Recruiting Providers in an Age of Critical Shortages

By Lisa A. Mark, MD, VP of Medical Affairs/CMO, Thomas Saul, VP of Practice Operations, Emily Campbell, AVP People/Patient Experience

UVM Health Network - Alice Hyde

We are living in what feels like an age of never-ending critical shortages. Whether you are seeking to buy a new vehicle, find baby formula to feed your newborn, surprise your family with a next-generation gaming system, or connect with a primary care provider or medical specialist, the frustration can be overwhelming.

How did we get here? Is this really our “new normal”? What is Alice Hyde doing to adapt and overcome challenges — not just in the current environment, but five, 10, 15 years from now? That last question is one that we will work to answer in some depth, but first let’s set the stage for where we are right now.

We know that health care is experiencing a critical shortage of employees and providers, but why? The ongoing pandemic has played an important part. It has broken supply chains, continues to inflict burnout on our people at alarming rates, created disconnects between our communities and the hospitals which care for them; and has placed unprecedented financial stress on our health care institutions.

Critical shortages of both primary care providers and specialists have been building for decades, and were a major issue even before COVID-19. Shortly before the pandemic struck, the Association of American Medical Colleges (AAMC) finalized projections for its annual report on physician supply and demand. Its conclusions, released later in 2020, remain deeply troubling: a nationwide shortfall of between 21,400 and 55,200 primary care physicians, and between 33,700 and 86,700 specialty care physicians, by 2032.

Both of these trends are especially acute — and problematic — in rural regions such as the North Country. In 2019, Alice Hyde had four open positions on its medical staff, and was actively recruiting for two physicians — a gastroenterologist and an OB/GYN — and two Advanced Practice Providers (APPs).  APPs are medical providers who are trained and educated similarly to physicians, and perform many of the same duties – including performing exams and prescribing medications.

By August of 2022, Alice Hyde was actively recruiting to fill six physician vacancies, spread across our primary care, endocrinology, gastroenterology and orthopedics service lines, and 3 APP vacancies (primary care, cardiology and orthopedics). The provider shortage has also forced our hospital to engage locums physicians — travelers — to a greater extent than ever before, to ensure critical services remain available in our community.

As a result, we are working on multiple fronts to close these provider gaps, re-imagine how our recruitment teams do their work, and build long-term strategies and programs that will support our mission of caring for our community
now and in the future.

Educating the Next Generation of North Country Providers

In 2013, UVM Health Network — CVPH founded its Family Medicine Residency Program (FMR) as a joint venture between the hospital, UVM’s Larner School of Medicine, and Fletcher Allen Health Partners (now known as UVM Health Network). That program has been extraordinarily successful:

• To date, 68 percent (13) of the program’s 19 graduates have remained in the region.
• Alice Hyde is among the institutions which are benefiting. Later this month, the hospital will welcome Dr. Stanley Yang, who graduated the program in 2022, to its primary care team.
• The CVPH-based program is also attracting the next generation of aspiring providers within our community. Dr. Joseph Tousignant, a Malone native, is currently enrolled in the program and will graduate in 2024.

Recruitment, Re-imagined

Giving our recruitment teams the support they need means working with our local, regional and national partners to address our short-term needs, and  build long-term strategies for our future:

• By establishing a Network-wide nurse recruitment team, we are building capacity within our recruitment pipelines and ensuring our recruiters are better-able to focus on challenging or critical recruitment issues.
• By participating in a new initiative led by the Northern Boarder Regional Commission, we are also taking advantage of a new opportunity to recruit providers from other countries through what is known as a J-1 visa. The initiative, which expands J-1 visa eligibility, allows these providers to stay and work in medically underserved areas and during health professional shortages.

Retaining Providers

It is also clear that health care systems must take more responsibility for cultivating and retaining new providers. The FMR works hand-in-hand with long-running efforts across our Health Network to expose medical students to hospitals throughout our region and to the practice of medicine in rural communities. These opportunities expose the next generation of providers not just to our hospital, but to our communities and what it means to be a rural health care provider. Alice Hyde has been one of the earliest adopters of this work:

• Providers like Dr. Paul El Azoury, Dr. William Latrielle, Dr. Prabhjot Manes and Dr. Gerald Cahill host medical students during clinical rotations each year.
• Even during the pandemic, Alice Hyde providers hosted or taught 10 provider students per year as they progressed through our Health Network’s educational programs.

Grassroots Support and Workforce Development

That work goes hand-in-hand with Alice Hyde-led efforts that have been ongoing for many years, and which support health care careers and workforce development in our community and at our hospital:

Alice Hyde Auxiliary scholarships provide thousands of dollars each year to high school and college students pursuing careers in health care.

The hospital’s participation in the New Visions program, which gives high school students hands-on experience in what it’s like to work in health care, allows hundreds of students to get experience working in health care careers. The hospital recently resumed accepting students through New Visions, after pausing the program for more than two years due to the pandemic.

The Alice Center, Alice Hyde’s long-term care facility, hosts a Certified Nurse Aide (CNA) Training Program that offers students full-time employment during and after the completion of their training.

Preparing the next generation of providers, providing opportunities to stay within our Health Network and serve our communities, re-imagining our recruitment process to adapt to the particular challenges of the moment, and continuing to re-invigorate grassroots programs that develop and retain talented health care professionals are all important pieces of this work. It’s a strategy that not only addresses the critical provider shortage, but ensures our providers are prepared to meet the needs of the communities we serve both now and in the future.