Train Rural, Work Rural: The Potential for Advanced Fellowships in Addressing Rural VA Healthcare Workforce Shortages

Area of Science:

• Healthcare workforce development
• Rural health disparities
• Veterans Affairs healthcare systems

Background:

• The United States faces a significant healthcare worker shortage, particularly in rural regions.
• The Veterans Health Administration (VHA), the largest integrated healthcare system, experiences high vacancy rates, impacting rural veteran care.
• Professional training programs are recognized as key strategies for enhancing recruitment and retention in underserved rural areas.

Purpose of the Study:

• To evaluate the VHA Advanced Fellowship program's effectiveness in retaining trainees in rural settings.
• To assess the program's contribution to VHA workforce stability, especially in rural and underserved areas.
• To inform VHA strategies for mitigating rural healthcare workforce shortages.

Main Methods:

• A cross-sectional study analyzing fellowship data from June 2018 to August 2023.
• Surveys collected data on fellowship characteristics (location, topic, duration) and post-fellowship employment (rural/non-rural, VA/non-VA).
• STROBE guidelines were followed for transparent reporting of observational study methods.

Main Results:

• Only 13% of VHA training sites are in rural-serving facilities, with 6 of 22 fellowship programs located there.
• Fellows trained in rural-serving VHA sites were significantly more likely to be employed in rural areas post-fellowship (63% vs. 2%).
• Trainees from rural-serving fellowships also showed higher rates of continued employment or affiliation with the VHA.

Conclusions:

• The VHA Advanced Fellowship program demonstrates success in retaining healthcare professionals in rural areas.
• The program should be integrated into VHA strategies to combat rural workforce shortages.
• Further research is recommended to examine long-term retention and explore expanding rural fellowship sites.