Physician staffing in rural medicine is a unique challenge. Many administrators begin with a traditional recruiting path, trying to find physicians who will relocate or a local doc willing to provide call coverage.
But both approaches have shortfalls. It can be difficult to attract physicians to move to rural communities, and local doctors can quickly get burnt out when trying to balance call coverage on top of their regular shifts. In the end, rural hospitals often end up with physician shortages resulting in gaps in coverage that need to be resolved quickly.
When these shortcomings are realized, administrators are forced to look at alternative options. Two of the most frequently used solutions include hiring a locum tenens provider or implementing a 24/7 hospitalist model – such as Rural Physicians Group.
As a rural medicine leader, you must move quickly to meet the needs of your community. But how do you know which answer to ending your physician shortage is the right one? What are the differences between the two?
Let’s look at the pros and cons of 24/7 rural hospitalist models and locum tenens.
24/7 Hospitalist Model Specializing in Rural Medicine
Full-coverage hospitalist models that specialize in rural medicine offer stability and alignment – clinically, culturally, and financially. Focused on “right-fit” providers, these permanent solutions aren’t just staffing services. Instead, they match your hospital with experienced physicians who align with your community’s unique needs.
Physicians in these types of models tend to be leaders on your medical staff and ultimately become a part of the community.
Pro: Committed to Rural Medicine
You’ve likely encountered other models that don’t seem to understand the demands of rural medicine. But providers specializing in the rural space know how your hospital is different. They know your community relies on your hospital for access to care, especially specialized care. With deep experience and a passion for practicing at the top of their license, rural hospitalists in this model are prepared to lead in the most challenging situations.
Pro: Keep Patients Local
With dedicated and experienced hospitalists available around the clock, fewer patients need to be transferred to more urban hospitals. This results in a better patient experience as they have the support of their local community and family members. And less transfers have a double positive effect on your hospital’s financial health: the additional revenue from patients that don’t need to be transferred and fewer patients going straight to urban hospitals in the future because they become more confident in your hospital’s ability to treat them.
Pro: Continuity of Care
With this model, hospitalists are available at your hospital 24 hours a day for shifts that usually span 5-10 days. This, combined with fewer transfers, means that more of your patients can rely on one physician throughout their time at your hospital. This greater continuity of care reduces mistakes, improves quality, and enhances the patient experience at your hospital. Even more rare, this model gives patients and their families around-the-clock access to a hospitalist via cell phone. If they have a question or concern, patients and their families can always reach the care team.
Pro: Remove the Burden of Recruiting
Rural hospitalist models permanently remove the burden of recruiting physicians. The challenge of recruiting – especially to a rural community – is a long, expensive process. Healthcare doesn’t stop when a physician moves or retires. Your workload is demanding enough; where do you make the time for physician recruiting? How do you convince an experienced hospitalist to join your staff? Can you convince their spouse and family to relocate? This model solves these challenges immediately.
Pro: Elevate Staff Skills & Admit Higher Acuity Patients
There’s a perception in the general population that the standard of care in rural areas is less than larger communities. You know this, and you know it’s untrue. Hospitalists who specialize in rural medicine are driven to make sure it stays untrue. With a 24/7 rural hospitalist model, your hospital is working with physicians who are comfortable in the rural setting and feel called to serve there. Importantly, these hospitalists approach their work with a teacher’s mindset and help your medical staff elevate its skills.
A collective increase in knowledge and confidence leads to accepting higher acuity patients and thus more revenue.
Pro: No Direct Management Responsibilities
Recruiting physicians to a rural hospital is only one part of your challenge as an administrator. Hiring people means people management, and that can cost you significant time and money. But with this model the hospitalist group leads those efforts. The rural hospitalist group takes care of scheduling and other administrative responsibilities associated with hiring and managing physicians. And if a physician doesn’t align with your hospital, they’ll manage their transition and replacement.
Pro: Dynamic Investment in Your Hospital
A rural hospitalist model invests in your hospital as much as you invest in them. From establishing consistent workflows to leading interdisciplinary meetings, these physicians appropriately place themselves at the center of your community – rather than just an extension. As a rural hospital leader, your investment is flexible. This model is all-inclusive when it comes to pricing, so you don’t have to manage the headache of unpredictable costs if you need additional coverage.
Con: Providers Typically Don’t Live Locally
Despite the predictability, continuity, and alignment of a 24/7 rural hospitalist model, the providers do not live in your community. In the beginning, these hospitalists could be viewed as “outsiders” as they earn your community’s trust.
Con: Higher Upfront Investment
Due to the experience level and professional billing structure of a hospitalist model that specializes in rural medicine, the contract for this permanent solution may come at a higher price tag than traditional recruiting and hiring. The return-on-investment of this model proves it to be a stronger financial investment, but this could be an initial concern for some administrators.
Locum Tenens Staffing
Locum tenens is a relatively popular solution for staffing pressures in hospitals. They offer a relatively quick and flexible way to bring in physicians but are designed to be a temporary measure. So, while they do meet short-term demands, they do not stabilize rural environments.
Locum tenens is a short-term answer to physician coverage with many implications for the hospital and community.
Pro: Solution to Immediate Staffing Needs
Locum tenens provides coverage in the event that your usual providers are unavailable, or you find yourself without enough staff, offering your community the medical care it needs during that time period. Locum tenens can also fill a gap for your hospital if a physician is on an extended leave, or if you’re in the process of recruiting a new full-time physician.
Due to their short-term design, your commitment is not binding and you have the opportunity to re-evaluate your strategy frequently. Physicians can be quickly added, removed, or rotated out as needed.
Con: Providers Don’t Specialize in Rural Medicine
Hospitalists who don’t have experience in rural medicine present critical problems across your hospital and community. Where the 24/7 rural hospitalist model above stands out, locum tenens can negatively impact your patient experience, medical staff experience, and your hospital’s bottom-line. At a high level, providers who don’t understand rural medicine environments – and won’t be there for long – may not align with your clinical, cultural, or financial goals.
Con: Lack of Continuity
In a locum tenens environment, the amount of time providers are onsite varies widely. Schedules are not clearly defined, and patients are unlikely to be treated continually by the same care team. This can increase the probability of mistakes, decrease quality of care, and negatively impact the patient experience.
Con: Transfer Patients Out & Fewer High-Acuity Patients
When it comes to higher acuity cases, staffing models that use locum tenens usually lean on the “stabilize and ship” approach. Hospitalists who don’t specialize in rural medicine may not understand the reality of a rural environment; that is, they are the onsite care leader and do not have access to specialized providers. That means these temporary providers are less likely to be comfortable serving high-acuity patients.
Con: Expensive & Unsustainable
Locum tenens is an expensive and unsustainable option because they don’t encourage long-term stability. Like a bandage, these models provide coverage without providing structural solutions. Bandages serve a purpose, but they are not permanent solutions.
Although staffing shortages across the country continue to rise, the right coverage partner can help you lead your community through these challenges. Hospitalist groups that specialize in 24/7 rural medicine are prepared to serve your community, providing long-term stability when the world seems anything but stable.
Rural Physicians Group offers hospitalist and surgicalist programs that are committed to providing excellent patient care in the most cost-effective manner. In addition to being experienced providers with teacher’s mindsets, each physician understands the business of healthcare and is a champion for enhancing the patient experience.
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