Rural Physician Workforce Policy: The Texas Medical Association recognizes the following 25 recommendations for improving physician supply in rural Texas: (CM-PDHCA Rep. 1-A-11).
Practice Incentive/Benefit and Other Recruitment Programs
1. Federal and state rural practice incentive/benefit programs should be sufficiently funded to be successful in recruiting and retaining physicians in rural, underserved communities.
2. Physicians, medical students, and residents should have easy access to information about rural practice incentive programs. Further, the programs should be widely publicized by state authorities, the Texas Medical Association, and the Texas Osteopathic Medical Association, and application forms readily accessible and user-friendly.
3. Area health education centers need to be adequately funded through federal and state funding sources to: (a) provide recruitment and retention services in rural areas; (b) assist in locating reasonable housing for student and resident preceptorships; and (c) provide practice support services to providers and communities, as referenced in other principles listed herein.
4. Incentives should be developed by state authorities to encourage physicians to add a secondary, part-time practice in rural, underserved communities located within a reasonable distance of their primary practice site. Physicians are encouraged to consider hiring and supervising mid-level practitioners, as appropriate, to augment their secondary practices.
5. Physicians are urged to adopt telemedicine services in their practices as outreach to patients in underserved communities, when applicable and purposeful in meeting health care needs.
6. Physicians should be informed of the potential impact of the employed-practice model on their scope of practice and should seek professional advice before signing hospital employment contracts, including resources provided by the Texas Medical Association and the Texas Osteopathic Medical Association.
Promoting Rural Practice
7. Information on rural physician shortage areas should be readily available through coordinated websites of state agencies such as the Texas Department of State Health Services, the Texas Medical Board, area health education centers, and the Texas Department of Rural Affairs, to practicing physicians, medical students, and residents seeking rural practice opportunities, as well as to underserved communities. To assist physicians in selecting practice opportunities, comprehensive community profiles should be compiled to identify characteristics and statistics such as: population demographics (percentage child-bearing [for obstetrical needs], aged [for adult medicine-needs], etc.); insurance status; supply of physicians and other health professionals; degree of physician shortage; socioeconomic status; as well as educational and recreational opportunities.
8. Physicians who locate to rural areas, as well as medical students and residents interested in locating to rural areas, should be informed by state and/or local authorities of benefits and incentives available to strengthen the financial viability of their practice, including Medicare bonus payments, recruitment assistance, publicly funded locum tenens programs, etc. Further, they should be informed of the health care infrastructure in their area, including systems of care such as federally qualified health centers, indigent care clinics, rural health clinics, hospitals (including critical access hospitals), long-term care facilities, emergency medical services, and hospice. They also should be informed about the availability of other health providers and services such as nursing, pharmacies, therapists, and medical equipment.
9. Physicians should be informed by state authorities, including the Texas Medical Board, of the unique peer review services offered by the Knowledge, Skills, Training, Assessment, and Research (KSTAR) Program at Texas A&M University Health Science Center for rural hospitals and physicians.
10. County medical societies, hospitals, and other health facilities (when available) should facilitate communication between new physicians and physicians with established practices in the community to help new physicians be better prepared for entering practice in an underserved community.
11. Physicians who receive benefits through state loan repayment programs also should be informed by state authorities of specialized practice support services, including practice start-up, billing, locum tenens, professional development and CME, staff recruitment and training, telemedicine, and so on.
12. Physician practice reentry programs should be widely publicized and monitored to assess their ability to meet demands by state authorities, the Texas Medical Association, and the Texas Osteopathic Medical Association. Further, when licensed physicians allow their Texas medical license to lapse, they should be informed by the Texas Medical Board of the potential obstacles to relicensure should they decide to reenter practice following an extended absence from practice.
13. Outreach should be provided by state authorities, to physicians without a full-time medical practice to promote volunteer work or part-time practice at clinics in underserved communities.
14. Federal and state policies that impact rural medicine, e.g., payment policies, should be monitored by the Texas Department of Rural Affairs for their potential impact on the viability of rural practices. The Texas Medical Association and the Texas Osteopathic Medical Association should continue to advocate for reimbursement parity between Medicaid and Medicare beyond the two-year period authorized by the Patient Protection and Affordable Care Act. In addition, reimbursement policies that discount professional services to be delivered in rural communities discourage rural practice and should be addressed.
15. Physicians in practice and those in training programs should be informed by the Texas Medical Board, Texas Medical Association, Texas Osteopathic Medical Association, and other state authorities of special state medical licensing provisions applicable for practice in rural, underserved areas.
Preparing Physicians for Rural Practice
16. Medical schools and residency programs should be incentivized by state authorities to develop and adequately support rural education and training tracks. Examples include bonuses for medical students or residents who participate in rural training tracks, and additional state formula funding for medical student and residents in rural training tracks.
17. Appropriate screening criteria should be used by medical schools for identifying student-applicants and residents most likely to be successful in rural practice.
18. To measure outcomes, assessments should be conducted to identify whether students and residents who participate in rural educational or training tracks are retained in the state for practice after completion of training.
19. Area health education centers should offer opportunities for community physicians who volunteer as preceptors to access information and knowledge of practices that contribute to a positive clinical learning experience. Further, educational institutions should provide adequate support and incentives to recruit and retain physician preceptors, including appropriate levels of recognition and benefits for their teaching efforts. This will become increasingly important as community physicians face continuing pressures to increase productivity.
20. Medicare GME policies should allow for residency program-specific support rather than institutional support for resident training to allow GME funding to follow the resident throughout their training.
21. Primary Care Residency Review Committees (RRCs) of the Accreditation Council for Graduate Medical Education, and Primary Care Residency Review Committees of the American Osteopathic Association, should consider allowing more flexibility for residents to travel away from their core programs to rural areas in order to achieve established training goals for minimum numbers of procedures or encounters.
22. The impact of changes in resident duty-hour restrictions should be monitored for the impact on rural training programs and health care delivery in comparison to institution-based residency programs.
Rural Access to Care
23. The Texas Medical Association and Texas Osteopathic Medical Association should continue to advocate for a single standard of care for all Texans in all areas of the state.
24. Discussions are needed to develop solutions for providing after-hours care for patients of federally funded health clinics requiring urgent or emergent care to prevent undue burdens on community physicians.
25. Periodic research should be conducted by the Texas Health Professions Resource Center at the Texas Department of State Health Services to monitor significant changes in rural physician workforce trends, including physician demographics and practice characteristics. (CM-PDHCA Rep. 1-A-11).