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www.3RNet.org
Montana Rural Recruitment
and Retention Roadshow!
Mike Shimmens
Executive Director, 3RNet
Mark Barclay
Director of Member Services, 3RNet
www.3RNet.org
Introductions
• Name
• Facility
• Background
© 2015 3RNet April 2015 | 3
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Basics of Recruitment and
Retention Planning
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What is Recruitment?Is this your definition of recruitment?
• The process of finding and hiring the best-qualified candidate
• Timely and cost effective manner
• Process includes– Analyzing the requirements of a job
– Attracting employees to that job
– Screening and selecting applicants
– Hiring
– Integrating the new employee to the organization.
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What is Retention?Is this your definition of retention?
• An effort by a business to maintain a working environment which supports
current staff in remaining with the company.
• Many employee retention policies are aimed at addressing the various
needs of employees to enhance their job satisfaction and reduce the
substantial costs involved in hiring and training new staff.
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Or is this?
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“Recruitment and retention are not
separate events – they are part of a
process.” Tim Skinner, ex-officio ED 3RNet
RECRUITENTIONRetentionRecruitment
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• “Recruiting for Retention” The Recruitment and
Retention Manual of the 3RNet updated in 2009,
2013, 2015
• “Recruitment and Retention of Clinicians” NACHC
Manual by Illinois, Mississippi, Arizona and Virginia
PCA’s completed in 2005 and updated in 2010
• “Midwest Retention Toolkit” 2012
• Association of Staff Physician Recruiters (ASPR)
www.aspr.org
Basic Science
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R & R Plan Action Steps
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For me, it’s all about the team!
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Form a Recruitment and Retention
Committee
• No matter what the size of your organization this needs
to be thought out and roles assigned
• Some members may wear more the one hat in the
process, but it is a team effort
• Your efforts will be hard pressed to succeed if you skip
this step!
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How long do these steps take?• According to the Advisory Board, a typical recruitment timeline from initial
candidate response to signing averages 19 weeks – but best practice is six
weeks.*
• A compressed recruitment timeframe reduces chances that a candidate will
be lured away before signing, and should look something like this: – Initial candidate contact
– 24 hours: follow up with candidate’s initial contact
– 1 week: schedule and conduct pre-screen interview
– 3 weeks: arrange a site visit
– 48 hours: extend an offer
– 2 weeks: receive signed offer
• IS THIS REALISTIC? Should it be?
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Part I Planning and
Preparation
Planning and preparation are the
most important ingredients for
ensuring a successful recruitment
effort. They are also the most often
neglected.
‐ 3RNet
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1. Assess the Need
2. Gain support of key stakeholders
3. Form a recruitment and retention committee
4. Define your opportunity
5. Define the ideal candidate
6. Develop a recruitment budget
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People want to practice where
they are needed and welcome.
Show them they are supported
by as many members of the
community as possible.
‐ 3RNet
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Part II Searching for
candidates
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Step 7 Generate Candidates
• Use your unique selling points (USPs) in a creative way
with graphics, pictures, quotes, etc.
• Create many different types of ads:– Short profile
– Classified ad
– Internet version
– Promotional packages, maybe video?
– “Elevator speech”
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Step 7 Continued
• Use multiple methods of sourcing to have greatest impact– On line job boards and advertising like 3RNet
Montana 3RNet contact is: Crystal Bridges
[email protected] 406-457-8047
– Journals and print media
– Direct mail and email blasts
– Databases like PracticeMatch, PracticeLink and Profiles
– Social media – Facebook, LinkedIn, Twitter
– Search firms – Understand the different types and your
responsibilities (contingency, retained and hybrid)
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Part III Screening candidates
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8. Interview Candidates by phone or video conferencing
9. Conduct credential check
10. Interview the spouse/significant other
11. Check references
12. Conduct site visit
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Part IV Follow up and Follow
Through
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13. Follow up communication
14. Negotiations
15. Retention plan implementation
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Key Players in Rural
Recruitment and Retention
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Collaboration
• 3RNet Member
– “One stop shop”, Trusted Resource
– https://www.3RNet.org/locations
• Primary Care Office
– Loan repayment, J-1 Visa Waiver, HPSA designations
– http://bhpr.hrsa.gov/shortage/hpsas/primarycareoffices.html
• Area Health Education Centers (AHEC)
– Rotations, CE, Pipeline
– http://www.nationalahec.org/AHECDirectory.taf
• State Office of Rural Health - NOSORH
– http://nosorh.org/nosorh-members/nosorh-members-browse-by-state/
• Primary Care Association
– http://www.nachc.com/nachc-pca-listing.cfm
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3RNet.org• Non profit membership
association
• Each member in unique
• Celebrating 20 years
• Post any job
• In 2014, there were:– Over 45,000 active candidates
– 9,566 job postings
– 3,101 new candidate
registrations
– 1,718 professionals placed
Montana Primary Care OfficeRoadshow April, 2015
What do we do? HPSA Designations
HEALTH PROFESSIONAL SHORTAGE AREAS
A Health Professional Shortage Area (HPSA) is a designation, determined by the HHS Secretary, of a health workforce or provider shortage. A HPSA designation can be made for a geographic area, population group or health care facility. There are 3 types of HPSA designations:
Primary Care Dental Mental Health
Determining Factors of HPSA Scores Primary Care Dental Health Mental Health
Population to Provider Ratio X X X
% Below Poverty X X X
Travel Time/Distance to Care X X X
Infant Mortality/Low Birth Weight X
Access to Flouridated Water X
Youth and Elderly Population X
Substance and/or Alcohol Abuse X
• Many Federal and State programs use HPSA designations in
determining eligibility
• HPSAs determine funding priorities
› NHSC makes awards by descending HPSA score
o Awardees working in sites with HPSA scores of 14 and higher receive higher
funding than other awardees
o The State Loan Repayment Program (SLRP) requires participants to work in a
HPSA. Montana also uses HPSA scores to prioritize funding.
• HPSAs guide placement opportunities
› Scholars have a limited number of placement opportunities and the statute
directs them to serve in areas of greatest shortage
› J1 Visa Waiver participants are required to work in HPSA designated areas
WHY ARE HPSAs IMPORTANT?
BCRS chart
BHW
NHHSP
Native Hawaiian Health
Scholarship Program
NHSCSP
National Health Service Corps Scholarship Program
NHSCLRP
National Health
Service Corps
Loan Repayment
Program
NHSCS2S
National Health
Service Corps
Student to Service
Loan Repayment
Pilot Program
NHSCSLRP State Loan
Repayment
Program
FLRPFaculty Loan
Repayment
Program
NCLRPNURSE Corp
Loan Repayment
Program
NCSPNURSE Corps
Scholarship
Program
ScholarshipProgram
Students pursuing careers in primary care can
receive a scholarship now and serve later.
The scholarship* includes:
Payment of tuition and required fees (tax-free)
Some other tax-free educational costs (books,
etc.)
A monthly living stipend (taxable)
*available for up to 4 years
support
YEARS OF
SUPPORT = YEARS OF
SERVICE
Scholars commit to serve in the Corps upon
completion of their training — one year for
each year of support (at least 2 years).
Loan Repayment Program
UP TO
$50,0002 YEARS MINIMUM
With continued service beyond 5 years, health care
providers may be able to pay off all their student loans.
UP TO
$30,0002 YEARS MINIMUM
Federal NHSC Program Montana NHSC Program
NHSC Loan Repayment Programs
The State Loan Repayment Program provides cost-sharing grants to states to operate their own educational loan repayment programs for primary care providers working in Health Professional Shortage Areas (HPSAs) within their state
State grantees have the option to expand eligible disciplines in their programs to include registered nurses and pharmacists, and expand eligible site types to include critical access hospitals, long-term care facilities, and state mental facilities, providing greater flexibility than is available through the NHSC loan repayment program
• SLRP varies state to state as compared to the NHSC in:
Approved disciplines
Length of service commitment
Amount of contract offered
Ability to utilize alternative funding sources
Physicians24%
Nurse Practitioners 10%
Physician Assistants18%
Certified Nurse Midwives 1%
Dentists3%
Dental Hygienists3%
Mental Health Providers41%
Montana National Health Service CorpsAs of 9/30/2014
Loan Repayment Program81%
Scholarship Program4%
State Loan Repayment Program
15%
National Health Service Corps Programs in Montana
National Health Service Corps
17
22
76
92
55
75
Why do NHSC providers choose Montana?• Beautiful outdoors• Broad scope of practice • Community need/support
National Health Service Corps Eligibility
Site Eligibility
Provider Eligibility
NHSC Sites
Benefits
Recruit
providers and
residents dedicated
to working
where they are needed most
Post clinical job
openings on the
NHSC Jobs Center
and participate in Virtual Job Fairs
Connect with
other NHSC-approved sites
Receive
community and
site development assistance
Establish
an integrated
system of care that
includes the
uninsured and underinsured
Develop linkages
with academic
institutions and
other organizations
Approved NHSC Sites in Montana
347357 366
416
Below is an abbreviated version of eligibility requirements. Sites must:• Be located in and treat patients from a federally-designated HPSA;• Not discriminate based on the individual’s ability to pay, race gender, age, or sexual
orientation;• Accept Medicare, Medicaid, or Healthy Montana Kids;• Post and honor a sliding fee scale according to current federal poverty guidelines; and• Have been in operation for a minimum of 12 months prior to site approval.
The application cycle for to become an approved site is open from March 30- June 2, 2015. Sites have to be approved before providers can apply for loan repayment.
Other Considerations• Site approval does not guarantee loan
repayment
• Need to update point of contact as staff changes
• Need to recertify every 3 years, recertification opens in the fall (Sept-Nov)
https://programportal.hrsa.gov/cas/login?service=https%3A%2F%2Fprogramportal.hrsa.gov%2Fshared%2Fj_spring_cas_security_check
How to apply
1Determine HPSA
Status; enlist
State Primary
Care Office
2Complete and
submit the Site
Application
3Complete and
submit the Site
Profile Form
Must be licensed in
one of the following
Eligible disciplines
Diciplines
• Physician (MD or DO)
• Nurse practitioner
(primary care)
• Certified nurse-midwife
• Physician assistant
Dentist
• Dentist
(general or pediatric)
• Dental hygienist
• Psychiatrist
• Psychologist (health service)
• Licensed clinical social worker
• Psychiatric nurse specialist
• Marriage and family therapist
• Licensed professional counselor
Eligibility U.S. citizen or national
Currently work, or applying to
work, at an NHSC-approved site
Have unpaid government or
commercial loans for school
tuition, reasonable educational
expenses, and reasonable living
expenses, segregated from all
other debts
Licensed to practice in state
where employer site is located
Eligibility Provide direct patient care services in the outpatient setting
Minimum direct patient care in the outpatient setting requirements
Discipline specific
Special allowances for Teaching Health Centers, and Critical Access Hospitals
Can work at multiple approved sites to meet hour requirements
How to apply?
1Review the
Application and
Program Guidance
2Find a job at an
NHSC-approved
site or find out if
your current job
is at an NHSC-
approved site
3Apply online at
NHSC.hrsa.gov/
loanrepayment
nhscjobs.hrsa.gov
After receiving the award? • Site Considerations:
– Verify participants are fulfilling service obligation, notify NHSC of changes
– Afford providers the opportunity to fulfill service obligation
– Allow for site visits
– Ensure practice policies continue to align with NHSC eligibility requirements
• Provider Considerations:– Fulfill service commitment at approved site
– Can change between full-time and part-time
– Waivers and suspensions are offered in extreme situations
– Can transfer to different NHSC-approved site, with prior approval
– Hefty default provisions
J1 Physician Visa Program in Montana
• Underutilized: 30 J1 slots total, 10 of which are flexible
0
5
10
15
20
25
30
35
2009 2010 2011 2012 2013 2014 2015
Montana J1 Visa Physiciansapproved per year
Potential J1 Visa Physicians
MT PCO Role: J1 Visa Program
• Interpretation of Policy– Found at: http://dphhs.mt.gov/publichealth/primarycare/J1-Visa-Program
• Process applications/ Provide recommendation
• Provide technical assistance
Service Site/Employer Eligibility
• Be located in a federally designated HPSA or federally designated MUA, or in a federally designated MUP;
• Be currently in operation or ready to operate when J1 commences employment; • Have attempted to recruit a U.S. citizen physician for at least 6 months prior to the
application submission and must be able to document recruitment efforts/dates;• Agree to charge patients at the usual and customary prevailing rate in the area, unless
the; • Accept Mediciad/Medicare; • Use a sliding-discount-to-fee scale based on ability to pay for all patients at the facility
who are uninsured and at or below 200% of current Federal Poverty Guidelines (FPL). The current FPL is available at http://aspe.hhs.gov/poverty/index.shtml#latest ;
• Agree to sponsor the J1 Physician’s H1B visa for 3 years; • Agree to notify the MT PCO, in writing, of physician start date within 30 days of the
start date;• Agree to submit semiannual reports to the MT PCO;• Agree to notify the MT PCO, in writing, of any change in the employment contract
within 30 days;• Agree to site visits by the MT PCO staff
Application process
1.STEP ONE: A J-1Physician must apply for a case number (DS-3035 online application form) from the U.S. Department of State (DOS) website and must secure a bona fide offer of employment.
2.STEP TWO: The health care facility applies to the State Department of Health to request a waiver on the J-1 Physician’s behalf.
•Application Period : Begins October 1 each year. Applications are accepted on a rolling basis- goal is 2 WEEK processing once the application is received
3.STEP THREE: State Department of Health reviews and processes the J1 Visa Waiver Application (8 to 12 weeks). When requirements are met, State recommends the J-1 waiver to the DOS.
4.STEP FOUR: U.S. DEPARTMENT OF STATE (4-6 WEEKS) •U.S. Department of State reviews the J-1 waiver applications
•U.S. Department of State reviews and considers state recommendation with other policy considerations
•Generally, U.S. Department of State signs off on state recommendations and forwards the recommendation to the U.S. CITIZENSHIP AND IMMIGRATION SERVICES
5.STEP FIVE: U.S. CITIZENSHIP AND IMMIGRATION SERVICES (2-6 WEEKS) •Makes final waiver approval •Approves waiver recommendations
Name Title Business Address CityStat
eZip
Code Phone Email
Ann Badmus Attorney Cowles & Thompson 901 Main St Suite 400 Dallas TX 75202214-672-2000
Christopher Flann AttorneyImmigration Law of Montana, P.C. 8400 Clark Rd Shepherd MT 59079
406-373-9828
Benita Adams Paralegal Cowles & Thompson 901 Main St Dallas TX 75202214-672-2260
Kyle Clauseen Attorney Morgan Theeler LLP 1718 N Sanborn Blvd Mitchell SD 57301605-996-5588
Brian Bruner Attorney Bruner Law Group 6609 Horseshoe Curve Chanhassen MN 55317612-205-5494
Robert AronsonManaging Attorney
Aronson & Associates, PA 1221 Nicollet Mall Minneapolis MN 55403
612-339-0517
Kelli Stout Attorney Husch Bleackwell LLP4801 Main St, Suite 1000 Kansas City MO 64112
816-983-8309
Ellie NajfabadiAttorney at Law Law Offices of Carl
Shusterman600 Wilshire Blvd. Suite 1550 Los Angeles CA 90017
213-623-4592x107 enajfabadi@shusterman
.com
Cameron Halladay
Immigration Legal Assistant
Miller Mayer Attorneys at Law
P.O. Box 6435
Ithaca NY 14851607.273.4200 [email protected]
Otieno B. Ombok Attorney Jackson Lewis P.C.44 South Broadway, 14th Floor
White Plains
NY 10601914-872-6895
Bringing it altogether in Havre, MT
A Glance at the Numbers 7 Mental Health Providers 1 Dentist, 1 Dental Hygienist 1 Primary Care Physician (possible 3 more) 1 Pharmacist 1 Oncologist/Hemotologist $530,000 in loan repayment
Bullhook Community Health Center Alone: Grant Expenditures: $892,304 Over 3,000 patients served
76% below 200% poverty line About 20% American Indian 1,422 Medical 1,637 Dental 1,637 Mental Health
Increase in Cervical Cancer Screening from 31-63% Adolescent Weight Screening from 5.1-34.3% Tobacco Cessation Counseling from 61.2-88.1% Childhood Immunization from 34.8-77.8% Diabetes Control from 64.4-70.8%
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Factors to Market Your Rural Community: Accessing Strengths/Challenges, Community Marketing, and Finding Solutions
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How do we market for rural providers?
• High Salaries?
• Loan Repayment?
• Hunting and fishing?
• Is an advantage, still an advantage, when most everyone
offers it?
• What factors make ourselves stand out from our
competitors?
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What factors matter in rural?
78
Geographic
• Schools
• Climate
• Perception of Community
• Spousal Satisfaction
Economic
• Loan Repayment
• Competition
• Part-time Opportunities
• Signing Bonus
Scope of Practice
• Emergency Care
• Mental Health
• Obstetrics
• Administration Duties
Medical support
• Nursing Workforce
• Call/practice Coverage
• Perception of Quality
• Specialist Availability
Hospital and Community Support
• EMR
• Welcome & Recruitment
• TelevideoSupport
• Plan for Capital Investment
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Where did these factors come from?
• Idaho Family Medicine Residency – Dr. Dave Schmitz
• Boise State University– Dr. Ed Baker
© 2015 3RNet April 2015 | 79
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Geographic Factors
• How does geography make rural recruiting different?– Have you ever used “town has a grocery store” as a selling
point in an urban area?
• Sample factors: schools, religious/cultural opportunities,
spousal satisfaction
• What types of candidates do strengths in these factors
matter to?
© 2015 3RNet April 2015 | 81
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Example – Geographic Factors
• Access to a larger community– Advantage: Loan repayment, outdoors, and 40 miles to a
large city.
– Challenge: No specialty shopping/restaurants, 2 hours to
large city on tough roads
– Solutions: shared transportation, weekend scheduling,
online options, bring services to you
• Despite geography, how can we get rural providers what
they need?
© 2015 3RNet April 2015 | 82
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Economic Factors
• How does compensation make rural different?– Its all about quality of life/compensation balance
• Sample factors: loan repayment, income guarantee,
competition
• What advantages does rural have economically?
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Example – Economic Factors
• Part-time Opportunities– Advantage – flexible, offer part time
– Challenge – need full time
– Solutions – job sharing, multiple recruits
• Can rural offer the flexibility newly trained physicians are
looking for?
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Scope of Practice Factors
• What are we asking rural physicians to do?– Clinic, ER, nursing home, impatient, mental health,
supervise NPs/PAs, and administration?
• Sample factors: OB/C-section, endoscopy, teaching
• Offer, but don’t require
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Example – Scope of Practice Factors
• Mental Health– Advantage – not required, specialists available
– Disadvantage – isolated, lack of referral options
– Solutions – telehealth, allied providers, psych NPs
• What do rural physicians want to do?
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Medical Support Factors
• How is a physician’s practice supported in rural?– Team based care? I’m the only provider here!
• Sample factors: transfer arrangements, EMS, ancillary
staff
• Trained in urban, practicing in rural
• Onsite, virtual, traveling
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Example – Medical Support Factors
• Specialist availability– Advantage: onsite, visiting, or virtual access
– Disadvantage: no access
– Solutions: telemed, partner relationships, professional
contacts
• How can we make sure physicians don’t feel isolated in
rural?
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Hospital and Community Support Factors
• How does the community support the physician?– Cookies at the doorstep, urban vs rural
• Sample factors: hospital leadership, EMR, internet
access, welcome and recruitment program
• Something urban usually can’t offer
• A rural physician is greatly appreciated, and often a pillar
of the community
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Example: Hospital and Community
Support Factors
• Physical plant and equipment– Advantage: nice facility, good technology
– Disadvantage: older facility, lack equipment
– Solutions: plans for capitol investment, fundraising,
candidate as champion
• Why is it important for candidates to feel valued in rural?
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Montana advantages
-8.00
-6.00
-4.00
-2.00
0.00
2.00
4.00
6.00
8.00
Mea
n S
core
Top 10 Factors- Apgar
Overall
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Montana challenges
-8.00
-6.00
-4.00
-2.00
0.00
2.00
4.00
6.00
8.00
Mea
n S
core
Bottom 10 Factors- Apgar
Overall
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So what does this mean?
101
• What do physicians want?
• It depends.
• By knowing your strengths, you can target
specific groups of physicians those
strengths are desirable to
• If your strengths don’t align with your
ideal, changes must be made
Scope of
Practice
Salary Outdoors Call
Schedule
Loan
Repayment
Services Physical
Plant
Part
Time
Telemed
Hospital 1 X X X X X X X
Hospital 2 X X X X X X
Hospital 3 X X X X X X
Hospital 4 X X X X X X X
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Takeaways:
• Recruitment is a process
• Leverage collaboration– 3RNet, SORH, PCO, PCA
• Identify and communicate strengths
• Invest in challenges
• 3RNet Manual/Factors book
© 2015 3RNet April 2015 | 102
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Thanks for coming…
• 3RNet Manual
• Why Rural is Different Factors Book
• Available for viewing until October 15th, 2015
• 3RNet.org/MTRS– Password: montana15
© 2015 3RNet April 2015 | 103
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Questions?
– Mike Shimmens, Executive Director• [email protected]
• 1-800-787-2512 ex 2
– Mark Barclay, Director of Member Services• [email protected]
• 1-800-787-2512 ex 1
