In rural America, physician recruitment is a life or death issue for patients and hospitals alike. The National Rural Health Association (NRHA) reports that more than 25 percent of the U.S. population lives in rural areas, yet less than ten percent of the country’s doctors practice there. In fact, a new poll indicates that one out of every four people living in rural areas said they couldn't get the health care they needed and about a quarter of those said it's because their health care location was too far or difficult to get to.
Even more concerning, there’s actually a decreased life expectancy in rural America and hospital closures in rural towns aren’t helping. In the NPR poll, close to one out of every ten respondents said their small-town hospital had recently closed. As a physician recruiter, you know hiring and retaining candidates for rural opportunities is no easy task though. For some rural communities, the need is so dire their pitch is essentially that: come here and make a difference.
There’s still basic supply and demand, so compensation is always a factor. While it’s true that less populated areas still tend to have a higher average compensation than larger cities (per Doximity’s Third Annual Physician Compensation Report), the reality is that salary alone isn't enough to incentivize doctors to work in rural communities. Here are a few things to consider when you’re selling candidates on rural jobs.
1. Signing bonuses and paid sabbaticals are at the top of the list. In 2018, the average signing bonus for physicians was $32,692 (per the 2019 Review Recruiting Incentives from Merritt Hawkins), though the New England Journal of Medicine (NEJM) reports that some doctors have seen seeing signing bonuses for non-urban opportunities as high as $100,000 — particularly for primary care. Lost Rivers Medical Center in Arco in central Idaho, where the elk and bear outnumber the human population, says the cornerstone of their recruitment is ten weeks of paid sabbatical a year.
2. Building better relationships with patients is easier in rural posts. Beyond bonuses and paid sabbaticals, there are other important points to note about rural opportunities. Many doctors want to get back to their roots, enjoy a slower pace, or be part of a small-town family. They also want to spend more time with patients — and in a rural setting there’s not only an opportunity to help underserved patients, there’s more opportunity to build better patient relationships. Most physicians who have practiced medicine in rural areas agree that their relationships with patients are better than they are in urban or suburban practice, according to locumtenens.com.
3. Doctors can experience the full spectrum of medicine in rural America. A lot of people think rural doctors don’t get to see interesting cases or that their medical skills will atrophy, but that’s simply not true. “I hear it all the time. You’ll be bored, and your mind will turn to mush,” writes Edwin Leap, MD. “Anyone who believes that their skills in medical care will deteriorate outside a teaching center has probably not spent much time, well, outside a teaching center. Rural America deserves the same high-quality care as everyone else.”
4. What does your candidate love? Sell that. Do you know candidates who love the great outdoors? If they like to hike, bike, fish, etc., they’re bound to enjoy certain rural locations. Ogallala Community Hospital in Ogallala, Nebraska says recruiting doctors to their hospital has required them to become “social matchmakers.” In smaller communities it’s easier to set up those types of relationships. For example, if a doctor likes sports, administrators suggest they volunteer as team physician at the high school; or if they are an art lover, they could volunteer on the planning committee for the local arts festival.
5. Rural communities typically offer a far lower cost of living than urban ones. The cost of living takes into account several necessary expenses that most of us need to live from day to day, including housing, food, childcare and educational costs, transportation costs, and medical costs. While a lot of factors influence how people spend to live, it can make a big difference for doctors who are paying of medical school loan debt. Do some homework on the cost of living for areas you’re recruiting for. One good example is Missouri, which comes in fourth lowest on the cost of living index but also has the most rural health clinics (369). Here’s a breakdown of rural health clinics in all 50 states.
Rural physicians are a rare breed but working in rural America has a lot to offer physicians – personally and professionally. At the end of the day, your opportunities are about what makes physicians more satisfied with life and their career. Our team of Client Success Managers recently offered some tips for getting candidates excited about rural positions. You can read all 8 ways to attract candidates to your rural positions here.