Health Care: Filling Tennessee's Needs

Health Care: Filling Tennessee’s Needs

By Dena Owens

Access to quality health care can seem like a luxury to residents of underserved communities.  Difficulties accessing services can be frustrating, to say the least and life threatening at their worst.  Fortunately, there is an organization that connects physicians with underserved patients in rural and economically challenged urban sections of Tennessee — the Rural Partnership.

An effort that began in 2006, the Rural Partnership matches resident physicians with practice opportunities in Tennessee’s rural and inner-city areas.  Public and private sector collaboration, financial incentives, and other strategies are used to meet this challenge.  The organization is funded by TennCare, the state’s health insurance plan.

During the past year, the program placed 11 physicians in underserved rural and urban areas.  After recently completing a two-year statewide assessment, the Rural Partnership identified 372 vacant positions for doctors in Tennessee.  It is essential to recruit residents to fill this large number of vacancies.

“We have 104 physicians registered with the Partnership,” said Rural Partnership board secretary, Mary Ann Watson, assistant dean for Graduate Medical Education at the University of Tennessee Health Science Center.  The Partnership’s recruitment strategies are developed by a statewide board and by Cindy Siler, its chief executive officer.

“One of the most effective marketing tools we have is word of mouth,” said Siler.  “We meet personally with community groups, residents, and seasoned physicians throughout Tennessee.  In resident presentations, we provide photos of places where opportunities exist.  We discuss the types of practice environments available such as community health centers, critical access hospitals, health departments, and private practices.  We direct residents to our Web site for program details,”

The Partnership offers a stipend to recruit residents for the matching process.  It is available to residents enrolled at one of four medical schools in Tennessee:  the University of Tennessee Health Science Center, Meharry Medical College, East Tennessee State University, and Vanderbilt University.

Stipend recipients amass $25,000 a year for three to four years of residency in exchange for practicing full time in an underserved area for each year the income is awarded.  This incentive is provided in addition to the resident’s compensation.

The Rural Partnership has awarded eight stipends since 2006.  One recipient, Dr. Marc Courts, is a pediatrician in Loudon, Tennessee.

“The stipend got me started, but I receive far more in continual smiles and gratitude as I serve children previously deemed underserved,” Courts said.  “I get rock solid support from the Loudon community and from my partners who are as sharp and dedicated as any physicians I’ve ever met.  I also benefit from the Rural Partnership team that still calls or stops by to see if I need anything.”

Since the state of Tennessee offers fewer stipends compared to other states, the organization anticipates the need for more financial incentives.  To respond, the Partnership is working with the Tennessee Department of Health on two related initiatives. First, they plan to reactivate the Loan Repayment Program, which provides funds that help physicians in underserved areas repay student loans.  Second, they are attempting to reinstate Practice Incentive Grants, funds that help rural communities support the establishment of a medical practice.

The Rural Partnership has placed doctors in rural or urban underserved areas in 11 Tennessee counties:  McNairy, Greene, Marshall, Meigs, Hawkins, Loudon, Monroe, Dickson, Fayette, Davidson, and Shelby.

“Every community we’ve visited has been pleased with our approach and accommodating of the minimal participation fee,” said Siler.  Community providers pay an annual fee of $500 to obtain locator services.  Once a physician is secured, providers pay a placement fee between $500 and $8,000 based on community size and/or the size of the medical entity.

The greatest challenge facing the Rural Partnership is the growing physician shortage in Tennessee and the entire nation. Gathering community statistics is also challenging.  The State Department of Health identifies federally designated areas with physician shortages or a lack of health care resources.  To supplement this data, the Partnership obtains its own demographic information directly from communities.  The Partnership conducted a two-year Health Care Professional Demand Assessment to determine specific practice openings.

“Until we had the results of this assessment, we did not have a way to identify true practice opportunities throughout the state,” Siler said.  “We want to visit all possible sites to gather adequate data and ensure the ‘perfect placement.’ ”

Building relationships with individual residents is a complex but fun program task.  Residents are bombarded with invitations about positions throughout the nation.  So, to remind those who perform residency outside of Tennessee about the Rural Partnership’s opportunities, residents are entered into a tracking system and receive periodic communication.

As community visits increase, so do requests for other types of health care providers.  Many areas need advanced practice nurses, mental health professionals, and dentists.  But for now the Partnership’s TennCare funding is designated only for placing primary care physicians.  As concerns for other types of medical placements grow, the organization may consider addressing these needs.

Strong stakeholder relationships with TennCare, the Tennessee Department of Health, the Tennessee Hospital Association, the Tennessee Primary Care Association, and the Rural Health Association of Tennessee enhance the Partnership’s services.

To retain physicians, the Partnership will continue to promote incentives for practicing in rural or inner-city communities.  Rewarding experiences await those who want to meet the challenge — a lower cost of living, community appreciation, and cultural diversity can provide a desirable lifestyle for physicians who choose to practice in underserved areas.

To learn more about the Rural Partnership, visit