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CAP Takes On Rural Australia

Ed Baker
Ed Baker

Ed Baker, director of the Center for Health Policy, in partnership with David Schmitz, chief rural officer and program director of Rural Training Tracks at the Family Medicine Residency of Idaho, have partnered with the University of Melbourne to implement their Community Apgar Program (CAP), which examines issues surrounding physician retention and recruitment, in rural areas of Australia.

Though CAP has been implemented in many U.S. states including: Idaho, Wyoming, North Dakota, Wisconsin, Alaska, Indiana, Montana, Maine, Utah, and Iowa this is the first time the program has traveled internationally. The program aims to help communities better understand the important issues related to physician recruitment and retention.

Baker, Schmitz, and Daniel Terry, researcher at the University of Melbourne, chose to implement CAP in 14 Australian communities to help identify strength and improvement areas for rural Australia’s capacity to recruit and retain physicians. Center for Health Policy staff, led by Lisa MacKenzie, senior research associate, analyzed questionnaire data from those communities, produced reports, and created an international database to help communities address physician workforce challenges.

Schmitz traveled to Australia last fall to assist in presenting the results from the 14 facilities that participated in CAP. Baker, Schmitz and Terry worked to organize data from Australian communities to identify factors for action.

Map of Australia

Said Terry, “Implementing CAP started a new conversation that health services had not previously had about family physician recruitment and retention.”

Additional healthcare workforce projects in Australia are anticipated in the 2016-2017 time period.

As a result of the recognized need for recruiting and retaining family physicians in Idaho during their study, Baker and Schmitz, supported by the Idaho State Office of Rural Health, developed CAP in 2007. The tool has proven useful in creating a database to identify trends, overarching themes, and best practices in specific communities at the national and international level. The program utilizes the Community Apgar Questionnaire to assess and provide individualized information for Critical Access Hospitals (CAH), Community Health Centers (CHC), and rural health clinics to improve their health care workforce planning.

Picture of Dave Schmitz and Daniel Terry.
Dave Schmitz and Daniel Terry

Through growing partnerships with state Offices of Rural Health, Area Health Education Consortium, state hospital associations, and 3RNet, this project grew to serve communities and states across the US, and now Australia. Beyond the CAH tool, tools have also been developed in cooperation with partners for recruitment in CHC’s, rural health clinics, and for recruitment of nurses. Future work will include tool development for recruitment of leadership, such as rural hospital CEOs.

Regions using CAP receive an analysis of specific comparative strengths and challenges that certain communities face, providing results in actionable plans. Communities also obtain information that they may utilize for addressing state-specific issues as well as to establish an evidence based platform for the advocacy of those issues. Participants in CAP add to the database and develop and implement the ‘best practices’ across their community networks.

CAP enables researchers and health care providers to gain an overall understanding of, appreciation for, and

Dave Schmitz and a kangaroo share a selfie.
Dave Schmitz and a kangaroo share a selfie.

identification of solutions for specific communities. For example, CAP identified Idaho’s strengths as: recreational opportunities, internet access, employment status, community need/physician support, loan repayment, transfer arrangements, income guarantee, competition, stability of physician workforce, ancillary staff workforce, and community volunteer opportunities. Idaho’s greatest challenges were: access to mental health, schools, shopping and other services; few or no provisions of allied mental health services; lack of spousal satisfaction; lack of access to electronic medical records; lack of access to larger community; perception of community; lack of obstetrics providers; and too small of a nursing workforce.

Boise State University, in its collaboration with the Family Medicine Residency of Idaho and now the University of Melbourne at Shepparton, contributes  to better health and access to care in rural and remote communities increasing the amount of and improving access  to academic literature. Boise State serves as a content expert in the area of physician recruitment and retention in rural communities along with its collaborating partners. Boise State, through CAP, continues to make an impact directly in rural communities, one community at a time.