Addressing Workforce Shortages

According to a June 12 blog posted by the Association of State and Territorial Health Officials (ASTHO),, rural communities not only tend to have fewer physicians, nurses, specialists, and other healthcare workers, but also face higher rates of chronic disease, mental illness, and obesity than their urban counterparts.

As a result, healthcare personnel working in shortage areas often experience isolation from their peers and burnout since they see a greater number of patients and work longer hours than personnel in non-shortage areas.

State and territorial health officials and their Primary Care Offices (PCO) are working with federal partners to provide training and tools for providers and residency students currently working or looking to work in underserved areas.

PCOs also manages data collection regarding Healthcare Provider Shortage Areas (HPSA). State legislatures are attempting to reduce gaps in the available healthcare workforce through a variety of measures. These measures include passing legislation to increase provider recruitment and retention programs to appropriate funding for healthcare workforce development programs.

ASTHO reports that several states are currently introducing and passing legislation. For example, in April 2019, Washington State enacted a law to increase access to primary care by establishing the International Medical Graduate Workgroup consisting of governor-appointed members that represent the department of health, health insurance carriers, community, and migrant health centers.

The workshop will study barriers to practice for international medical graduates and make recommendations on how the state can implement an international medical graduate assistance program by January 1, 2022.

In addition, the state enacted a law in May 2019 to establish the Washington Health Corps, a program to provide loan repayment and conditional scholarships to health professionals in return for completing a commitment to work in underserved areas of the state.

Also, the California Senate passed Assembly Bill 1759 in May 2019 requiring the Office of Statewide Health Planning and Development to allocate funding for four programs to increase the healthcare workforce in rural and underserved areas.

The funded programs focus on increasing the diverse pool of students pursuing careers in healthcare, and how to expand recruitment and training for students from areas of the state with a large disparity in patient-to-doctor ratios. In addition, the goal is to expand recruitment for students from underrepresented and low income backgrounds. Two additional programs focus on expanding the number of primary care physicians and psychiatry residency positions in HPSAs.

In May 2019, both chambers of the Alaska State legislature passed a bill to provide student loan repayments and direct incentive payment to eligible healthcare professionals. This bill would also authorize the Commissioner of Health to appoint an advisory council to advise the Department of Health on the program.

This advisory council would also provide oversight and evaluation for the program to include identification and monitoring of underserved and professional shortage areas, eligible sites, and provide program data management.

Hawaii’s Senate and House passed S.B.1404 May 2019 to expand the state’s loan repayment program to include additional eligible healthcare professionals who serve in federally designated HPSAs or in other rural or underserved areas of the State.

Lastly, Iowa enacted a law in May 2019 to provide opportunities for residency students to participate in rural rotations for exposure to rural areas of the state. The University of Iowa will also conduct a physician workforce study on workforce challenges related to recruitment and retention of primary care and specialty physicians, examine current and projected physician workforce data by regions within the state, and analyze the availability of residency positions with an emphasis on the need for recruitment and retention of physicians in rural Iowa.

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