Recruiting and retaining physicians poses a significant challenge for rural hospitals.
In fact, a 2016 Merritt Hawkins white paper cited 6,080 Health Care Professional Shortage Areas for primary care nationwide, 67 percent of which are in rural locations.
There are several reasons hospitals in rural areas have trouble recruiting physicians. Many rural hospitals are in towns that may not be attractive to physicians, and they are often in isolated geographic areas with a more limited local candidate pool.
Becker's recently caught up with two rural hospital CEOs to discuss this particular challenge and how they are working to overcome it.
UCHealth Yampa Valley Medical Center
Frank May, CEO of UCHealth Yampa Valley Medical Center, believes location plays a large role in whether rural facilities are able to recruit and retain physicians. His 39-bed hospital sits in the mountain resort community of Steamboat Springs, Colo. He says this makes it a desirable location for many physicians, while other rural facilities in the state may not offer the same surroundings.
Mr. May says physicians who enjoy the outdoors and the isolation in northwest Colorado are drawn to YVMC. However, he says case volume presents a bigger challenge for his facility.
"Having a variety of physicians in the market is important to the delivery of primary and specialty care, having those services locally and being able to take care of your patient population," he says. "I also know the case volume of services we provide can drive how physicians are compensated — some might receive a salary, where others are better suited on some type of a production structure. That can also have influence on whether we can recruit and retain someone."
Part-time subspecialists such as pulmonologists and rheumatologists are particularly difficult for YVMC to recruit, as patient volumes in those areas don't necessitate a full-time position. However, since the hospital joined Aurora, Colo.-based UCHealth, it expects improved access to those kinds of subspecialists.
When recruiting new physicians, Mr. May says it's important to find candidates who are committed to the community they serve.
"You can recruit someone under a two or three-year contract, and if they're not happy and they leave, it really creates a cycle. Sometimes you have to do that because you need particular services, but I think finding the right person who's committed to a community [long term] and understands the lifestyle, challenges and benefits is really important," he says.
Mr. May also encouraged rural facilities to pay attention to telemedicine as a way for them to improve resources for patients. YVMC has looked at various opportunities in this area, including telemedicine services for the intensive care unit, and anticipates implementing telemedicine initiatives in the future as part of its new relationship with UCHealth.
Island Hospital
Like Mr. May, Vince Oliver, CEO of Anacortes, Wash.-based Island Hospital, believes location is a large part of physician recruitment and retention. But he says physicians' greater interest in shift work — something the 43-bed public hospital district and other rural facilities can't typically offer — also plays a role. Instead of shift work, many organizations offer an on-call schedule.
"That means if they get a call at 8 or 9 at night, they are going to have to come in and admit that patient and it gets to be really difficult," says Mr. Oliver. "We have three Ob-Gyns deliver 450 babies a year and require family physicians to be able to do a complete medicine package from cradle to grave."
This kind of schedule and training is not always attractive to candidates.
Another challenge for IH is recruiting general surgeons, who are needed in rural areas due to their wide range of training and abilities. It recently took the hospital about a year to fill a general surgery position. Meanwhile, Mr. Oliver says, not having a needed general surgeon was costly and put a strain on surgical volume.
Compounding the challenge is the need to compete with larger hospitals in urban areas and academic medical centers, which can offer incentives such as large signing bonuses and write-offs of school loans.
It is also difficult for IH to recruit internal medicine physicians who want to practice in an outpatient setting. These physicians see patients in their clinic and also work hospital shifts, but many physicians don't desire both.
To overcome these challenges, IH seeks to put together a full hospitalist program that provides a physician in-house at all times, says Mr. Oliver. Building this type of program is expensive, and, since IH is not a critical access facility, it does not receive additional reimbursement from CMS that could be used for the initiative.
"But we may have to bite the bullet and find a way to fund a full 24-hour service and perhaps eliminate other services to help pay for it," he says.
Mr. Oliver says the hospital's latest and most successful recruiting efforts have come through the osteopathic medicine schools that are new to the Anacortes area. This is because the schools focus on recruiting students who want to stay in the state. The last five physicians hired by IH have been DOs from those schools and the residency program.
The hospital has also had recruitment success working through a search firm. It keeps open positions and continually receives candidates.
"We don't look to say this doctor will retire so let's open up that slot. Instead, we already have candidates and we'll keep talking to them and try to keep them interested," says Mr. Oliver. "And, when these things pop up, I think we have good crop of candidates to look at. Sometimes timing doesn't work, but it's been far more successful than just opening up a search."
IH also does a physician needs assessment every three years to identify where more clinicians may be needed. That helps the hospital develop a three-year recruitment plan and budget accordingly.
Additionally, Mr. Oliver says community members, such as elected commissioners, city officials and education leaders, will help sell the area to a candidate when he/she visits.
"All of those people give time in recruitment efforts, and I think candidates feel and get a great sense of this community so when they leave and are considering this opportunity, it's not just the job and the package and the compensation, but they're considering coming into this community and they've met a wide variety of people," he says. "We think it's successful, and some of our candidates who have come here have really appreciated it."