Approximately 25% of the U.S. population lives in rural areas, but only 10% of physicians practice in rural areas.  This maldistribution of physicians over the last several decades has occurred for many reasons:

• Medical education in the United States has become specialized, centralized and urban.
• Many practitioners emerge from medical programs with a staggering amount of debt and go on to practice in urban areas, where they often receive a higher salary.

More doctors is not the answer

Simply increasing medical school slots is not the answer. According to the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, “Sizeable growth of the physician workforce in the last two decades has not resolved the maldistribution of physicians.”  On March 24, 2009 — House Energy and Commerce Committee Chairman Henry A. Waxman said that a congressional overhaul of the health care system must not only provide for universal coverage but also for more primary care doctors and nurses to ensure that an insurance card actually gives the holder access to treatment.

Physicians need to be rooted in the rural community

In a joint 2008 statement, the American Academy of Family Physicians and the National Rural Health Association stated that medical education anchored in rural places, nourished and funded through significant federal, state and local community support, and meaningfully connected to both regional academic institutions and local physicians in practice has great potential to address both present and future needs for physicians who provide care to rural populations.

DMU launches program to combat rural physician shortage with incentives

Concerned about the growing physician shortage in rural Iowa, Des Moines University (DMU) has embarked upon a “grow your own” program.  DMU and its Area Health Education Center have created the Rural Iowa Provider Education (RIPE) Program.

The RIPE Program provides specialized education, training and tools to better prepare students for service in rural, underserved areas of Iowa.  Because one of the known barriers for students choosing a rural medical practice is the tuition debt load from medical school, DMU has made an on-going commitment to annually provide the equivalent of six full tuition scholarships to students enrolled in the Rural Medicine Educational Pathway. In return, graduates agree to maintain a fulltime primary care medical practice in an approved Iowa community for a period of four years.

Are plans like DMU’s RIPE the answer to the shortage of physicians in rural areas? Are there other concerns or issues at hand? How would you bring more physicians into rural areas?

You can find more information about the RIPE Program on DMU’s website.

Hospitals are routinely asked to participate in surveys measuring the quality of care provided. As hospitals consider whether to invest the time and manpower into completing these surveys, they need to be assured the survey is using evidence-based metrics that promote quality and safety improvement. For that reason, Iowa hospitals have historically not participated in the Leapfrog Group Survey.

The history of Leapfrog

In 2000, a number of large employers and public purchasers founded the Leapfrog Group in an attempt to persuade hospitals to adopt practices thought to improve the quality and safety of medical care. The Leapfrog Group initially recommended three hospital patient safety practices, or “leaps”:

• Computerized physician order entry.
• Staffing of intensive care units by trained intensivist physicians.
• Evidence-based referrals for high-mortality surgeries.

Unfortunately, these leaps primarily targeted urban hospitals. In Iowa, this would equate to 18 percent of the 117 community hospitals. To quote the Leapfrog Group, “Computer physician order entry and ICU physician staffing are still considered a stretch for rural hospitals because of the staffing and resource constraints involved in fully complying with them.”  This may lead one to question why Leapfrog  set forth benchmarks that hospitals would be unable to achieve.

The Leapfrog Safe Practices Survey and response from JAMA

In 2004, Leapfrog adopted a fourth initiative, the Safe Practices Survey. Leapfrog said this would allow all hospitals to report efforts toward implementing the National Quality Forum’s Safe Practices for Better Healthcare.

Fast forward five years to a study just published in the April 1 edition of the Journal of the American Medical Association. That study showed hospitals that ranked highly on the Leapfrog Group’s Safe Practices Survey had about the same inpatient mortality rates as facilities with lower rankings.

In a written response, the Leapfrog Group said that the study addresses only one of several elements of the hospital survey, adding that the data used in the comparison “limits the conclusions that can be generalized from the study.”

The Leapfrog Group adds that although the process and structure measures in the Safe Practices Survey are “perfectly sensible…clearly we cannot assume that structural and process improvements automatically lead to the outcomes we desire.”  This explanation from Leapfrog echoes Albert Einstein, who said, “Not everything that can be counted counts, and not everything that counts can be counted.”

Iowa hospitals continue to receive high marks

In study after study, Iowa hospitals continue to rank at the top of the leader board for quality patient care. Part of this success can be attributed to the ongoing work of the Iowa Healthcare Collaborative, a provider-led nonprofit organization designed to promote rapid cycle clinical performance improvement. IHC’s initiatives facilitate engagement, the sharing of data and the rapid deployment of best practices. IHC highlights success stories and reports on clinical performance information in its 2008 Iowa Report. The IHC Board has also affirmed its position that Iowa hospitals not report to the Leapfrog Group.

Questions?

Do you have questions about the Leapfrog Group survey or IHA’s position on this issue? Please leave a comment and a member of IHA’s staff would be happy to respond.

The mismatch between the skills required for most jobs and the skills of the U.S. workforce is having a significant impact on all businesses and industries, including the health care sector.

Hospitals need reliable ways to measure foundational skills to ensure they are hiring the most qualified, trainable candidates. ACT, a  not-for-profit organization that provides assessment services in the areas of workforce and education, has two products that fit the bill for hospitals: WorkKeys and the National Career Readiness Certificate.

WorkKeys

WorkKeys offers both cognitive skills assessments and personal skills measures, enabling employers to assess the full potential of applicants.

Mercy Iowa City incorporates the WorkKeys assessment into their application process.  Applicants are assessed on applied mathematics, reading for information and locating information. Results are then compared to the skills level needed for the position.

Since implementing the WorkKeys assessment into the pre-hire process, Mercy has experienced a decrease in employee turnover, gains in productivity and improved staff morale.

National Career Readiness Certificate

The National Career Readiness Certificate (CRC) verifies to employers an individual has essential core employability skills in reading, math and locating information.

ACT has researched over 16,000 occupations and these three skills are highly important to the majority of jobs in the workplace. Sixteen states have already implemented a statewide Career Readiness Certificate program and Iowa is among 19 other states in the process of doing so, according to the National Organization for Career Credentialing.

Iowa Health – Des Moines is the first organization in Central Iowa to join the Career Readiness Certificate Employer Consortium of organizations recognizing the Career Readiness Certificate. According to Sue Allyn, Iowa Health – Des Moines, Vice President for Human Resources, “It is one more assurance that a person is skilled and ready for our workplace.”

What Works Well at your Hospital?

These tools are just two examples of how hospitals can continue to ensure they are hiring the most qualified candidates into their workforce.

What is working well in the hiring process at your hospital? Are you using another tool to help screen for the best job candidates?

Share your tactics in the comments below.