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Rural Health Information Hub

Telehealth Models for Promoting Workforce Recruitment and Retention

In rural communities that are facing shortages of physicians and specialists, telehealth can be used as a tool to promote workforce recruitment. For example, telehealth models can allow rural communities to implement alternative staffing models. Many telehealth programs allow advanced practice clinicians, technicians, and other healthcare workers to practice at the top of their license while receiving remote supervision from a physician or other clinician. Depending on the telehealth model, supervising clinicians may watch a live video feed, review patient records, or communicate with rural staff via telephone.

In addition, younger providers who have been trained in the use of health information technologies may be more encouraged to practice in a rural facility that has telehealth infrastructure in place. Providers who are unwilling to relocate to rural areas may also be willing to telecommute on a part- or full-time basis. The Center for Health and Research Transformation's report, Behavioral Health Workforce in Rural America: Developing a National Recruitment Strategy, found that offering behavioral teleconsults through initiatives like Project ECHO helped recruit providers who were not comfortable with addressing behavioral health issues alone.

Telehealth can help retain rural healthcare workers by facilitating contact with other providers, decreasing feelings of isolation, and offering opportunities for continuing medical education. Receiving additional support from other professionals may help rural providers avoid burnout. For example, telehealth consultation services can help alleviate the workload of rural providers who are expected to perform multiple functions because of workforce shortages. One study of rural clinicians and hospital administrators found that tele-emergency services helped recruit and retain family practice physicians by distributing the responsibilities of being on-call for emergency services.

Examples of Recruitment and Retention through Telehealth

  • The Humboldt General Hospital EMS Rescue service in rural Nevada uses telehealth to help train and recruit employees and volunteers. The rescue service partners with the Great Basin College Emergency Medical Services Program to provide training to local Humboldt staff and volunteers through videoconferencing. In turn, Humboldt offers work experience placements to Great Basin students. Humboldt has successfully recruited and hired Great Basin students after they completed their program.
  • Acadia Hospital, part of the Eastern Maine Healthcare Systems, uses telehealth to provide 24/7 psychiatric consultations to medical providers at rural emergency departments. The telepsychiatry program has helped to address long-standing challenges to recruiting qualified behavioral health providers in rural Maine. Providers are more willing to join Acadia Hospital because of the opportunity to practice remotely. In addition to psychiatrists and psychiatric nurse practitioners who are based in Maine, the program also includes psychiatry staff from Massachusetts and Indiana.
  • Avera Health in South Dakota found that using teleconsulting for emergency and trauma cases helped advance practice clinicians practice at the top of their licenses with remote supervision, which helped alleviate the need for physicians to be on call. The improved call schedule helped the health system with recruiting providers.

Implementation Considerations

Programs seeking to staff specialty services with technicians or advanced practice clinicians should be aware of state statutes that regulate remote supervision by physicians. For example, some states do not allow advanced practice nurses to receive supervision through telehealth. Programs may need to consult with state boards of medicine, nursing, and pharmacy to ensure they are in compliance with the latest telehealth regulations. In addition, programs that recruit staff across state lines should be aware of challenges related to licensing and credentialing.

Rural programs looking to recruit pharmacy technicians, dental assistants and hygienists, licensed practical nurses, and other healthcare workers with certificates or associate degrees may seek to build partnerships with local community colleges. Rural programs can offer training experience to students and provide information about telehealth applications. For example, the pharmacy technician program at the North Dakota State College of Science includes telepharmacy models in its curriculum.

Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Funding & Sustainability.

Resources to Learn More

Effect of Tele-Emergency Services on Recruitment and Retention of US Rural Physicians
Describes aspects of tele-emergency care promoting the ability of rural hospitals to recruit and retain physicians, and improve workplace conditions.
Author(s): Potter, A.J., Mueller, K.J., MacKinney, C., & Ward, M.M.
Citation: Rural and Remote Health, 14(3), 2787
Date: 8/2014

Lessons from Tele-Emergency: Improving Care Quality and Health Outcomes by Expanding Support for Rural Care Systems
Summarizes literature on tele-emergency studies. Discusses the advantages of using tele-emergency services to improve rural healthcare quality including the ability of rural facilities to recruit and retain staff, timeliness of emergency care, and access to resources.
Author(s): Mueller, K.J., Potter, A.J., MacKinney, C., & Ward, M.M.
Citation: Health Affairs, 33(2), 228-234
Date: 2/2014