The constant struggle to recruit providers is a reality many rural facility administrators and community health center recruiters have to deal with every day. Unlike rural health systems, large urban health systems have seemingly bottomless coffers that place rural health systems at a clear disadvantage. Financial incentives are a part of recruitment but there’s much more to the process.
While salary, loan repayment, and signing bonuses are necessary to capture interest, they are not enough to guarantee recruitment in this market. To ensure successful recruitment, you need to entice clinicians to not just choose the position, but to also relocate their families and root themselves in the rural community.
Success requires a major paradigm shift. You are selling much more than a job. You are selling a rural community. You are selling the ability to shape their unique identity as a rural provider. In the following sections, we will examine best practices to attract physicians and nursing staff to the rural community, as well as proven community-based retention strategies that ensure rural healthcare professionals remain for the long haul.
Recruitment for rural healthcare takes time, planning, and preparation. Leaders of a rural health care facility must begin to understand the psychological motivations of rural candidates. While an urban facility focuses on cutting-edge subspecialties and amenities like museums and restaurants, the rural healthcare market must focus on the benefits of providing rural healthcare including autonomy, serving patients with profound health needs, and providing rural lifestyle opportunities.
If your rural recruitment goal is to attract nurses and physicians who have an affinity for being known and highly specialized, you’ve come to the right place. Recruitment should be aimed at people who want to practice in rural settings because they appreciate the benefits of such rural health care practices.
The large hospital setting results in clinicians acting like a cog in the machine. A clinician can easily get lost in the sea of specialists in the large hospital setting as a case becomes complex. There is great independence in rural medicine. Family medicine clinicians get to practice medicine in its fullest in the rural setting. In a single week, a rural family medicine clinician can be called to work in emergency and trauma, take care of children and treat patients with complex, long-term conditions. Practicing medicine at this full scope can be rewarding for the right physician.
Rural job applicants care about how significant their work is to patients in their town. As a pillar of their community, health care workers know and respect their patients. There is also no greater honor than treating your friends and colleagues. High-volume, urban jobs are transactional. For burnout health workers, these jobs hold zero appeal. Rural practice gives them the chance to make deep, lasting bonds with their patients.
Though rural medical practice presents challenges, it is a refuge from city life. Candidates desire rural medicine due to shorter drives to work, a lower cost of living, easy access to nature and outdoor recreational opportunities, and safe and small communities to raise families in.
Lack of awareness is the largest hurdle to rural recruiting. Candidates do not know what they do not know. Studies have shown that after participating in a rural clinical rotation, clinicians are three times more likely to choose a rural placement for practice. If you aren't collaborating with medical and nursing programs and allied health residencies for rural clinical rotations, you are missing an excellent talent acquisition method. Working and interacting with the community in a small, remote area is an extremely effective way of recruiting staff.
Having candidates commit to an interview means you've mastered selling the clinical opportunity. You must then master selling the opportunity of the community during the site visit, which can make or break rural healthcare recruiting.
Unfortunately, rural hospitals often fall into the trap of using site visits as routine, standard corporate interviews, i.e. walking candidates through the facility, a few interviews, and cafeteria lunch. This is a critical error. The site visit shouldn't just be about the clinical facility, but rather, an immersive, fully community-oriented experience.
There’s one rule when it comes to rural clinician recruitment and retention. Happy spouse, happy clinician. Clinicians won't take jobs in locations their spouses won't tolerate and will quit if they feel isolated in a new location. Before you bring a potential candidate for a visit, know their spouse’s interests and goals, especially career related. Introduce them to potential networking contacts in their area. Take the time to get the family a tour of the school by the principal, not a quick look from a car.
Partner a candidate with a friendly, high-energy local real estate professional. Send the agent with the candidate to view all the most desirable neighborhoods and point out all the local real estate that is both affordable and offers lots of land and space for the candidate's money. Providing prospective employees with the option to instantly improve their standard of living and upgrade their quality of housing with a rural salary can quickly shift perspective.
Avoid conference room meals. Instead, set up dinner at the best restaurant in town (or the home of a respected member of the community) and invite important members of the local community, such as the mayor, the school superintendent, some important businesspeople and local doctors who moved there and enjoy practicing. Let the new arrival see that the local community really wants and values the possibility of him moving there.
Moving is universally recognized as one of life’s most difficult endeavors. Friction created by the unpredictability of housing in more remote areas (where traditional buying and renting are not available), and the added complexity of rural relocation, can lead candidates to give up the recruitment process altogether.
If you are aiming to be the most competitive recruiter for rural nursing or a physician staffing agency, you need to provide the candidate with the option for white-glove relocation support. This will prove to the candidate that you truly care about their well-being before they have even had their first day on the job.
Even with the luxury of having a surplus of land, rural areas are generally characterized by a lack of decent rental or short-term accommodations. A job candidate coming from the city will likely assume that temporary rental options are plentiful. However, rural areas usually have a severe shortage of rental apartments, and as a result, many rural communities will struggle to attract job candidates.
Most rural health facilities manage the demand by owning or master leasing units of transitional housing for sixty to ninety days for new clinicians and their families. Doing this gives the clinician the time and ability to begin work with just their suitcases, without any stress, and the ability to survey and locate housing for themselves and their families for the long term.
Don't only give your employees a stipend to move. Give them a dedicated moving liaison. This person can assist with local service setup, including finding the right internet provider for their location, pediatricians and dentists, and even child care. They can provide contact info for plumbers and mechanics, as well.
Contract signed, truck moved, orientation done. Most agencies would be done, but a clinician’s stay in the rural area really begins after this point. For rural health center directors, retaining clinicians is their primary focus, especially in the long run.
A clinician’s first 90 days are critical in determining if they will stay in a community for the long haul. Without an intentional, welcoming process in place, they will quickly begin feeling isolated and will be quick to leave once their contract ends and their student loans have been satisfied.
For each new arrival, pair them with a “mentor family” from inside or outside the organization that is as similar as possible in their makeup (i.e. kids the same age, hobbies they share). It is not the mentor family’s role to discuss the hospital; it is their role to invite the new clinician to family barbecues, take them on local secret hikes, help the clinician navigate local sports programs, and ensure the clinician is included for their first Thanksgiving.
Rural areas are generally considered to be tight knit and closed to outsiders. It is your responsibility to facilitate that access. Cover the cost of a clinician's membership at the local country club, Rotary club, or rec center. Also help them join a community activity like cycling, a community theater board, or even hunting and fishing.
Isolation is a fact of rural practice. Be purposeful and make it part of the plan for the doctors and nurses. It should be social and professional. Make space in their schedules for working together, reviewing tough cases, and hanging out with each other. A rural medicine culture and a cohesive rural medical staff needs a dedicated space to blow off steam.
Rural health clinics frequently try to solve their retention issues by providing some form of financial compensation. It is true that staff deserve a decent pay; however, this is a very short-lived solution. The positive effect of pay compensation lasts for a very short period. A retention bonus pays off staff, but doesn't make them stay.
Community integration is the #1 predictor of rural retention beyond 3 years.
A retention bonus is unlikely to convince Clinicians to work in a rural location. Instead, Clinicians work in a location where they enjoy the school system, their spouses can have local careers, where deep friendships are built, and where the community as a whole has a sense of responsibility over its health.
As clinicians begin their practices in a town, suggest to them that it would be a good idea for them to get involved in community leadership. This might involve becoming members of the local school board, directing local community health initiatives, or becoming team physicians at the high school. Community engagement helps providers transition from “visiting professionals” to “hometown locals” and changes how the community perceives the health center and the provider.
Clinicians that leave for cities from the countryside are often worried about professional growth, and for good reason. Counteract the drain by having generous professional growth budgets and cutting-edge technologies. Showing them that professional growth can happen in a rural area helps with recruitment and retention.
Clinicians don't just decide to leave their job at a particular moment. A frustration has probably been growing for some time. There are obvious things to look out for, such as if a clinician is absent from work or is showing poor performance. However, there are things you can do to address a clinician's frustration before they result in a letter of resignation. This involves having 'stay' interviews on a regular basis. You could have one after a clinician has been with you for 6 months, one after 1 year, and another one after 3 years. These 'stay' interviews involve asking the clinician direct questions, such as, "What has been most frustrating about your practice?" or "How have your family been?" and even, "What can I do to make things easier for you?".
Attracting and keeping providers in rural areas takes more than just simple job offers. It takes understanding the needs and desires of providers. Rural recruiting is similar to other community recruiting. If done right, it can build long term passionate clinicians that will serve the community for many years to come.
There is a huge need to get rural staffing right. Relode is ready to partner with you to help build a rural mission based workforce. With a relationship focused approach, Relode is designed to build and maintain rural partnerships, with quality and accountability.