[White Paper] Rural Recruitment: Results from our Rural Physician and Administration Survey

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President of Jackson Physician Search, Tony Stajduhar, reviews the results of our recent rural physician and administrators survey and provides a summary of action items administrators should consider when recruiting physicians to their community.

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Rural Physician Recruitment: Results from our Rural Physician and Administration Survey

By Tony Stajduhar, President, Jackson Physician Search

The Current State of Rural Physician Recruitment

The number of physicians practicing in America’s rural areas is on the decline. From 2013 to 2015, the overall supply of physicians in the United States grew by 16,000 but the number of rural physicians declined by 1,400. These facts compound the problem that while 20 percent of the U.S. population is rural, only 12 percent of the primary care physicians work in a rural area. This survey reports the results from the perspective of rural hospital administrators and rural physicians. The insights lead to recommendations which may help with this growing disparity.

With all of the data trending in the wrong direction for rural healthcare administrators, the challenges of recruiting and retaining physicians to work in rural communities have reached new levels of urgency. In a perfect world, rural health systems would be able to allow the free market to dictate what they can offer physicians to practice in non-metropolitan areas, but that isn’t the case.

Many rural health administrators have had to address physician recruitment in more creative ways than just offering more compensation. However, a recent survey sponsored by Jackson Physician Search has identified that a gap exists between what administrators think is important to their physicians versus what the physicians claim are important to them.

This paper will review the results of what rural physicians say is essential to them in their practice setting in contrast to what rural health administrators identify as important to their physicians. Lastly, we will provide a summary of action items that rural health system administrators should consider when recruiting physicians to their community and what they need to do to keep them engaged.

Summary of the Jackson Physician Search Rural Healthcare Survey

Recruitment

The Jackson Physician Search survey presented 23 questions about the advantages and challenges physician providers and healthcare administrators face in rural medicine.  Over 150 physicians provided their responses about a wide range of issues including the top attributes of their organization, whether those attributes were highlighted during the recruitment process, and their own levels of personal and professional fulfillment among other key topics.  Seventy eight percent of the physician respondents stated that they were currently practicing in a community of less than 25,000 people.

“We returned to my husband’s hometown because of the need in the region. We feel that we have made a huge difference in the community.”

105 rural health system administrators responded and shared their views to the same questions asked of the physician providers.  90% of those administrators stated that their organization was in a rural community.

Organization Culture

As shown below, both physicians and administrators are aligned in their beliefs that the organization is truly Patient-focused as that was the number one response on over 50% of all surveys received. However, as we will discuss in more detail shortly, there are clear areas for alignment opportunity with both Autonomy and Participatory Decision Making.

Culture

We see alignment between Physicians and Administration, although with varying degrees of importance, with the attributes related to Teamwork and a Family-friendly Environment. For the physicians, the importance of teamwork and a family-oriented environment showed up in the top three on a third of the surveys, while almost half of the administrators rated it as one of the organizations top attributes. Administrators can utilize this alignment with their physicians by ensuring that the organization is maximizing the opportunities to continually foster the family atmosphere. In rural and small-town settings, the health center is always going to be a focal point in the community, and using that visibility to engage in local sponsorships and activities is a natural way to keep staff and their families involved.

“I was offered the opportunity to choose my practice patterns, and staff. They also assured me that I would be involved in decision making.”

One of the biggest takeaways from this question for administrators in their recruitment efforts is the weight that physicians placed on Autonomy and Participatory Decision Making.  As shown in the results above, administrators may be discounting the importance of those attributes to their physicians.  In smaller hospitals and community health settings, administrators should be highlighting the ways that physicians can be more autonomous when compared to larger urban hospitals and systems. Developing a participatory decision-making culture will not only help attract physicians to the practice, but it will encourage longer-term retention and physician engagement.

Choosing a Rural Practice Location

When the rural-practicing physicians were asked to rank the top factors for choosing to practice in their rural community, the most cited reason was Community Culture which landed in the top three on the most surveys.  Compensation, unsurprisingly, was also in the top three along with Proximity to Family/Friends/Colleagues and Community Culture.

Factors for Choosing a Rural Practice

In their own words, physicians overwhelmingly speak about the role culture plays in their decision to accept an offer and also to stay in a position. This critical piece of information cannot be overlooked by rural practice administrators. In a recent Jackson Physician Search presentation, the idea of how culture and fit intersects can be described using “Three C’s”, Connection, Comfort, and Confidence. These traits will inherently draw a physician to be more open to accepting an opportunity in a smaller, rural or community health setting. Making a connection with the administration team, being comfortable in the workplace and interactions with staff during a site visit, and feeling confident that personal values are in alignment with organizational values can all be the factors that tips the decision scale in your favor.

“When I was recruited, I didn’t feel like they were just filling a slot. Throughout the process, I could sense that they were looking for someone who fit in with what they were about as an organization.

To contrast that to the responses provided by administrators when asked to identify the top reasons why physicians choose their organization, overwhelmingly, Compensation was cited as one of the top three reasons.  The second most cited reason was the Preference or Needs of a Spouse or Significant Other. Another financial factor, an Offer of Loan Repayment was the third most significant factor.

While compensation is always going to be a factor in recruitment, the disparity in responses to this question highlights that factors the physician feel are important differ from the assumptions of those recruiting and hiring physician candidates.

Recruitment Incentives for Rural Practice

When asked to identify the single MOST influential incentive that was offered by the practice/organization, Physicians and Administrators agreed upon Compensation, but then diverged.

Incentives for Rural Practice

While physician responses to this question were varied, clearly respondents that are considering rural opportunities want more autonomy than they can get in metropolitan settings.  As demonstrated by their written responses, physicians want to be included in decision making and want to have the freedom to nurture their desired practice philosophy. These may not be concepts that can be enacted in larger settings, but are uniquely possible in rural and community health settings.  Administrators should be taking every opportunity to cultivate a participatory culture that fuels physician engagement.

Without having to rely solely on outbidding a competitor for the physician’s services, let’s look at the results of a survey question that asked respondents to identify the primary reason they declined other offers they were considering before choosing the rural practice offer.

Reasons for Declining Other Offers

Of the physicians that responded to this question, most indicated that they weren’t interested in the Geographic Location or that they were concerned about the Work Schedule Demands of the offer they declined.  Other responses from physicians worth noting, were Compensation Level, Organizational Culture, and not having Flexibility to Use Telemedicine.

“I had genuine concerns about the practice philosophy of the organization I turned down.”

Recruiting physicians to work in rural settings will always require administrators to do more homework on the physicians they are recruiting and then to be more creative when developing an offer. Unless a physician was born in or near a similar rural community, administrators will have to rely on selling the location to those they are recruiting. Understanding the physicians background enables you to make the connection of what will be appealing to the doctor and their family if they choose to practice there.  Plus, having a participatory culture and organizational values that are evident throughout the recruiting process gives the administrator a selling point that can help smooth over any initial objections to practicing in a rural setting.

Retention

Turning our attention away from the reasons physicians accept or decline offers to work in a rural practice or health system, let’s examine what they say will keep them in that setting. The first retention question asked respondents to identify the most compelling incentive that could be offered to ensure that the physician would stay for at least the next five years.  Not surprisingly, both physicians and administrators identified Increased Compensation and a More Flexible Schedule as compelling reasons to remain in the practice.  Administrators also indicated that they felt a Retention Bonus would be a factor for physicians to compel them to stay, yet, from the physician survey, the Retention Bonuses barely registered as a response.

“I didn’t feel like they were just filling a slot. Throughout the process, I could sense that they were looking for someone who fit in with what they were about as an organization.”

Most Compelling Incentive to Stay

Job Satisfaction and Engagement

Respondents from both the physician side of the equation and the administrative side answered similarly when asked to describe “What they love most about their job.”  Both groups expressed a deep passion for providing care to the members of the local community.

“I felt a personal obligation to give back to my hometown community. I love caring for people who truly appreciate what I do.”

Almost exclusively, the physicians expressed their enjoyment at being regarded as a valuable Member of the Community, and how they have the ability to develop Relationships with their patients that they wouldn’t find in a metropolitan practice.

Administrators responded with gratitude for being able to provide healthcare to an Underserved Community as one of the biggest joys they found in their work. Many responded that it is the Personal Relationships they have developed with the staff and community that keep them in their position.

Interestingly, when physicians were asked to identify things that “kept them up at night” many of their responses centered on three main themes. Many cited needing help in keeping up with Electronic Health Records.  Others stated that because they are predominantly alone or part of a small group, they fear missing something with a diagnosis, while many more simply cited a general Lack of Resources.

On the administration side, challenges that interfere with their work include Reimbursements and other Financial Issues, and a significant amount of the responses included a statement about Physician Vacancies and Recruitment.

With that, let’s summarize the things administrators should be considering for the successful recruitment and retention of their physician staff.

Considerations for More Successful Rural Recruitment and Retention

As demonstrated through the results of both surveys, physicians and administrators agree that Compensation will be at or near the top of the list when it comes to recruiting to a rural practiceCompensation will always be important, but administrators should be mindful of the other reasons physicians consider a rural practice to allow them to find physicians who will fit, succeed, and stay with their rural practice setting. Consider the following employment incentives in mind when recruiting.

Recruitment

  1. Doctors want assurances of autonomy.

“I am frequently consulted with to help make important decisions for the organization. We have a plan in place where I will become a true medical director in time.”

In their own responses, physicians gave much more weight to being autonomous as an appealing factor in a job offer. Not in the sense of executive fiat, but more in how they practice medicine without being dictated to by executives.  This is one advantage that larger metropolitan settings typically cannot provide to their physicians and should be a point of emphasis for rural administrators.  Armed with the knowledge that 43% of physicians consider having more autonomy as an important attribute to their career, administrators should demonstrate that they are prepared to offer the autonomy that a physician needs throughout the recruiting process.

  1. Demonstrate a team-based culture.

Physicians also appreciate an organization focused on teamwork and collaborative decision-making. Culture and fit are widely discussed as important factors for physicians in feeling engaged in the workplace. Throughout the recruitment process, the organization should be putting their best brand ambassadors front and center to provide candidates with a glimpse of who your organization is and what you are about.

“I met with all of the providers and everyone expressed how collaborative the environment was. Community involvement was also evident throughout the process.”

  1. Recruit the family as a whole unit.

Both physicians and administrators identified having a family friendly environment as an appealing attribute of the organization. Highlighting the best aspects of the community, and involving community leaders in the process will go a long way in demonstrating the community’s value to the physician. Specifically, taking time to ensure that spouses and significant others are engaged in the process can be a deciding factor once an offer is being considered.

  1. Get administrators involved.

One of the lost arts of physician recruitment is the involvement of Hospital CEO’s and Administrators.  Physicians rank the impact of culture on their job consideration as number 3, according to the survey.  Culture is typically established from the top, so there is no better representation of culture than from the Hospital administrator taking the time to share his or her vision and philosophy to the candidate. This demonstrates to the candidate that the administration truly wants their family to join the organization – and the community – and cares enough to show it. A close friend, retired CEO of a major metropolitan healthcare system, employed his best practice to attend every dinner with physician candidates to show his support and desire for them to move there. My obvious question was “how did you find the time?”. He believed it was the best investment of time he could make and was often told that his interest in them helped them with their employment decision.

We find that fewer administrators take the time to do this simple, yet impactful, task and show their appreciation for the candidate’s time in interviewing. I say this tongue in cheek, but “Doc Hollywood” was a great example of pulling out all the stops to acquire the talents of a physician in rural America. You might not have a squash festival in your community, but you do have the community leaders who should realize how important it is to recruit medical talent to your town.

Retention Factors

As with recruitment, compensation will always play a role in keeping individuals from seeking new opportunities.  The best strategy for retention is two-fold. First, hire individuals who are a fit for your organization and community.  A good hire is easier to retain than someone who just fills a vacancy. The second strategy is to keep your staff engaged to ensure that they are achieving fulfillment in their career and performing at a high level.

  1. Provide leadership opportunities.

As identified in their responses regarding what compelled them to accept an offer, many physicians cited leadership opportunities.  Obviously, additional responsibilities will typically drive higher compensation.  It is also important to find ways to allow physicians to challenge themselves, whether it is through leadership or research opportunities, or even teaching. The key is to make an effort to better understand your staff to stay equipped to help them stay engaged and give them the latitude to challenge themselves.

  1. Flexible Schedule.

Your physicians want more control over their schedule.  In most cases, that is a big ask, but it can be an opportunity to engage with your provider staff collaboratively and determine reasonable solutions.  Some respondents identified that if they had assistance with electronic health records or in some cases a better workflow to manage administrative tasks, they would be better positioned to control their clinical hours. As noted earlier, when asked to identify a compelling reason to stay another five years, physicians cited a reduced or more manageable work schedule. Identifying and then mitigating the factors that are contributing to excessive work hours is critical to your retention success.

Summary

Nearly 68% of the physician respondents to the survey had roots in a rural community during their lifetime. In many cases, it was they, their spouse or partner, or extended family that were raised in a rural community.  What our survey has shown is that while compensation and other financial incentives matter, other factors swing the decision to accept an offer to practice in a rural community.  Rural health system administrators must develop a culture that is attractive to physicians and more importantly demonstrate that unique environment throughout the recruitment process.

Here at Jackson Physician Search, we are truly appreciative of all our partnerships across the country and thank all of our rural clients and participants of this study for helping us drive alignment between rural administrators and physicians, while working towards increasing medical access for rural communities across the country.

To speak further about specific questions regarding your rural physician and advanced practice provider recruitment, feel free to reach out to a JPS Consultant here.

About Jackson Physician Search

Jackson Physician Search specializes in permanent recruitment of physicians and advanced practice providers to hospitals, health systems, academic medical centers and medical groups across the United States. The company is recognized for its track record of results built on their clients’ trust in the skills of their team and the transparency of their process.

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