OPCA has multiple avenues of support for Oregon's Community Health Centers in regards to recruitment and retention through a variety of partnerships and initiatives, including the Oregon Recruitment and Retention collaborative with the Oregon Primary Care Office, the Region X Collaborative (Region X is a federally-defined geographic area that covers the northwest states of Alaska, Idaho, Oregon and Washington. In addition to OPCA, four additional primary care associations operate in Region X as well as four Primary Care Offices) and the Northwest Regional Primary Care Association, which hosts updated recruitment and retention resources on their site.
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OPCA has partnered with the Oregon Office of Rural Health, which provides Community Health Centers with a variety of tools and services to help recruit various types of providers for both urban and rural sites.
The Office of Rural Health (ORH) has a full time recruiter who works with Oregon practice sites to market their opportunities and communities to health care providers and their families nationwide. ORH has access to thousands of providers interested in practicing in Oregon’s rural communities through our membership in the national nonprofit Rural Recruitment & Retention Network (3RNet) and academic institutions. ORH promotes rural and frontier Oregon communities, lifestyle and practice opportunities through various social media outlets. ORH connects interested providers with practice opportunities and informs them of available incentive programs. For more inforation on this recruitment and techincal assistance offered through ORH, please visit their website.
National Health Service Corps: The National Health Service Corps (NHSC) offers loan repayment programs for primary care providers. This program is open to licensed primary care medical, dental, and mental and behavioral health providers who are employed at an NHSC-approved site and began work by July 15, 2014. Awardees receive up to $50,000 in exchange for two-years of service if they practice in a Health Professional Shortage Area (HPSA) of 14 and above (Tier I). Awardees can also receive up to $30,000 in exchange for two-years of service if they practice in a HPSA of 13 and below. In FY2013, all of the NHSC's loan repayment awards were made to providers located in a Tier 1 HPSA. There were a total of 4,505 awards made (2,106 new and 2,399 continuations) totaling $169.7 million.
In recent years, the NHSC has become better at tracking any potentially conflicting employment contract obligations to assure compliance with the Loan Repayment statute. Some CHCs have expressed concern with this renewed focus.
The NHSC program recognizes the importance of allowing signing bonuses for both the Loan Repayment and Scholarship program for the following reasons:
• It is an contractual issue between the employee and employer
• It is an industry standard in health care
• It is sometimes simply a signing bonus without an obligation
• It may involve an employment obligation, but not a service obligation
• NHSC employees cannot receive different compensation by their employer due to their LRP status/service obligations
Examples of contract language being denied include requiring the applicant to remain employed at a certain site in exchange for receiving a signing bonus and/or relocation allowance.
To assure an applicant's eligibility and/or retention at your CHC, you may want to consider the following:
1. CHCs can include the following language in their employment contracts and this has been satisfactory to the NHSC and State Loan Repayment programs: "Any obligation to the CHC is waived if accepted into the NHSC or State Loan Repayment program."
2. Additionally, should a Loan Repayment recipient decide to stay at your CHC beyond their NHSC contracted Loan Repayment period, CHCs may want to revise the employment contract and offer a "retention bonus" as an added incentive.
Oregon Area Health Education Centers (AHEC): The Area Health Education Centers Program is a partnership between OHSU and Oregon communities. Its purpose is to improve the education, training and distribution of health care professionals in Oregon through a statewide network of centers.
The Oregon Primary Care Office: Under the Primary Care Office Agreement with the U.S. Health Resources and Services Administration (HRSA), the Primary Care Office works to improve primary care access and reduce health disparities for low-income and vulnerable Oregonians.
Through this agreement, OHPR submits an application for three types of federal designations from the Bureau of Health Professions, Shortage Designation Branch:
- Health Professional Shortage Areas (HPSA)
- Medically Underserved Areas (MUA)
- Medically Underserved Populations
These designations target millions of dollars of federal resources to improve health care in underserved areas of the state. We estimate these designations bring in over $20 million per year in unmatched federal resources.
The Oregon Primary Care Office is available to FQHCs in Oregon to help FQHCs understand and improve their HPSA scores, which are used by HRSA to determine eligibility for loan repayment programs and other recruitment tools that are valuable for sustained Community Health Center operations.
To learn more, contact Marc Overbeck.
STAR2Center: The STAR² Center is a project of the Association of Clinicians for the Underserved (ACU). In July 2014, ACU received a national cooperative agreement to develop a clinician workforce center for recruitment and retention at community health centers. In partnership with the federal Bureau of Primary Health Care, ACU created the STAR² Center (pronounced Star Center) to provide free resources, training, and technical assistance to the health centers facing high workforce need.
If you have any questions or suggestions, please contact Allison Abayasekara at 844-ACU-HIRE.
At OPCA, we believe that the best way to retain quality staff is through staff engagement; therefore, the primary focus for OPCA's technical assistance around retention is vis-à-vis staff engagement, specifically, helping Oregon Community Health Centers understand:
- How staff engagement is linked with staff retention
- How to measure staff engagement
- When to measure staff engagement
- How to analyze the results of staff engagement surveys
- How to use the data collected from staff engagement surveys to increase staff engagement (and retention)
OPCA can provide technical assistance to health centers interested in measuring and improving staff engagement.
If your health center is interested in learning more about staff retention through staff engagement, please contact OPCA's Claire Tranchese.
It is a longstanding and widespread practice for physicians to retain substitute physicians to take over their professional practices when the regular physicians are absent for reasons such as illness, pregnancy, vacation, or continuing medical education, and for the regular physician to bill and receive payment for the substitute physician's services as though he/she performed them. The substitute physician generally has no practice of his/her own and moves from area to area as needed. The regular physician generally pays the substitute physician a fixed amount per diem, with the substitute physician having the status of an independent contractor rather than of an employee. These substitute physicians are generally called "locum tenens" physicians.
Section 125(b) of the Social Security Act Amendments of 1994 makes this procedure available on a permanent basis. Thus, beginning January 1, 1995, a regular physician may bill for the services of a locum tenens physicians. A regular physician is the physician that is normally scheduled to see a patient. Thus, a regular physician may include physician specialists (such as a cardiologist, oncologist, urologist, etc.).
Payment rules for locum tenens vary by payor and Health Centers should consult with each payor to determine the acceptable billing processes. Medicare has published their rules here.
Recruitment & Retention Plans
One of the keys to success for Community Health Center recruitment and retention is to have a plan. Fortunately, NACHC has developed an excellent toolkit for this very purpose. Additionally, HRSA has provided grantees with a sample plan to be adapted to meet the specific needs of health centers.
The Community Health Association of Mountain Plains States (CHAMPS) has developed very robust recruitment and retention resources, including a sample workplan. You are encouraged to alter the document to serve the individual needs of your organization.
Please click HERE to view, alter, save and print the workplan.