title: Effect of tele-emergency services on recruitment and retention of US rural physicians.
abstract: BACKGROUND
  As competition for physicians intensifies in the USA, rural areas are at a disadvantage due to challenges unique to rural medical practice. Telemedicine improves access to care not otherwise available in rural settings. Previous studies have found that telemedicine also has positive effects on the work environment, suggesting that telemedicine may improve rural physician recruitment and retention, although few have specifically examined this.
  
  
  METHODS
  Using a mixed-method approach, clients of a single telemedicine service in the Upper Midwestern USA were surveyed and interviewed about their views of the impact of tele-emergency on physician recruitment and retention and the work environment. Surveys were completed by 292 clinical and administrative staff at 71 hospitals and semi-structured interviews were conducted with clinicians and administrators at 16 hospitals.
  
  
  RESULTS
  Survey respondents agreed that tele-emergency had a positive effect on physician recruitment and retention and related workplace factors. Interviewees elucidated how the presence of tele-emergency played an important role in enhancing physician confidence, providing educational opportunities, easing burden, and supplementing care, workplace factors that interviewees believed would impact recruitment and retention. However, gains were limited by hospitals' interpretation of the Emergency Medical Treatment and Labor Act as requiring on-site physician coverage even if tele-emergency was used.
  
  
  CONCLUSIONS
  Results indicate that, all other factors being equal, tele-emergency increases the likelihood of physicians entering and remaining in rural practice. New regulatory guidance by the Centers for Medicare and Medicaid Services related to on-site physician coverage will likely accelerate implementation of tele-emergency services in rural hospitals. Telemedicine may prove to be an increasingly valuable recruitment and retention tool for rural hospitals as competition for physicians intensifies.
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, USA. andrew-j-potter@uiowa.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Potter
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, USA. keith-mueller@uiowa.edu.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Mueller
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, USA. clint-mackinney@uiowa.edu.
authors.forename: A Clinton
authors.initials: AC
authors.lastname: Mackinney
authors.affiliation: Department of Health Management & Policy, University of Iowa, Iowa City, USA. marcia-m-ward@uiowa.edu.
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D010560:Personnel Selection; D010820:Physicians / Q000523:psychology*; D019035:Rural Health Services; D020377:Self Efficacy; D017216:Telemedicine / Q000379:methods*; D014481:United States; D000078329:Workforce; D017132:Workplace
keywords: Emergency Care; Medical; North America; Nursing; Qualitative Research; Workforce