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Help Wanted: Rural Safety Net Clinics Struggle to Attract Physicians

From rugged mountains to grassy plains, there is a landscape for every taste and every Coloradan.

Rural and frontier geographies also face unique and varied health issues, especially when it comes to caring for their most vulnerable residents. And rural health care providers — including certified rural health clinics and community safety net clinics —are on the front lines of providing that care.

Safety Net Clinic Week, hosted this week by the Colorado Rural Health Center (CRHC), is a good time to examine these challenges. With the help of Kelly Erb and Ashley Mills from CRHC, we decided to take a deeper dive into issues facing rural safety net clinics. We asked them three questions.

Question: We know that it is often difficult for rural clinics to attract and retain clinicians. What innovative approaches are being used to fill this gap?

Answer: For its part, CRHC plays “matchmaker” for rural clinics and providers. Using a database of rural clinics that have expressed a need for more providers, CRHC pairs them with students and providers that have shown interest in rural medicine early in their careers.

Another major effort in place to help place physicians in rural clinics is through the National Health Service Corps, which provides student loan repayment to physicians who practice in provider shortage areas. This program is up for reauthorization on September 30, which has some rural clinics worried about being able to recruit physicians in the future.  The state also sponsors its own Colorado Health Service Corps which functions similarly to the federal program.

CRHC recently worked with the state legislature to pass HB16–1142, a preceptor tax credit which compensates rural physicians for supervising medical students completing their training in rural areas.

Question: We also know that the opioid crisis has hit rural communities particularly hard. How are rural clinics responding? How is the provider shortage in this field being dealt with?

Answer: One of the best steps clinics have taken to help combat the opioid crisis has been improving prescription protocols to help prevent substance abuse disorder. By reducing the frequency and number of prescribed opioids, clinics can help prevent individuals from becoming addicted to opioids.

Unfortunately, there is still a shortage of providers to care for those individuals who already have a substance use disorder. One potential option would be to extend programs like the Colorado Health Service Corps or CRHC’s matchmaking program to include licensed addiction counselors.

Question: What other issues should be on our radars about rural health in Colorado?

Answer: Financial sustainability is always an issue for rural safety net clinics. Because they don’t rely as heavily on federal grant money, rural health clinics are not as beholden to federal reforms as their counterparts, the federally-qualified health centers, but they still have concerns.

For instance, the Medicaid expansion has provided health insurance to thousands of Coloradans, which means more sustainable revenues for safety net clinics. This has allowed them to expand their services and hire more providers. Federal reforms to Medicaid could put these expansions in jeopardy.

Another concern for rural safety net providers has been regulatory barriers to expanding their services. The push to integrate dental and behavioral health services has never been greater, but some obscure zoning and regulatory barriers are making it hard for small clinics to keep up. One example is the need for separate entrances for each specialty that occupies a building. For small rural clinics, this might not be possible, and stands in the way of providing care to patients.

Here at CHI, this is our bottom line. Safety net clinics, both rural and urban, fill a critical gap in caring for the state’s most vulnerable populations. But without the providers and financial stability to keep them afloat, patients in rural areas could find themselves with nowhere to go or long(er) distances to travel.