Attracting and Retaining Physicians in Rural America

Recruiting quality physicians to practice in nonmetropolitan areas is more often than not a top challenge for healthcare leaders at facilities in rural communities.

Yet a number of C-level executives at hospitals, health systems, clinics, and medical groups situated in small towns and off-the-beaten-path locales recurrently attract and retain exceptional candidates. Here, we look at some of the issues that impact rural health in the United States today and offer practical solutions, highlighting important findings and examples from our past and present clients. As reported by U.S. Census Bureau Director John H. Thompson, rural communities cover 97 percent of our country’s landmass and are home to approximately 60 million people (i.e., 19.3 percent of the population).1

The shortage of doctors in rural and underserved areas, which often lack the amenities and advantages commonplace in urban and suburban locales, makes filling job vacancies and new opportunities more difficult for facility leaders in these locations. In addition to dealing with depleted pipelines, administrators have to compete with their urban and suburban counterparts for top talent.

Apart from striving to provide essential medical services and optimal care for patients and families in their communities, hospital and practice managers at rural facilities and small-town medical practices must take into account the support and benefits that attract potential physician recruits to nonmetropolitan areas as well as the financial impact the absence of adequate coverage can have on their organizations—from loss of revenue, to bankruptcy, to closure.

Medicus Healthcare Solutions recently spoke with members of the C-suite at rural healthcare organizations in different parts of the country, as well as the former healthcare executive of a Missouri-based health system, about the success they have enjoyed both with appealing to and retaining quality physicians. Read on to learn what you can do to attract the best candidates more efficiently and better ensure their acceptance of job offer.

According to findings of the National Ambulatory Medical Care Survey (NAMCS) and the NAMCS Electronic Health Records Survey in 2012—published in a data brief from the National Center for Health Statistics—the supply of primary care physicians was significantly greater with increasingly urban physician’s office locations, from 39.8 per 100,000 population in nonmetropolitan areas to 53.3 in large central metropolitan areas.2

Seek referrals

Recommendations from doctors and other medical professionals within your organization are often the number one way to attract physicians. Make certain your staff is aware of your referral program and its associated bonuses, and knows that you are actively recruiting. Also, contact the medical school closest to your facility, as well as the residency program, and let them know that you have openings for physicians and what the positions entail.

Use a combination of recruitment efforts and a personal touch

In addition to inviting referrals from staff, administrators should employ other options to attract and retain quality clinicians, such as recruitment firms, online physician sourcing tools, third-party websites, and locum tenens staffing companies with permanent placement divisions. Then, when potential recruits are identified, they should be contacted quickly to establish their expectations and discuss job openings and requirements.

“We place a personal phone call to potential physician recruits to better understand the type of opportunity they are looking for and be sure they have a good understanding of our community as well as our hospital and its programs. It is an initial screen that ensures we are able to offer what they desire. Then, if all parties are interested in moving forward, we invite the provider for an on-site visit” (Marlene Garone, MD, Vice President Medical Affairs at UPMC Chautauqua WCA, Jamestown, New York).

“We have a couple of headhunter firms engaged to not only find internal medicine physicians, but also hospitalists. It is important for rural facilities to diversify their efforts and create new opportunities to further their reach and ultimately meet the needs of their healthcare organization and community” (Richard G. Hilton, FACHE, Administrator/CEO at OCH Regional Medical Center, Starkville, Mississippi).

When possible, visit potential candidates in their own communities

If physicians who would have to relocate to accept an offer express interest in an open position at your health system or facility, make arrangements for your recruiter to first meet with them on their own turf. The gesture will convey your enthusiasm, and also give these providers a chance to get acquainted and comfortable with your physician retention specialist prior to scheduling a visit to your organization.

Make it personal

Help a possible candidate envision what life would be like in your rural community. Provide him or her with welcome packets and links to helpful area websites before they decide whether they are coming in for an on-site visit. Similarly, during conversations prior to meeting, ask questions like, “What do you like to do in your spare time?” and “What are some of the activities your family enjoys?” Once you know the answers, check to see if your community or neighboring towns have such offerings. For instance, if a physician likes to go camping, send him or her specifics on the area campgrounds and trail system(s). Or if the provider has a child in the Girl Scouts, provide relevant details and contact information and/or connect him or her with the troop leader.

“One of the most important pieces for retention is open communication. Although rural hospitals have smaller groups, it can be a scheduling challenge. But it is important and worth any extra legwork. We had many Sunday night meetings because it was the only time we could get administrators and physicians together. These group strategy sessions ensured everyone received updates and information at the same time, and directly from administration. They also provided a platform to providers to ask questions and voice any concerns” (Debi Koelkebeck, former Senior Vice President, Freeman Health System, Joplin, Missouri).

Provide a warm, welcoming introduction

When arranging for a potential candidate to travel to your facility, secure accommodations at a charming area bed and breakfast or nicely appointed local hotel that will provide a hospitable reception, comfortable stay, and taste of the local flavor. If possible, build in a little extra time for the physician to unpack and rest before coming in for the on-site visit.

7 Challenges of Attracting Physicians to Rural Practice Environments

  • Shortage of academic medical programs
  • Lack of family and an established social network
  • Fewer employment opportunities for spouse/significant other
  • Fewer entertainment opportunities (e.g., concert venues and family attractions) and dining options (e.g., upscale restaurants and variety of ethnic foods) than urban locales
  • School systems with fewer offerings than those situated in metropolitan areas
  • Less diversity in religion, which could impact provider’s ability to practice his or her faith
  • Inclination of newly trained physicians finishing residency and fellowship to remain close to where they’ve trained

Accentuate the short commute

For physicians considering relocation from a major urban area or the suburbs, a nearly nonexistent commute can be akin to a lifestyle boost, and it presents more time to spend with loved ones and enjoy personal pursuits. They will never have to be stuck in rush-hour traffic or leave for the hospital, clinic, or medical group an hour or two before their shift begins, and they could be home within minutes at the end of their workday.

Offer loan repayment/forgiveness programs

Presenting these types of recruitment programs is an excellent way to appeal to possible physician candidates. In exchange for variable levels of loan repayment/forgiveness from the federal and/or state government, clinicians who enter such programs must agree to practice at an approved site in a medically underserved area for a given amount of time. To participate, facility administrators should establish that their facility is located in a Health Professional Shortage Area, though it may not be a requirement.

“We are in a medically underserved area, which allows our facility to offer both loan forgiveness programs and visa sponsorship for physicians who require that support” (Marlene Garone, MD, Vice President Medical Affairs at UPMC Chautauqua WCA, Jamestown, New York).

Arrange for a group meal with staff

When possible physician candidates come to town for an on-site visit, invite them to special dinner with some of your facility’s doctors and administrators. If candidates are married and their spouse accompanied them on their trip, extend the invitation to them, too, as well as to the wives and husbands of admins and physicians attending the dinner. Should their kids be in tow as well, invite them and the children of the physicians and administrators who will be present. It is a great, relaxed way for everyone to get acquainted and learn about each other.

“Our administration is very familiar with our doctors and their families. Equally important, our physicians are familiar with each other’s families. In fact, several of our doctors regularly socialize with each other on a regular basis, and some even travel out West on hunting trips together. At dinners with members of our staff, candidates are impressed that everyone really knows each other and their families. They’ll hear admins asking our physicians questions like, ‘How did your son do pitching last night’s game?’ or ‘Is your daughter excited about next week’s dance recital?’ and vice versa. These exchanges are genuine, and it shows. We even have relationships established with local restaurants that will open up for these dinners exclusively, if they are scheduled to take place when they’re normally closed” (Doug Strange, Chief Financial Officer, Colquitt Regional Medical, Moultrie, Georgia).

Involve spouse/partner/kids in the process

If a likely physician recruit has a significant other or is married with kids, including these individuals in the process can lead to a more positive experience and allow everyone to get a feel for the organization as well as the area. Consider implementing a buddy system to connect physicians’ spouses with their colleagues’ significant others, making their families aware of social clubs, and connecting them with local areas of interest. The more you can do to engage wives, husbands, and children and help them integrate into the community, the greater the likelihood for retention.

Outline educational opportunities for children

Providers with families want to live in or near excellent school systems. If there are desirable programs and/or good public and private schools in close proximity to your facility or group, make sure candidates are aware of them.

“Local private and parochial schools are happy and willing to provide tours to physicians and their children, if they accompany their parents to an on-site visit. The school’s representative will talk to them about their institution’s educational philosophies, curricula, activities, and other factors. At the end of the day, these tours can make or break an agreement” (Debi Koelkebeck, former senior vice president of Freeman Health System, Joplin, Missouri).

Invite local realtors to conduct home tours with physicians, family members. If you do not already have relationships with real estate agents in your area, develop some. More often than not, these professionals are delighted to show properties to candidates as it can and does lead to sales commissions. Home tours can help candidates visualize themselves living in your community. Spouses and other family members may be able to tour a few places on their own during a provider’s an on-site visit. If they find a house they are interested in renting or purchasing, they can often arrange to return to their favorite(s) with the physician later the same day.

Focus on the positives and highlight advantages

Emphasize the strong points of your organization and community—as well as any exceptional advantages or offerings—before a new provider accepts a position at your facility, health system, clinic, or group. Also, it’s important to set up a well-organized program to help you underscore these plusses.

For example, if your healthcare organization is situated in an area where housing costs are significantly lower than those in other parts of the country, make potential candidates aware of it. If salaries are fairly comparable to those at other facilities in the U.S., the cost of living will be markedly lower, which can allow providers and their loved ones to enjoy a very pleasant and comfortable lifestyle. Or if your area boasts excellent goings-on for its residents, from sailing lessons to community theater productions, let possible recruits know about these opportunities, too.

“One amenity that greatly appeals to potential candidates is our physicians’ lounge, a large L-shaped room with couches, big-screen TVs, and plenty of food. We offer everything from a salad bar, to a meat and threes, to prepared sandwiches. Monday through Friday, breakfast and lunch are prepared by a chef who actually sets up in the lounge on Wednesdays and makes made-to-order omelets and some stir-fry options. The food is great and free, and it promotes a collegiate atmosphere, something we strive for at our facility” (Doug Strange, Chief Financial Officer, Colquitt Regional Medical, Moultrie, Georgia).

“After showcasing our facility, we take candidates on a tour of the area and also show them potential housing options. Mississippi State University is located here, so there are ample opportunities for sports enthusiasts to go to baseball, football, and basketball games. Our area also offers great shopping and good restaurants, and the issues providers face in urban areas—like traffic, parking, and a lengthy commute—are nonissues for our doctors” (Richard G. Hilton, FACHE, Administrator/CEO at OCH Regional Medical Center, Starkville, Mississippi).

Endnotes

  1. United States Censure Bureau. “New Census Data show Differences Between Urban and Rural Populations.” Release No. CB16-210. December 8, 2016.
  2. Hing E., Hsiao, C. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. “State Variability in Supply of Office-based Primary Care Providers: United States 2012.” NCHS Data Brief, No. 151, May 2014.

About Kerri Hall

Kerri Hall, Senior Vice President – National Sales holds memberships with a number of organizations, including the American College of Healthcare Executives (ACHE) and the Medical Group Management Association (MGMA). She earned her Bachelor of Arts in Business Management from the University of Massachusetts Dartmouth.

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