone.

Between January 2000 and June 2001, says Tonkin, her company, which is owned by HCA, brought 99 foreign nurses here to work at several of the hospital chain’s facilities. “Is that a lot?” Tonkin wonders aloud. “No, but word of mouth has been getting out about our success in helping foreign nurses come to America, and we’re beginning to see our recruiting efforts pay off. More and more are coming in every month.”

----------
(only cache version gotten, original no longer works)

http://64.233.167.104/search?q=cache:WFI2qH552x0J:msnbc.msn.com/id/6634291/+HCA+%22foreign+nurses%22&hl=en

---------------------------

http://modernhealthcare.com/storyPreview.cms?newsId=3811&archive=N

Additional visas to ease wait for some foreign nurses
Story posted May 11, 2005 12:30 PM EDT
Up to 50,000 additional visas for registered nurses and physical therapists are expected to ease a lengthy wait for nurses from China, India and the Philippines. The visas were passed by the Senate Tuesday as part of a military and tsunami aid spending bill, which cleared the House last week. The State Department sharply restricted visa approvals for nurses from China, India and the Philippines in January to prevent the countries from exceeding an annual.....

[area51]

27. "outsourcing high tech jobs--just being done in reverse."

I think it's called "inshoring". I met several nurses from other countries when my dad was in the hosp. I'm not saying they're not qualified, but I can't help but feel that they were hired for the same reason factory jobs are offshored & tech is offshored -- b/c our govt. lets the powers that be get away w/it.

[MaineDem]

3. And the cuts just made in the budget will hurt even more

Cuts to Medicare and Medicaid will burden rural health centers with unreimbursable costs further hurting the rural poor - and middle classes.

I know firsthand about the lack of specialists in rural areas. I drive more than 2 hours to see qualified doctors.

This is a side issue but this is one reason why the 24-hour waiting period for abortions is a very bad idea. Why should a woman have to make that trip twice?

[Mend]

4. Arizona requires a special test instead of honoring other

state medical licenses.....a doctor just can't easily apply and get a license as in many other states. I am not so sure they really want more doctors.

[Bridget Burke]

5. Some in the Medical Industry DO want to limit the number of doctors.

Why have so many doctors that some would be willing to take rural positions? Or not be able to specialize as they please?

Certification laws can vary from state to state. Of course, we need to ensure that MD's have the education & (for older ones) the experience. But some of the laws are needlessly complex.

"The Medical Industry" does not include most doctors who actually care for patients. But it does include HMO's, insurance companies & MD's who've moved to executive positions.

How about helping finance medical school for those willing to take less-glamourous postings? I'm sure many young doctors would be glad to begin their careers without crushing debt.

[hayu_lol]

6. Picking up the debt load of young MDs has been tried...

Many put in some time in a rural area...and then as quickly as possible take off for the more lucrative cities/choicer living areas.

How do you hold 'em down on the farm when they've seen gay Paree?

[DrBloodmoney]

7. As a young physician

I can tell you that at my medical school, CYA medicine is taught from day One. It is also a very expensive medical school. Zero of the top 25%, and only a couple of the in the top 50% of the class exited medical school to enter residency tracks that would make them 'primary care physicians.' We all left to enter specialty fields (where the money is). That left the bottom 50% of the class to pursue the primary care route.

There are federal programs to put physicians in rural communities by subsidizing their education. My limited experience with the recruitment for these programs suggests that it would be difficult to recruit young medical students to this because you force them to commit to a field of study prior to entering medical school (most of us changed our minds about specialties numerous times during medical school).

http://www.federalgrantswire.com/national_health_service_corps_scholarship_program.html

Quite simply, it is a pipe-dream to have specialty physicians in every small town or community. There are not enough cases for those physicians to maintain their level of training or their interest in a particular specialty. They have to be at major medical facilities or in cities with major medical facilities with high numbers of cases.

[SharonAnn]

24. Doctors want to limit the number of medical school slots and thus

the number of doctors.

I'm from a very medical family and have seen the protectionism first hand for many, many years.

This, and the protection of incompetent doctors.

[davsand]

8. They need to recruit locally, IMO.

I have no doubt that rural areas are under-served, just as I have no doubt that most people from an urban area would be less than thrilled to transplant to some rural area. It really DOEs take a certain type of person to appreciate life outside a metro area.

Seems to me that these areas where they are serious about getting new Docs, should think about recruiting from the college grads from those same rural areas.

If they could get Med school paid for and be guaranteed a home to live in (shoot--there's an awful lot of property that goes up on foreclosure these days--why can't THAT be fixed up and deeded over to a new Doc?) it might be more attractive to sign an agreement that they'll practice there for a period of years.

The biggest worry I could see to this is that the potential Docs might wash out in Med School. I have no idea what the drop out rate is in that area of study--but I can't imagine it'd be terribly high if the cost of the education was covered and the kids were screened based on academic performance.

If they REALLY wanted to make it easy, the area recruiting could even offer a stipend for the Med Students so they wouldn't have to worry about making ends meet.

A free Medical Degree, free title to property of your own, and a recession proof job waiting for you--that might not sound like too bad of a deal to somebody that wants the education and has already lived in a rural area before.



Laura

[bmbmd]

9. I have practiced medicine in undrserved areas for a large chunk

of my career. I don't have time to enumerate the problems with rural medicine-Lets just say I left fatigued, burned out, uninspired, bitter, disappointed, financially disadvantaged over my classmates who chose the city, and very near to leaving medicine altogether. Now, in a more urban setting, at fifty years old, I am happier than I've ever been. I'm a better doctor, a better husband, a better father, and a better person. I do not regret the years I spent in the country-I have wonderful memories and wonderful friends. I think I made a difference. I just am not man enough to continue that abuse.

I believe the solution is in physician extenders.

[MaineDem]

10. We're getting the opposite end of the spectrum

We seem to be getting docs who are ending their careers. They seem ready to slow down and become good old country doctors. The most recent spent his career as an ER doc. Now that his family has grown he wants to spend some time in a quieter environment.

I'm sorry you had such a porr experience. I know that your presence was important to some, if not all, of those patients you served.

We're also seeing an influx of PAs and NPs. I suppose if that's just the first point of contact and they're ready and able to refer to a specialist (considering the specialists are at least an hour away) it's better than nothing.

[davsand]

13. Abuse? Were you abused by the local system?

Were you unhappy with the local system--the hospitals other Docs and insurers or was it the long hours??? The patients themselves??

I'd love to hear more!


Laura

[bmbmd]

14. I am on call three nights a month now.

Every ninth weekend. I once made after hours ER visits for one-hundred eighty consecutive nights in west Texas. I ran ventilators, put in pacemakers, and operated a dilaysis unit in northern Montana-none of which I am qualified to do. I felt like I was exposing my patients to danger, and myself to litigation. I missed my colleagues. It is harder to stay current in the rural areas because of lack of interaction with colleagues. After four years of college, four years of med school, and three years of residency in big cities, I missed the amenities of larger communities. I missed the Dallas Cowboys, I missed Troy Duncan, the channel eight weather guy. I worked ninety hours a week, I collected about fifty per cent of my billing. I hated the board of directors of the hospitals-they had not a clue about hospital finance.
I was second-guessed by people who thought there must be something wrong with you if you worked in a remote location. All in all, I found it dreary, discouraging work which was not intellectually stimulating, emotionally fulfilling, or professionally satisfying.

[MaineDem]

15. I hope I misunderstood

But it's disheartening to see that a freakin' football team is worth more than rural patients!

:eyes:

[Mend]

17. I don't watch football. They tried once to recruit me to a rural

area in the south where I would be the only doctor in my specialty for thousands of patients. They told me I would be on call every single night. I asked about vacations and they said I would have to carry my cell phone. Did I mention that the money stunk? I did that kind of work when I was in training for years but once in practice we have a right to a life and our families need us also. I stayed here where I earn three times as much helping people in all income levels and rotate call like a normal doctor and now I expect to work into my seventies.

[bmbmd]

18. Ridiculous reply.

Rural medicine is hard and unrewarding on a number of levels. I had the opportunity to improve my practice, my income, and my quality of life by moving to an urban area. As one who has walked the walk, I'm here to tell you that rural medicine is almost un-doable.

[davsand]

31. Thank you for sharing a bit of your story.

It sounds like you were not happy, and I don't blame you AT ALL for making a change to something that you liked better. If you are miserable in your job it colors EVERY aspect of your life (especially when you work the kind of hours that Docs do!)

I guess it stands to reason that not everyone is gonna be practicing at Mayo Clinic or Johns Hopkins or (insert the name of a hospital with some prestige here,) but I had never considered that you'd be viewed as less skilled by your peers for choosing to work in a medically under-served area. I understand that snobbery exists, but I do find it terribly sad, however.

I seriously do think, however, that maybe your misery was due, in part, to the fact that you were accustomed to life in a more metropolitan area. Adjusting to life in a rural area can be pretty tough on anybody even IF they are not facing professional issues along with it. Frankly, I've wondered about the impact of it on the Docs' families along with the Docs.

To be honest, I think hospital CEOs are pretty much of the same ilk every place, but it stands to reason that they would also be subjected to some very real attitude about working some place that wasn't considered "top notch" just like you were as a Doc. It doesn't excuse them, but I do actually feel a tiny bit more sympathetic to them after this exchange (trust me--this minor attitude change comes really hard for me because I typically loathe the hospital guys.)

Collections for Docs seem to be a really big issue, and I seriously have no idea how to even discuss that with you. My guess is that you may have been in an area with some very real poverty issues. I don't find you to be unreasonable to expect to get paid for your services, however.

I suppose it is possible that people were just screwing you over, but everything I've ever seen on the issue of med collections would indicate that people DO want to pay their bills but they get intimidated by the size of them. Depending on your area of practice that could be a very real issue, I guess. (You have to admit that getting a bill from a Doc that is for more than you've earned in one or two YEARS could be pretty overwhelming.)

Given the need for Continuing Medical Ed and the costs of malpractice insurance, the old "Country Docs" are a thing of the past. I have to wonder if the day will come when the people who live in rural areas will be forced to teleconference with a Doc rather than see one in person...

bmbmd, thanks for answering. I appreciate it.



Laura

[bleedingheart]

33. when I graduated from engineering school the chairman of our dept

told us that we should look very carefully at all offers we got regarding employment. "To go for more money to a location without much to offer is worse than working for less in a better place".

He was right.

I took a well paying job in rural/depressed area of Ohio and a year and a half later I was out of there and working in a more urban area. I had been undermined by colleagues, projects were underfunded and the company I worked for was breaking all sorts of laws and even poisoning the environment around them...it was awful and I wanted nothing to do with them.

So the same issues apply in many other jobs as well....

However the solution for rural areas in my opinion would be to recruit physicians with families who want the "rural" life, and then offer them free housing and perhaps pay off their remaining medical school debt as well as a decent salary...and then have them sign a x -year contract...

[area51]

28. "physician extenders"

What are physician extenders?

[zalinda]

11. Isn't now when outsourcing should really take place

If you have a rural doctor, he should be hooked up to a high speed internet. He should have access to specialists who can look at a problem through a video camera and guide the doc in what he should feel for, or look for. It could be a specialized hospital, where the vast majority of it's funding comes from the government, to support rural doctors with specialist advice.

I understand that this may be just a hollywood hype that it is doable, and maybe expensive, but it's something that clearly should be looked into.

zalinda

[DrBloodmoney]

12. It's all money...

... sure some of those things are technologically feasible. They were 5 years ago. But it's still cheaper to have patients drive 4 hours to the nearest major medical center to have specialized treatment than it is to provide that type of infrastructure.

[Gregorian]

16. It is. In a different way.

I've been watching this phenomenon. For some reason, the doctors have been leaving the rural areas where I've lived. Recently I tried to get a doctor, and was told it would take months because so many had left. Then I called back and found that the new doctor was some kid who had just arrived from Bombay. It was weird. I don't know if he was a good doctor or not. But he sure seemed half assed to me. And I've worked in hospitals for many years. He was a rookie.

Bottom line, in my opinion, is that this is the ratcheting down of doctor salaries. They're taking in the doctors who will accept lower pay.

I also sold a property to a doctor who had just been laid off. The hospital was ridding itself of all highly paid staff, and bringing in the lower wage doctors.

edit- By the way, I really like your idea. It's perfect. If we just put the people first, then we will have all of these capabilities. (What we need is to rid ourselves of politicians.)

[FlemingsGhost]

20. Doctors? Surely, Jesus can heal them.

There never seems to be shortages of churches in rural areas. Jesus must be "on call" a lot.

[NNguyenMD]

23. J-1 Visas are a back door route for foreign doctors to practice in the US

they require that once these forgeign physicians complete their training in the US, they're indebted to commit I believe 1 or 2 years practicing in a rural community that their program chooses for them. I say this without any judgement of opinion of these programs. I'm currently a medical student and am learning immensely from many of these doctors who are graduates from India, Pakistan, Lebanon, the middle east and Phillipines. But thats one route I know the government is taking to brining in more rural doctors. Also mind you, many of these foreign physicians are just as good, if not better than US graduates at physical exam and beside skill. In the US, we take for granted the availiability of CT scanners, MRIs, and pathology labs that do our bidding, these foreign physicans are very good at extrapolating data from physical exam and history.

[classics]

25. Who cares.

They only serve the rich anyway.

Like I could get a doctor to look up from his crossword puzzle to clamp off a gusing artery without a insurance card. Pfft.

[MaineDem]

26. That's certainly not true in my area

We're served by a rural health center and they see EVERYONE who walks through the door. Medicare and mMdicaid covers a lot of it but I'm not sure how much things will change with the recent cuts.

But your statement is blatantly incorrect as a blanket fact. My doctor - a she by the way - even makes house calls when needed.

I have nothing but praise for the health care professionals who serve rural Maine. I just wish there were more of them.

[davsand]

32. Amen to that, MaineDem!!! There are a lot of Docs who care!

There are a few uncaring assholes out there, but far more common are the Docs who DO help out whenever they can. There are a lot of unsung heroes out there who do charity work and they never get any recognition for it.

I really hold the Docs far less accountable for the current problems in our medical system than I do the insurance companies and the hospital policy wonks.



Laura

[SoCalDem]

29. Communities used to pay for the educations of young people

in exchange for their medical services for a specified amount of time after graduation. Lots of these young medicos ended up staying there after their "repayment' period was up

[anotherdrew]

30. who's surprised? this is what republican rule is meant to lead to...

what else can it lead to? Our entire national socio-economic framework is about to fall apart from lack of investment, maintenance, leadership and vision.