In 2009, Ashland (Kan.) Health Center had an urgent need for a qualified medical technologist, but its search came up short. The 24-bed hospital located in the center of this rural community of 900 residents provides emergency and acute care services, along with ancillary services such as physical therapy, lab and X-ray services. While another small, rural hospital is located about 25 miles from Ashland, the largest metropolitan area, Wichita, is 160 miles away. The hospital's lab was one of the most understaffed in the state, says CEO Benjamin Anderson. Only two individuals were covering laboratory, X-ray and CT combined.
To expand its search, Anderson started looking abroad. With the help of a recruiter, they located Celvin Bernardo, a citizen of the Philippines who was working in Saudi Arabia. Bernardo accepted Ashland's offer and planned to start work in about eight weeks. He left his job in Saudi Arabia and returned to the Philippines to prepare for the move.
But a few obstacles got in the way. U.S. Citizenship and Immigration Services denied the H-1B application Bernardo needed to work in the United States on the grounds that the position did not require someone with a bachelor's degree.
"We knew the position did in fact require this level of education and training and so we appealed the decision," says Anderson. Ashland hired David Zaritzky Brown, an immigration attorney with experience in the health care field, to file the appeal. "It was important for USCIS to realize that in Ashland's case it was not about the size of the hospital, but the complexity of the work the medical technologist would be doing," says Brown.
After much back and forth, the USCIS Administrative Appeals Office finally approved Bernardo's application this past January.
While Bernardo's case may not be typical, it does indicate the desperate straits rural hospitals find themselves in given the severe shortage of qualified health care professionals in those regions. Shortages exist for a range of professionals, from licensed practical nurses and physician assistants to laboratory technologists and imaging technicians.
"These areas have historically struggled to recruit and retain well-trained health professionals. The smaller and more remote the area, the more difficult the challenge," says John Supplitt, the American Hospital Association senior director, constituency section.
The Rural Assistance Center says those areas are especially hard hit because of such factors as an aging workforce, lack of educational and training opportunities for younger people, smaller staffs and heavier workloads, and higher pay and more benefits offered in metropolitan areas.
Finding the Right Fit
While Ashland searched abroad to fill its opening, not all rural hospitals may need to follow that path. For Carl Hanson, administrator of Minidoka Memorial Hospital in Rupert, Idaho, the most pressing challenge to recruiting and retaining health professionals is finding individuals who are satisfied living in a rural area and working at a rural hospital.
Hanson tackles that problem by targeting people who already live in the community. A job shadowing program introduces local high school students to the hospital and to health care work. Local colleges and universities use the hospital for training. Scholarships, grants or other financial aid are available to local residents, many of whom are older than traditional students.
The Wallowa County Health Care District in Enterprise, Ore., also must compete for a tight workforce, but CEO Dave Harman says a number of local attractions make recruiting a little easier. Located in the northeastern corner of Oregon, Enterprise boasts a lake, a small ski area, a vibrant artistic community, and, Harman wryly notes, no stoplights.
Wallowa usually finds health professionals who are from the area or familiar with it and want to take advantage of the lifestyle and beautiful surroundings.
Wallowa conducts a lengthy prescreening interview to determine if the fit is right. "We want to be sure that not just the candidate, but the wife or husband understand and like our community," Harman says. Also, if someone wants to be able to get to an airport in 30 minutes, he or she won't be happy with the hospital and community.
With serious candidates, Wallowa goes the extra mile, putting on community dinners and helping spouses find employment.
Lynne M. Connelly, R.N., director of nursing for Benedictine College in Atchison, Kan., says locating employment for spouses is key. "If a husband or wife can't find work, then the couple will probably not relocate to the area."
Mary LaRowe, president and CEO of St. James Mercy Health System in Hornell, N.Y., says her rural hospital serves as a training ground for some new graduates. "After one or two years of experience, these young people are often lured away to larger institutions," she says.
However, two nearby colleges provide an opportunity to get to know and work with a number of students who eventually fill some positions.
St. James operates a radiology school that offers students clinical experience and training. The hospital is able to recruit top talent from the program. In addition, scholarship programs have allowed St. James to assist in career development and advancement, aligning the hospital's long-term plans with that of employees, LaRowe says.
Even so, St. James has particular difficulty recruiting and retaining behavioral health professionals, specialty nurses, licensed certified social workers, physical and occupational therapists and speech pathologists.
Start With More Training
L. Gary Hart, director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences, agrees that local individuals are more likely to practice in rural areas. Creating a better pipeline for them to go to health professional schools is essential, says Hart, co-author of a 2008 report on rural health workforce issues prepared by the Advisory Committee on Interdisciplinary, Community-Based Linkages. He advocates increasing financial support for rural schools that train health professionals and assisting students with education costs and repaying loans.
Minidoka's Hanson says schools should designate training slots for people who commit to returning to their rural areas. LaRowe suggests colleges might offer internships at rural facilities to individuals from nonrural areas so they can experience the environment and maybe decide they prefer it to a metropolitan setting. "The hometown feeling you have of working side by side with those who share your passion is very rewarding," she says.
Federal policies supporting Title VII of the Public Health Services Act have had a powerful influence in the past, says the AHA's Supplitt. Among other things, Title VII programs provide scholarships and loan repayment to students who agree to work in medically underserved areas for three years.
In the Lab, at Last
Back in Kansas, Celvin Bernardo finally began working as a medical technologist at Ashland Health Center in April. The delay in receiving government permission was not only difficult on him and his family, but the hospital and residents in the community also suffered, says CEO Anderson.Ashland's two laboratory professionals faced a heavy workload, regularly working six-day weeks and sharing on-call duties.
Ashland leaders were pleased that Bernardo didn't change his mind during this lengthy process. "Our care is going to improve here because of this new hire," Anderson says. The hospital is helping Bernardo with some of the relocation costs and the first several months of housing expenses. A community drive also helped stock his home with supplies, from a baby crib to a rice cooker.
While the application process was an ordeal, Bernardo never gave up his dream of working in this community. "Living and working in a rural area is like living with an extended family because you get to know everyone," he says. He's also pleased that his two children will be raised there.
Joan Szabo is a freelance writer in Great Falls, Va.