A greater focus on developing new healthcare education programs at community colleges would be key to supplementing rural hospital workforces in Oregon, according to experts.
Rural health representatives discussed the challenges those facilities face at the 2023 Oregon State of Reform Health Policy Conference. Health Management Associates Principal Dr. Jeanene Smith referenced an Oregon Office of Rural Health (ORH) report that states that 35 percent of Oregonians live in rural or frontier communities, and rely on physicians, physician assistants, and acupuncturists who provide care locally.
“That’s a fairly large percentage of our state that often is not always considered as much as the metro, urban areas,” Smith said. “Many of the issues we’ll talk about today are issues in both the urban and rural setting, but predominantly more of a problem in rural communities.”
Dr. Lesley Ogden, CEO at Samaritan North Lincoln Hospital and Samaritan Pacific Communities Hospital, said rural hospitals have always had workforce recruiting challenges, but they were exacerbated during the COVID-19 pandemic.
“Then COVID comes along, and we have 20 percent of our workforce, across the board, leaving,” Ogden said. “What we’re left with now is workforce shortages across healthcare that are quite dramatic. We spend a lot of time focusing on doctors and nurses. But what we’re finding now is a healthcare shortage across the board. I have just as much need for an imaging technologist. Sometimes they’re harder to find than a doctor or a nurse.”
Ogden said rural hospitals will need to focus on several areas to entice people to work in rural areas, including loan repayment, tax credits, workforce development programs in rural areas, and the development of new programs in community college systems.
“Our four-year universities cannot develop the workforce we need,” Ogden said. “They don’t have the capacity. We have to have more, broader educational programs from the ground up. We know people stay where they’re educated, where they grow up, if they can find those educational opportunities.”
ORH Director Robert Duehmig agreed with Ogden.
“Our four-year institutions are not structured in a way to respond to this kind of need. So community colleges need to be at the table more. If I’m growing up in Astoria, and I want to be a lab tech or a (medical assistant), I’m not going to go to the (University of Oregon). I need to know that my community college is offering those programs. Or that my workforce investment board is. They’re not a salary position that you would go off to get an education for from a four-year (school). You do it locally, and you would stay there.”
— Duehmig
Duehmig said more can be done at the K-12 education level to attract students to the health sector as well.
“Look at our K-12 system,” Duehmig said. “We do not encourage kids to go into science in K-12. We should look at a way to make sure every high school graduate can graduate with an EMT basic license. Then they’ve got that sense that science and healthcare is something they can do in their community. They can move up to (be) a paramedic, to work in a hospital.
Hospital operating costs continue to rise as well, Ogden said. While the COVID-19 pandemic required the employment of many travel nurses, her hospitals continue to employ more travelers than before the pandemic, she said.
“So our labor costs shoot up,” Ogden said. “This is still much higher than we are used to paying for our workforce.”
The ability to provide employee compensation that attracts workers to hospitals rather than other businesses is also a barrier.
“McDonald’s is paying $20 an hour for minimum wage and you, as a healthcare entity, are struggling to figure out how to get a minimum wage of $15 an hour. I want to get there, and pay my people more, but how am I going to do it? Labor costs start getting larger and larger. At the end of the second quarter, half our rural hospitals in Oregon did not make enough to cover their costs. And some were way beyond even getting close. And that is a really scary place to be.”
— Ogden
ORH administers the Rural Insurance Subsidy program, which supports rural healthcare workforces by providing partial payments to authorized medical professional liability insurance carriers on behalf of providers who would otherwise have to pay for the full cost of malpractice insurance.
“We will pay a subsidy for providers under liability insurance,” Duehmig said. “When that first came about 15-18 years ago, it was focused on (obstetricians) because we were already challenged with keeping (them) in rural communities. It’s expanded out to cover rural providers that meet certain requirements. It’s generally nurse practitioners and physicians in rural communities. Fewer physicians and providers are independently employed, and independently paying (for) their own liability insurance.”