As Regional Vice President of Recruitment for the Jackson Physician Search Western division, my team and I work closely with rural healthcare organizations to find physicians who will be a great fit for their communities. We also spend a lot of time talking to physicians who are open to rural opportunities. In discussing their job search priorities, the conversation usually centers on compensation, the call schedule, and whether the rural community in question feels like home. Those all matter, of course, but new research indicates one question belongs near the top of the list, and in my experience, most candidates never ask it directly:
Who backs you up?
This question encompasses two kinds of backup. First, colleague backup refers to who covers your patients and your call when you are sick, on vacation, or otherwise unable to work. Second, specialty backup refers to who takes the patient you can’t or shouldn’t manage alone, and how quickly. For rural physicians, the answer shapes your workload, your scope of practice, and your stress level. According to new research, it may also shape how long you stay in the job.
What the Rural Physician Specialty Research Shows
Jackson Physician Search, LocumTenens.com, and MGMA recently surveyed 227 clinicians and administrators with rural experience for the report Rural Healthcare Specialty Priorities. Among current rural clinicians, 65% said they lack adequate specialist and colleague backup, a higher level of dissatisfaction than was reported on pay. Just 42% said compensation did not fairly reflect their scope, call, and workload. Another 39% said their workload was not sustainable for the next two years.
The statistic on backup correlated with likelihood to leave. Among current rural clinicians without adequate backup, 67% said they were at least somewhat likely to leave their position within two years. Among those with adequate backup, the figure was 44%. While the survey doesn’t prove that one causes the other, the pattern is hard to ignore.
Physicians who have already left rural practice told a similar story. Inadequate specialty support or colleague backup was the second most common reason they gave for leaving (31%), just behind workload or burnout (33%). Asked what would bring them back, former rural clinicians put better specialty coverage and backup (45%) nearly even with competitive pay (47%).
What a Coverage Gap Looks Like From the Inside
When specialty coverage is missing or stretched thin, the additional work often falls to the physicians who remain. When asked how their organizations dealt with inadequate staffing levels or vacancies, current rural clinicians in the survey reported:
- Taking on clinical work beyond their usual scope (40%)
- Spending more time coordinating transfers and outside referrals (36%)
- More stress or burnout (35%)
- Carrying additional call or cross-coverage (23%)
The additional work might be acceptable occasionally, but the research suggests inadequate staffing levels are the status quo. Among respondents who named them as high-impact specialties, only 21% said family medicine coverage was adequate. Most described it as insufficient (35%) or fragile or at risk (33%). The numbers were even starker for other specialties. Only 7% described permanent local OB/GYN capacity as adequate. The figure was 9% for psychiatry, 13% for internal medicine, and 18% for general surgery. In many communities, the physicians are still there, but one departure could create a serious gap.
None of this means rural practice is the wrong choice. In fact, there are many benefits of rural physician jobs. Nearly half of current rural clinicians (49%) would recommend it to a colleague in their specialty, and quality of life and connection to the community topped their reasons for staying. The goal is to go in knowing exactly what support you will have.
How to Ask About Backup
A vague question gets a vague answer. Ask “Is adequate support here?” and you will almost always hear yes. The following questions are harder to answer with a generality:
- Who covers my patients and my call when I’m out? Ask how many physicians share call, what the rotation looks like, and what role APPs play.
- Where is the nearest specialist for the cases I’ll see most? Go specialty by specialty: general surgery, OB/GYN, behavioral health, cardiology, and whatever else your practice depends on. Is that coverage on-site, visiting on set days, or available by telehealth? If a transfer is needed, how long does it typically take?
- What happened the last time a physician left? How was the gap covered, and how long did it last? Ask if and how the organization leverages locum providers and/or telehealth for support. In the survey, administrators most often bridged their most consequential vacancy with capacity already inside the building, and only 19% said the interim arrangement came from a contingency plan that already existed.
- Is anyone expected to retire or cut back hours soon? Sixty-four percent of rural administrators in the survey expect at least one physician to retire or substantially reduce hours within five years. Ask for details on the succession plan.
- What do the physicians say? Ask to speak with the doctors you would be covering with, not only leadership. Their account should match what you heard in the interview.
How to Evaluate the Answers
Strong answers are specific. They include names, numbers, and a process that details who covers call and how often, which regional center accepts transfers, how the last vacancy was handled, and how long it lasted. If leadership can walk you through a real example, that tells you the system has been tested.
Watch for answers that stay general. “Everybody pitches in” often means the remaining physicians absorb the work. Uncertainty about what happened during the last vacancy, coverage that depends on one person, or succession plans that exist only in conversation are all worth a follow-up question.
A thin spot is not automatically a dealbreaker. An organization that says, “We’re short in OB right now, and here is what we’re doing about it,” may be a better bet than one with a polished answer and no detail behind it. Honesty about the gaps is a good sign about the culture.
Finally, get the important commitments in writing. Call expectations and coverage arrangements belong in your contract.
Ask Before You Sign
Rural practice offers what many physicians want most: meaningful relationships with patients, broad scope, and a real place in the community. The physicians who thrive in rural settings tend to be the ones who knew what they were walking into. Backup is the part of the picture that is easiest to overlook in an interview and hardest to fix once you have started. Be sure to ask the right questions — and understand the implications of the answers — before you accept the offer.
At Jackson Physician Search, our recruiters work closely with rural hospitals and health systems across the country. We can help you ask the right questions, understand the answers, and find an opportunity with the support to match. Reach out to our team today or start searching physician jobs online now.
Download the full report: Rural Healthcare Specialty Priorities.
About Jeff Foster
With more than 15 years of experience in healthcare strategy and physician recruitment, Jeff Foster has partnered with hospitals, health systems, and academic centers across the country to strengthen their recruitment programs and improve processes.
A West Virginia native, Jeff began his career at Charleston Area Medical Center, where he specialized in candidate acquisition, practice start-up, and service line expansion. He later joined National Jewish Health, the nation’s #1 respiratory hospital, to help develop a strategic faculty recruitment office.
In 2016, Jeff joined Jackson Physician Search as one of the first team members in its Denver office. Since then, he has built a reputation as a leading expert in physician recruitment — earning Consultant of the Year multiple times and advancing to his current role as Regional Vice President of Recruiting. In this role, he not only works directly with hospitals to secure top talent but also mentors a growing team of recruiters, helping them achieve long-term career success.
What Jeff values most is seeing people thrive — whether it’s physicians finding their dream jobs, healthcare organizations strengthening their teams, or colleagues achieving new milestones in their careers.
Outside of work, Jeff enjoys skiing, playing soccer, and exploring the outdoors with his wife in Denver.
