The community is working on solutions to its workforce shortages. The mayor of Lampasas is creating a higher education counsel to develop a program between the town's high school and nearby colleges. The goal of the initiative is to enable students to earn college credits prior to their high school graduation. Villanueva and members of his staff also make it a point to visit classrooms and talk to students about pursuing a health care degree and committing to work in the town's health care sector.

"As we go out and we talk to these students in high school, a lot of them mention they want to come back and live close to their families, have a family of their own and reintegrate themselves into the community," says Villanueva. "I think we have a very, very good start, although it's at the grassroots level right now," he says.


Another critical access hospital that faces a workforce challenge is Mammoth Hospital, a 17-bed facility in the Eastern Sierra region of California. Although it's located in a rural community, it's also a popular resort area, drawing many extreme sports enthusiasts from Southern California.

"In terms of services, orthopedics is our primary service line because of the ski mountain here," says Gary Boyd, the hospital's CEO.

Recruitment of physicians is a big issue for Mammoth Hospital because of its unique location.

"It takes a special kind of person who wants to live at 7,000 feet with six months of snow," says Boyd.

The facility is far from an urban center, which makes it difficult for the hospital to adjust its staff to match the number of patients.

"Our volume is high in the winter and relatively high in the summer, and then in between, we have two what we call 'shoulder seasons,' where business in town is slow," says Boyd. "Having the ability to maintain a flexible staff is pretty tough and just attracting experienced staff takes a while."

Boyd says that lately Mammoth Hospital has been successful in maintaining its staff levels, as there are many people who are interested in living in a community that offers skiing, hiking and rock climbing. The hospital is also working on new strategies to attract and keep an adequate number of employees.

"We're looking at changing that model so we staff for the more moderate business, like during the summer and then flex up by addition of people who may be willing to come to our area and work in the winter," says Boyd. "We're actually starting to look at other hospitals in resort areas to see how they do it."

Several provisions in the American Recovery and Reinvestment Act of 2009 (ARRA) are aimed at alleviating the shortage of primary care physicians. In addition to increasing Medicare reimbursement for "evaluation and management" patient services, the law includes loan-forgiveness programs, particularly for medical school graduates willing to practice in rural areas.

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