A recent report from the March of Dimes highlights the alarming lack of access to maternity care experienced by millions of American women. In the five years the organization has been tracking the numbers, the U.S. has seen a 4% increase in maternity care deserts, defined as counties with no obstetric provider or birthing center/maternity department. In fact, currently, 36% of all U.S. counties are designated maternity care deserts, and 2.2 million women of childbearing age live in these areas.
For those rural areas that still provide obstetric care, OB/GYN recruitment is increasingly difficult. The national average time-to-fill for OB/GYN jobs is nearly nine months, but that number can easily double in rural communities. Why is it so challenging to recruit OB/GYNs to rural facilities, and what can rural organizations do to attract and retain OB/GYNs?
Rural OB/GYN Recruitment Challenges
Rural OB/GYN recruitment is especially challenging, partly because if a physician is the only one or one of few in the area capable of delivering babies, they are frequently on call. Another hurdle is that OB/GYNs increasingly expect to work with advanced technology, such as the DaVinci robot, which many rural hospitals may not have. And, of course, some OB/GYNs are hesitant to work in a state with shifting laws that impact a physician’s ability to care for women with complex pregnancies. So, rural healthcare organizations in those states are facing an additional challenge.
Two Out of Three Rule
Ask any recruiter, and he or she will tell you that, regardless of age or stage of career, three things matter most to physicians when evaluating job options: compensation, location, and work-life balance. If location is a challenge, it is imperative that the other two — compensation and work-life balance — are indisputably attractive. That said, rural organizations seeking an OB/GYN should offer above-median compensation accompanied by standout recruitment incentives. However, compensation alone is not enough. OB/GYNs want a healthy work-life balance, something difficult to provide to rural OB/GYNs.
Physicians in rural communities may see a lower volume of patients and generally experience a slower pace of life, which is often cited as a benefit to working rural physician jobs. Even if physicians are on-call more frequently, emergencies will likely be minimal. However, the nature of childbirth means the on-call OB/GYN could easily be called in for a delivery, and in a community with few OB/GYNs, he or she may be on call every third or fourth night (or even more frequently than that.) To give OB/GYNs their desired lifestyle, organizations must rethink their staffing plans and find ways to provide OB/GYNs with the support needed to foster a sustainable work-life balance.
Get Creative with Staffing and Scheduling
The best way to ease the workload for OB/GYNs is to hire more of them; however, as previously mentioned, recruiting OB/GYNs is increasingly difficult. Katie Moeller, Director of Recruitment at Jackson Physician Search, has found success by informing her clients of other staffing options. In her recent work with a rural Iowa hospital, she advised the client to consider hiring several Family Medicine physicians with Obstetrics training (FMOBs) instead of one Family Medicine physician, one Internal Medicine physician, and one Obstetrician-Gynecologist. Katie saw many FMOB candidates coming out of training and knew the care they provided would be similar. The three FMOBs could also share call with the sole OB/GYN on staff, making the jobs more desirable for all four physicians. The client was amenable, and within a month, they had three FMOBs under contract.
In addition to FMOBs, Nurse Midwives and OB Laborists are also great options to consider. Similarly, creative scheduling options help attract these providers as well. Four-day work weeks are increasingly standard, and 7-on/7-off or three weeks per month are typically even more attractive. Of course, this type of creative scheduling requires organizations to have multiple providers who can see patients while other OB/GYNs are off the clock.
Leverage Telehealth for Specialist Consults
A 2017 study published in Health Services Research Managerial Epidemiology explored the recruitment challenges facing rural versus urban OB/GYN practices in the upper Northwest. The study found that lack of access to specialty care was a common reason rural partners left their practices; however, through telehealth, it may be viable to improve access to specialists.
Organizations should strive to develop relationships with specialists in neighboring counties and establish protocols for requesting consults via telehealth. This will show OB/GYN candidates that they will have some support from these neighboring specialists should it be needed.
An Evolving Solution for an Ongoing Challenge
The challenges involved with rural OB/GYN recruitment are complex, and there is no simple solution. Increasing compensation may be temporarily effective, but it eventually becomes unsustainable as other organizations raise their offers to compete. Creating an environment that allows work-life balance will undoubtedly improve your efforts, though this will likely involve hiring even more providers, including FMOBs, Nurse Midwifes, and/or OB Laborists. The shortage of OB/GYNs will likely continue for now, leaving organizations to seek various solutions in their recruiting efforts. Competitive compensation, attractive work-life balance, and creative staffing and scheduling are all critical pieces of an evolving solution.
If your organization needs assistance with OB/GYN recruitment — or physician recruitment of any kind — the team at Jackson Physician Search is ready to help you explore your options. Reach out today to learn more.