Rural cardiology practices struggle to fill vacancies
A new survey put a spotlight on the many staffing issues facing rural cardiology practices and health systems. Respondents said cardiology capacity was adequate just 8% of the time. In addition, 62% of respondents said it is insufficient or fragile, and 24% rely mainly on alternative coverage or have no meaningful local cardiology capacity.
The Rural Healthcare Specialty Priorities: Rural Physician Workforce Survey report included many insights regarding cardiology. It was commissioned by the Medical Group Management Association (MGMA), Jackson Physician Search and LocumTenens.com. Feedback was provided by 227 rural clinicians and administrators from critical access hospitals, rural health clinics, federally qualified health centers and medical groups.
These responses come at a time when many healthcare organizations are short on doctors and would face a major care gap if just one of physicians left or retired.
Another key takeaway was the fact that 60% of respondents said losing local cardiology access would have significant consequences. Another 40% said patients already have a significant unmet need for cardiac care.
"Cardiologists working in rural markets are able to provide care perhaps faster and more conveniently for patients rather than having to travel to a tertiary care center," Tonya Hamlin, regional vice president, recruiting, at Jackson Physician Search, explained to Cardiovascular Business. "However they may feel the impact differently than colleagues in larger cities and feel stretched too thin with an unsustainable call burden."
Rural health leadership respondents said they are mostly trying to build additional capacity for cardiac care. About 47% said they want to grow capacity, and 24% said they are attempting to protect the care and coverage they do have.
"We are seeing some clients start or expand cardiology services without having supplemental resources in place, ranging from advanced imaging to cardiac catheterization labs," Hamlin said. "Patient access and convenience are strong reasons for growing the cardiology service line. Rather than long wait times, patients want to be seen sooner and closer to home. Being able to provide imaging, stress testing, Holter monitoring etc., locally saves time and quite possibly lives."
\Also, 15% of respondents said that cardiology is best handled through a referral or partnership. This was one of the higher shares of partnership care for any specialty included in this survey.
About one in five respondents also named cardiology as a top-impact specialty (17% of clinicians and 20% of administrators).
“The research recognizes an insightful truth: A rural shortage is not always an empty position. Often, the service is still operating but with little room to absorb a departure or another disruption,” Akash Madiah, acting chief executive officer of MGMA, said in a statement. “This report gives leaders a strategic framework to help identify that risk earlier and decide whether a specialty needs to be protected, grown or covered differently.”
Recruiting is a constant battle for rural organizations
Recruiting physicians for rural positions can be difficult. Recruiters at recent American College of Cardiology meetings told Cardiovascular Business they often have cardiology positions open for a year or more before they are filled. In some cases in more remote areas of the country, they have had cardiology positions open for more than two years.
This new survey showed that rural health organizations are rarely ahead on finding replacements for their physician vacancies. Sixty-four percent of administrators expect at least one physician to retire or reduce hours within five years, but only 41% of those have a formal succession plan for those departures.
“Nearly two-thirds of rural administrators already expect a physician to retire or cut back within five years, but our survey found that fewer than half of them have a formal plan for it,” Helen Falkner, president of Jackson Physician Search, said in the same statement “That’s where a lot of rural vacancies start. If succession planning waits for the resignation letter, you’re already behind. It has to start when a retirement first comes into view, with a timeline and a recruiting plan attached to every specialty the community can’t afford to lose.”
Respondents also said two-thirds of the most impactful physician vacancies from the past three years still have open recruiting searches today. Administrators said they directly connect longer patient wait times, heavier workloads for remaining staff and lost patient volume and revenue to these vacancies.
Rural staff retention should also be a key consideration
The survey also showed that the retention of clinicians already in place is an issue. Sixty-five percent of current rural clinicians said they lack adequate specialist and colleague backup, which impacts the flexibility of their schedules and job satisfaction. Among them, 67% said they are at least somewhat likely to leave their current position within two years, compared with 44% of clinicians who have adequate backup.
Also, 45% of clinicians who have left rural practice said they would consider returning. They said their top conditions to do so are better compensation (47%) and better specialty coverage and colleague backup (45%).
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]