It isn’t for a lack of trying. But, it has to be a good fit. Like many critical access hospitals across the nation who are situated in rural areas far removed from urban sprawl, Roosevelt Medical Center is struggling to hire a third provider. Still, they aren’t just going to hire anyone.
To date, there have been six interested candidates for the position vacated in June by long-time provider, Jay Lambert, who chose to return to his home state of Utah. Of those, RMC interviewed three applicants and two offers were made. However, one candidate declined the offer and decided to stay with their current employer, and RMC is awaiting a response from the second.
“The costs associated with hiring a new provider can be astronomical. That is why it is critical to hire people who are going to be a good fit in our facility as well as our community and who are likely to stay for an extended amount of time,” said Jennifer Kessner, CFO. In 2011, RMC spent $22,000 when outsourcing to locate just one provider, and those costs go up all the time.
Like other area healthcare organizations, recruitment and retention continue to be areas of concern and constant focus. In today’s mobile workforce, employees are not opting to spend decades with one employer, but instead continue their professional journey wherever it takes them. Oftentimes professional staff will cut their teeth in smaller facilities where they are able to work in many different areas and gain experience, but later choose to return home or move on to specialty areas of practice or to larger organizations where they don’t have to be on call.
“It’s very difficult to have successful recruitment in our rural area. A lot of this has to do with the remoteness and the lack of access to some of the amenities they are accustom to having in their everyday lives,” said Audrey Stromberg, CEO. It isn’t just the new employee making the transition either. The families coming along with those professionals also have to adjust. Therefore, retention of new providers, nurses, lab techs, and others becomes a community and neighbor effort, not just RMC administration, board, and staff.
But it isn’t just the lack of a corner Starbucks and city vibe that hinders successful recruitment in our part of the state. While the cost of living in the area has gone down some, the Bakken oil boom has increased the price tag on living and there are very few affordable housing options in smaller communities. Basic life necessities have to be affordable for low to middle income wage earners, which is where 90% of RMC employees are. When recruiting doctors, physician’s assistants, nurse practitioners, nurses, and lab techs, many of the candidates are fairly new graduates and have heavy student loan burdens so they also have to have affordable living arrangements.
“Being prepared for rural life in the social sense can often be more of a factor than facing the challenges of being medically trained for rural practice where those providers are truly on the front lines of medicine addressing everything that can happen to a person as far as their health goes,” Stromberg said.
Staffing is challenging with many healthcare professionals today wanting to switch to contract work, rather than full-time employment to reap the benefits of higher pay, mileage reimbursement, per diem and the ability to travel to other facilities. Currently, the clinic is trying to fill two nursing-staff positions vacated when one nurse went back to California after meeting a personal goal of working at RMC for one year to get clinic experience and one moved to Louisiana for family reasons. Meanwhile, the clinic is using temporary nursing staff to keep up with patient care while the search continues to find permanent staff members.
Also, when providers graduate they are indebted into the thousands and often look for employment opportunities boasting loan reimbursement. Currently, RMC cannot offer this incentive based on the current national loan reimbursement program, which factors in population based health issues for the area related to topics like poverty, provider ratios per population base and infant mortality. With that, the program distributes reimbursements based on the national number of applicants, as well as the amount of funding dedicated to the program. “The past two years, loan repayment incentives haven’t been awarded to applicants at facilities whose score has been less than 15 and currently our area sits at a score of 13 based on the area’s health issues,” Stromberg said.
Recruitment woes don’t stop with professional provider staff either. Finding qualified, dependable applicants to fill entry-level positions in nursing, housekeeping, and dietary departments is also challenging. Last year, RMC hired and terminated 53 employees, many in entry-level positions. Some of these employees lasted as little as a day after recognizing that healthcare is a demanding, and often emotional field that requires constant commitment to the patients served.
Even entry-level positions require general and departmental orientation as well as extended training in the areas of safety, infection control, and disaster preparedness.
“Healthcare is a very rewarding industry to be in. But, it takes a lot more than some people realize when they turn in their application. It’s demanding, emotional and constant. It’s a profession that often you take home with you at night,” said Jessica Schmitz, Director of Nursing for RMC.
While the numbers look staggering on paper, there are many staff members who have been employed with RMC for 15, 20, 25, and even 30 years. Over the past couple of years, half a dozen 20+ year employees have chosen to retire. Looking forward, there are more than a dozen “baby boomers” that will have been with RMC for more than 20 or 30 years who will be eligible for retirement in the next 10 years.
Strategically, RMC offers incentives for training and education in-house in an effort to capitalize on the grow-your-own concept where people who grew up in the area and have ties are more likely to stay and build their lives.
Through RMC’s Roosevelt Memorial Healthcare Foundation, scholarships are made available annually to local students pursuing degrees in healthcare, in the hopes they may one day return and use their services locally.
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