Before the COVID-19 pandemic, the term provider shortage was white noise to many healthcare professionals. They knew it was an issue, they knew it impacted patients, but the shortage seemed baked into the healthcare landscape – impossible to fix. And because shortages are the most extreme in rural areas, big hospital systems rarely felt the pinch. Then the pandemic hit and those staffing shortages became life or death as ICU wards turned into hellscapes and hospital staff faced brutal decisions.
The national provider shortage isn’t going away. In fact, 209 United States counties face “potentially dangerous shortfalls of intensive care unit doctors” right now, according to a new Health Equity Workforce Research Center analysis. Even when the pandemic recedes, the lack of qualified medical personnel will continue to hit rural and tribal communities especially hard. Considering that American Indians face shorter life spans and experience higher rates of conditions such as stroke, cancer, diabetes, and hypertension, these shortages are an ongoing crisis in Indigenous areas.
But there are several staffing solutions that can help.
Rural Barriers, Limited Care
According to a 2018 report from the U.S. Government Accountability Office, Indian Health Service (IHS) clinics have an average provider vacancy rate of 25%. One reason: 63% of primary care shortage areas are rural. More than half of American Indians live in rural areas, according to the First Nations Development Institute. It can be tough to recruit and retain providers at rural facilities, due to lower pay, limited medical equipment, and the remote location. In fact, IHS has an estimated 46% turnover for their physicians every year.
But while a fresh supply of additional clinicians is a definite boon, it’s not the only answer. IHS provides services to 2.2 million Native American people, but often lacks funding for emergency rooms or MRIs or telemedicine. Creating a new, functional emergency department or providing ongoing specialty services usually requires more expertise and long-term oversight than a temporary assignment of locum tenens providers can deliver on their own. The same holds true for delivering positive and consistent patient-provider relationships – the kind required for patient education and the management of chronic conditions.
What does work: 4 components in a holistic, multi-pronged approach.
Culturally informed care
Too many staffing agencies send in providers and call it a day. But that just doesn’t work for the patients or the providers trying to manage a new environment on their own. It’s crucial to prepare new staff with cultural knowledge so they can build trust by demonstrating respect. An NPR poll found that 23% of Native Americans experienced discrimination when going to the doctor or health clinic. Health professionals must understand Indigenous communities’ traditions, beliefs, and way of life to align their care delivery with their patients’ needs.
Clinical oversight
Fresh providers can offer a massive advantage, but systemic change requires fresh strategies. Clinical oversight in the form of chief medical and nursing officers, and medical directors, can improve quality initiatives and design process changes that elevate outcomes across a rural facility. Metric-driven improvements not only improve patient safety, but help hospitals stay open, meet compliance regulations, and achieve accreditation.
Community pipeline development
Managing a parade of outsiders streaming in and out of the community isn’t a long-term solution. A core of local health professionals who live in the communities they serve is infinitely better. Unfortunately, Native Americans represent only 0.4% of the physician workforce. This is why Dr. Mary J. Owen, director of the Center of American Indian and Minority Health and the University of Minnesota Medical School, said, “Effective recruitment and retention of American Indians and Alaska Natives into medicine and other health careers to increase our numbers are paramount.” Does that take time? Yes – but hiring community residents as medical assistants and paying their tuition for degree programs is a right-now solution that boosts local economics and increases healthcare literacy.
Onsite education
Medical staff at rural and tribal facilities face a common conundrum. Because their teams are understaffed, it’s hard to take time off to pursue a new certification or attend clinical training. The nearest teaching hospital or clinic is usually hours away or even in another state. Travel can entail not only missing their hospital shifts but finding childcare or eldercare. As a result, staff skillsets can quickly become limited or outdated.
Instead, many rural facilities are hiring outside expertise to provide onsite medical education and professional development. The staff learn new clinical skills and care delivery methods without missing a beat in their scheduled shifts, and the community gains new confidence in their local facility.
Improving Provider Shortages in Rural and Tribal Communities
Staffing shortages, like the care disparities that often accompany them, are the result of numerous systemic issues facing tribal communities. No, they won’t be solved overnight. But the above solutions can be implemented now – and help put rural and Native American communities on a more sustainable track to stronger healthcare outcomes.
