Evaluating rural healthcare workforce programs: Applying modified whole-of-person retention improvement framework in...

Healthcare workforce shortages are acute in rural areas. Using a holistic workforce retention framework, we examined evidence and identified gaps in recruitment and retention programs, using the Veterans Health Administration as a case study.

Rural workforce recruitment and retention initiatives were identified using VHA's 2023 Rural Recruitment and Hiring plan, and classified by rural focus, recruitment or retention, and strength of evidence. Initiatives were then mapped to a modified whole-of-person retention improvement framework (WoP-RIF) to assess coverage of domains: workplace/organizational, role/career, community/place, and financial.

Of 31 VHA initiatives, 19% exclusively focused on the rural workforce, 35% included rural, and 45% had no specific geographic target. One third (32%) focused on recruitment only, 48% focused on recruitment and retention, and 19% focused on retention only. Nearly three-quarters (71%) lacked sufficient evidence or were too early in implementation to assess effectiveness or ineffectiveness of the initiative. The strongest evidence existed for education loan repayment and nursing residency programs. For modified WoP-RIF domains, about half of initiatives focused on financial incentives (52%) or workplace/organizational programs (42%); 35% focused on role/career opportunities; and only three (10%) focused on community/place.

While initiatives exist to address workforce shortages in rural areas, using the VHA as a case study, these are more focused on recruitment than retention, and few address important aspects of retention outside of financial or workplace domains. More rigorous and holistic evaluations of workforce initiatives using the modified WoP-RIF framework would bolster evidence across the span of recruitment to retention for rural workforce development.