Idaho Family Physician Rural Workforce Study: The Community Apgar Questionnaire

1. Idaho Family Physician Rural Workforce Study:The Community Apgar Questionnaire Mary Sheridan Idaho SORH December 9, 2008 Written reports available at www.ruralhealth.dhw.idaho.gov

2. Background 2006 American Academy of Family Physicians report identified Idaho as one of five states expected to experience a serious shortage of family medicine physicians by 2020. Overall state population growth and increasing number of senior citizens Other states include Nevada, Arizona, Florida, and Texas

3. Background Access to physicians extremely limited in Idaho Idaho ranks high in number of physicians age 55 and older 97% of the state is a primary care HPSA Ranks 49 of 50 for rate of physicians: 200 per 100,000 population

4. Background Contract with Boise State University and Family Medicine Residency of Idaho to conduct a three-year study on recruitment and retention of family medicine physicians in rural Idaho Years 1 and 2 complete; year 3 about to begin

5. Background Contributors, supporters, and partners Family Medicine Residency of Idaho (FMRI) Boise State University (BSU) Idaho Hospital Association (IHA) Idaho Academy of Family Physicians (IAFP) Funding SORH/Flex grants In-kind: FMRI, BSU, IHA, IAFP

6. Background Year one: Written survey of family medicine physicians and hospital CEOs in rural counties Select CEO findings: satisfied with family medicine staff, report their physicians spend 32.6 hrs. on-call and spend 37 hrs. on direct patient care per week Select physician findings: satisfied and have broad scope of practice, report they spend 40 hrs. on-call and spend 44.3 hrs. on direct patient care per week

7. Year Two Develop an objective measurement tool to identify characteristics that may predict success or failure of a community’s ability to recruit and retain family practice physicians. Community Apgar Questionnaire (CAQ) Apply the questionnaire through structured interviews with CEO and lead physician by experienced rural family physician (FMRI rural director) at 11 CAHs

8. Community Apgar Questionnaire (CAQ) Survey Design 5 Classes: Geographic Economic Scope of Practice Medical Support Hospital and Community Support Each class includes 10 factors Total of 50 questions (factors) representing specific elements related to recruitment and retention of family medicine physicians in rural areas

9. Class and Factor Examples Geographic class: Schools, climate, patient mix, perception of community, spousal satisfaction Economic class: Loan repayment, salary guarantee, revenue flow, income guarantee Scope of practice class: Obstetrics, nursing home, C-sections, endoscopy/surgery Medical support class: Nursing workforce, EMS, call coverage, perception of quality Hospital and community support class: Physical plant and equipment, Internet, hospital leadership, EMR

10. Process FMRI director, Dr. David Schmitz, traveled to 11 CAH communities CEO and lead physician interviewed separately and asked to rate each factor as an advantage (major or minor) or challenge (major or minor) to the community Each factor also rated by importance (very important, important, unimportant, very unimportant)

11. Data Analysis Major advantage +2 Minor advantage +1 Minor challenge -1 Major challenge -2 Very important +4 Important +3 Unimportant +2 Very unimportant +1