Workforce shortages plague rural hospitals, legislation to address it stalls

This story is republished from The Daily Yonder. Read the original article.

With 2023 being the least productive year in Congress since 1933, legislation that could help rural hospitals with their workforce issues continues to wait for any action by lawmakers.

Advocates for rural hospitals and healthcare facilities say that workforce issues are one of the biggest challenges facing rural healthcare facilities currently.

Brock Slabach, COO of the National Rural Health Association, said the cost of the rural healthcare workforce is one of the things putting strain on the rural healthcare system. With pandemic-era assistance gone, inflation has had an impact on wages which further strains rural hospitals’ ability to make ends meet, he said.

“That’s obviously a big concern,” he said in an interview with the Daily Yonder. “Good robust funding for the National Health Service Corps, and things like student loan repayment programs through the Rural America Health Care Act - there's a lot of different bills that we're looking at out there that will definitely help in terms of going forward.”

While several Congress members have proposed legislation to bolster the rural healthcare workforce, not much has been done to pass them. With 2023 being the least productive year in Congress in almost a century, hundreds of bills are stuck in committee.

Among those bills are more than two dozen in both houses of Congress that would affect the rural healthcare workforce. One, the Rural Physician Workforce Production Act, introduced by U.S. Representative Diana Harshbarger (R-Tennessee), would allow rural hospitals to receive additional payments from Medicare for full-time equivalent residents who receive training in rural areas. Introduced in the House in February 2023, the bill was referred to the House Committee on Ways and Means, and the House Committee on Energy and Commerce, before being further referred to the House Subcommittee on Health, where it has been since February 17 of last year.

According to Kevin Stansbury, CEO of Lincoln Health in Hugo, Colorado, the healthcare workforce challenge is unprecedented.

“I've been in this business almost 40 years, and the combination of Covid with the rapid retirement of the boomer generation has really caused employment stresses unlike anything I've ever seen before,” he said during a podcast from the American Hospital Association “A National Staffing Emergency in Rural Health Care” on December 20, 2023.

Stansbury said the workforce is being pulled away by a number of things. Higher wages with the opportunity to work remotely, or in nearby cities, are increasing rural hospital’s competitiveness for employees, he said.

Another bill, the Rural America Health Corps Act, would establish a student loan repayment program of up to $200,000 for healthcare providers who work in a rural area for five or more years. Introduced in March by U.S. Representative David Kustoff (R-Tennessee), the bill has been in the House Subcommittee on Health since March 31, 2023.

And the Specialty Physicians Advancing Rural Care Act, or SPARC Act, would establish a student loan repayment program of up to $250,000 for specialty medical care in rural areas. That legislation was introduced in the U.S. Senate by Senator Jacky Rosen (D-Nevada) in March 2023 and is currently in the Senate Committee on Health, Education, Labor and Pensions.

“This is a new economy that we're operating in and there's a lot more remote opportunities for people to live in rural and work really around the globe. So, we're facing competition from employers around the world for the same employees that we used to be able to capture around being one of the larger employers,” Stansbury said. “Wages are rising very rapidly. We just don't have the reserves to keep up with that.”

In November, the White House released a number of initiatives it had put into place to develop the rural healthcare workforce pipeline. Among those initiatives were 1,000 medical residencies in rural and underserved areas to be paid for by Medicare. 

The Centers for Medicare and Medicaid (CMS) is working to implement another 200 training slots as part of the Consolidated Appropriations Act of 2023. CMS is also working to expand the rural healthcare workforce by allowing Medicare-funded rural residency training at Rural Emergency Hospitals.

But it’s not just physicians that are needed in rural hospitals, Debra Rudquist, president of Amery Hospital in Amery, Wisconsin, said on the AHA podcast. Nurses, lab techs, radiology techs, and other positions that require technical and professional degrees are in short supply as well. To compete with others looking for those same professionals has meant re-evaluating working requirements.

“We've had to change the way that we offer flexible options for our team members,” she said. “For our certified medical assistants, which is one of the areas of greatest shortage for us in our clinics, we used to primarily hire them to be full time and that meant a ten-hour day, four days a week. And now we're asking them what they want to work and trying to be very flexible and give them the types of hours when we can that meet the needs of them and their families.”

In some cases, said Karen Cheeseman, CEO of Mackinac Straits Health System in St. Ignace, Michigan, the solution may be in providing the remote opportunities that employees are now looking for by switching to telehealth.

The issue will be finding a way to attract more people back to the healthcare field. Working with local colleges and high schools, she said, will be key to getting students into the healthcare workforce pipeline. Still, it will take some work to figure out what that looks like, she said.

“Pre-pandemic professionals had a calling to come into health care, and now I feel as if there's a real level of hesitation,” she said. “How do we get them back in, encourage them that these are rewarding and fulfilling careers?”