HJAR Mar/Apr 2024

DIALOGUE 14 MAR / APR 2024 I  HEALTHCARE JOURNAL OF ARKANSAS It's really a roller coaster ride. While you're going through that roller coaster and hear- ing about all the layoffs, you're still strug- gling to find enough staff to cover all the needs out there. It's really hard to explain to people why we've frozen all these positions, yet we're out there looking really hard for these. We're offering $10,000 bonuses for this, or what- ever, because we need these. There are cer- tain physicians that are very difficult to find, but generically, overall, it's still very difficult to find good workers. I think we're blessed because we have a culture that seems to attract good people, and good people seem to attract other good people. So, we've been, overall, very fortunate as far as where we are, but it's still a struggle every day. Editor I know running a hospital, much less a rural hospital, is not an easy job. Do you have residents at your hospital? Peterson You know what? We do not. We have looked a few times. We're looking right now at whether we should start a residency program. It's a step that we would like to take, but we also see the expense associated with it, so we just haven't taken that step yet. Editor Why would it cost you money to start a residency program? Peterson There are several factors, but one is it requires a building. If you don't have the required facilities, then you're going to have to either remodel or build a new building, so there's some capital expense. The second thing is that, as far as the operations, and probably the simplest way I could put it is, you front all the cost. Then, you operate it for a year. Then, you put it on your cost report. About six months after you submit your cost report — the full process takes about six months — the government is going to reimburse you for that first year of operations. After that first year, you might be a year behind, but every year it's going to come. It's good and it's there, but that first year, you're basically fronting that cost. So, you have that first-year cost and some capital costs, which creates a little bit of a barrier for a hospital that has as tight of margin as we have. Editor Did your reimbursement go down, too? Peterson No, our reimbursement would not go down. As a matter of fact, that's how you start to get some of that money, when you can show on your cost report that you have those expenses. They reimburse you, but it doesn't start until you start showing them those costs. Editor I thought Washington Regional, when I interviewed them a while back, said that to have a residency program, they actually had to go… Peterson They did. They went from, if I remember right, a metropolitan statistical area level of reimbursement to a rural reimbursement area. They had to do that because rural areas can expand their residency program and get reimbursed for it, but metropolitan areas can't. I'm not going to pretend to know all the ins and outs, but I believe they got a grant from the state. They changed their location, so their reimbursement actually went down. But that did allow them to be able to expand and get reimbursed for those programs, so after a couple years, it probably washed out as working for them. Editor Just curious because of the old adage of having residents that "stay where they do their residency." Peterson They stay where they train. There are two very strong statistics out there. I think it's 70% of physicians will live within three hours of the female’s [in a relationship], whether the female's the spouse or whether the female's the physician, home or where they grew up. Then, there's another statistic that kind of conflicts with that — they're independent. There's one that shows about 60% stay where they're trained. So, training in a rural environment would definitely help with recruitment and help with keeping the physician supply up. It's no question. Editor Rural health primary care doctors wear a lot of hats that doctors in cities do not. What do you think makes a good rural health physician? Peterson I think what makes a good rural health physician is somebody who, firstly and critically, does have the proper training, but then who is genuinely concerned about “ “… across the industry, you're seeing layoffs because hospitals can't afford the same number of people they did before to take care of that same number of people. The wages have gone up so significantly, and yet, the reimbursement has not followed.”