title: Recruitment and retention of mental health care providers in rural Nebraska: perceptions of providers and administrators.
abstract: BACKGROUND
  The nationwide shortage of mental health professionals is especially severe in rural communities in the USA. Consistent with national workforce statistics, Nebraska's mental health workforce is underrepresented in rural and frontier parts of the state, with 88 of Nebraska's 93 counties being designated as federal mental health professional shortage areas. Seventy-eight counties have no practicing psychiatrists. However, supply statistics alone are inadequate in understanding workforce behavior. The objective of this study was to understand mental health recruitment and retention issues from the perspectives of administrators and mental healthcare professionals in order to identify potential solutions for increasing the mental health workforce in rural communities.
  
  
  METHODS
  The study used semi-structured focus groups to obtain input from administrators and mental health providers. Three separate focus groups were conducted in each of four regions in 2012 and 2013: licensed psychiatrists and licensed psychologists, licensed (independent) mental health practitioners, and administrators (including community, hospital, and private practice administrators and directors) who hire mental health practitioners. The transcripts were independently reviewed by two reviewers to identify themes.
  
  
  RESULTS
  A total of 21 themes were identified. Participants reported that low insurance reimbursement negatively affects rural healthcare organizations' ability to attract and retain psychiatrists and continue programs. Participants also suggested that enhanced loan repayment programs would provide an incentive for mental health professionals to practice in rural areas. Longer rural residency programs were advocated to encourage psychiatrists to establish roots in a community. Establishment of rural internship programs was identified as a key factor in attracting and retaining psychologists. To increase the number of psychologists willing to provide supervision to provisionally licensed psychologists and mental health practitioners, financial reimbursement for time spent in this activity was identified as important.
  
  
  CONCLUSIONS
  The present study showed that a comprehensive approach is needed to address workforce shortage issues for different types of professionals. In addition, systemic issues related to reimbursement and other financial aspects must be resolved to strengthen the overall rural mental healthcare delivery system.
authors.affiliation: Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. swatanabe@unmc.edu.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Watanabe-Galloway
authors.affiliation: Department of Psychiatry, Creighton University, Omaha, Nebraska, USA. drmadison@cox.net.
authors.forename: Lynda
authors.initials: L
authors.lastname: Madison
authors.affiliation: Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. klwatkins@unmc.edu.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Watkins
authors.affiliation: University of Nebraska Medical Center, Omaha, Nebraska, USA. anguyen@unmc.edu.
authors.forename: Anh T
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: University of Nebraska Medical Center, Omaha, Nebraska, USA. liwuchen@unmc.edu.
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Chen
mesh_terms: D002321:Career Choice; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000458:organization & administration; D006280:Health Workforce / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008507:Medically Underserved Area; D008605:Mental Health Services / Q000458:organization & administration*; D009329:Nebraska; D020380:Needs Assessment; D010558:Personnel Loyalty; D010560:Personnel Selection / Q000379:methods* / Q000706:statistics & numerical data; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration
keywords: Administrator; Allied Health; Medical; Mental Health; North America; Nursing; Psychiatry; Psychology; Public Health