Rural Hospitals Use Innovative Approaches to Recruit Physicians

By Hannah O. Brown
August 17, 2018

A key is promoting the most enticing elements of a community. In one refugee-rich county, a hospital lured doctors attracted to working with international populations.

When Benjamin Anderson, MBA, MHCDS, began working at Ashland Health Center in rural Kansas, the hospital was on the verge of closing. He was 29 years old, and it was the first time he had ever been called CEO.

Situated in Clark County (population 2,215), Ashland Health Center sits about 150 miles southwest of Wichita. When Anderson arrived, the hospital had no physician on staff.

The pressure of this desperate situation pushed him to devise a new approach to recruiting physicians to this rural part of the country. “When we don’t have any choice to become innovative or die, we become innovative,” he said.

benjamin anderson

Benjamin Anderson, right, CEO of Kearny County Hospital in Lakin, Kansas, stands with Prince Jean Bosco Kanani, an HIV specialist from Rwanda. Kanani, who oversees about one-third of the hospitals in his country, was visiting Lakin to study the hospital’s model for full-spectrum family medicine.| Photo from Benjamin Anderson

Based on his experience, Anderson identified five profiles of medical providers that move to rural areas:

  • The local doctor returning home.
  • The international doctor willing to work in rural areas to receive a Green Card.
  • The “troublemaker” whose behavior keeps them from landing a job in a city.
  • The doctor who is willing to move anywhere if the pay is competitive enough.
  • The missionary doctor who is driven by a greater purpose.

Of these groups, Anderson and his team decided that the missionary doctor was their first recruitment choice. He began to market his hospital as an opportunity for physicians motivated by their missionary spirit and religious faith. He reached out to family medicine residencies known for training doctors that work overseas. And he pitched the idea of working in a community with residents from at least 30 countries, many of whom were refugees working in packing plants and the livestock industry.

Kansas withdrew from the U.S. Refugee Resettlement Program in 2016, but not before hundreds of immigrants from across the globe settled in the area. According to the American Immigration Council, immigrants make up 7 percent of Kansas’ population. While nearly half of Kansas immigrants are from Mexico, others come from many other countries such as India, Vietnam, China, Guatemala and Somalia.

RELATED: In Rural Areas, Recruiting and Retaining Doctors Are No Easy Tasks

Anderson developed a strategy to lure doctors attracted to the challenges and rewards of working with international communities, which included paid time off for optional international mission work.

“We are telling these doctors, if you want to go to Somalia, cool, we will give you 10 weeks paid time off for you to go serve anywhere in the world you want to go, but Somalia is here,” he said. “By serving overseas, we realize you are better equipped to serve here. And by serving here you are better equipped to go overseas.”

RELATED: Understanding Recruitment and Retention

That tactic proved to be very successful. Anderson said he recruited a dozen providers in three years.

“The core of this whole approach is understanding people’s motivation,” he said. “What motivates them? What motivates them will determine, one, if they come and, two, if they stay.”

Though the international community of southwest Kansas is unique, the idea that you can target a specific niche of physicians based on their own interests and goals is not. A similar approach could be used to find solutions to physician shortages in other rural areas as well.

COMMUNITY APGAR PROGRAM

  • Community factors play a key role in the recruitment and retention of physicians to rural and underserved health care settings. The CAP helps to organize these factors for action.
  • Concept based on Apgar newborn evaluation  but instead uses measures that assess community readiness for recruiting physicians.

GOALS

  • Identify individual community strengths and unique opportunities for improvement in Critical Access Hospitals and Community Health Centers related to recruiting and retaining physicians.
  • Understand regional patterns affecting physician supply that can be addressed at the macro level.
  • Create a shared national database to facilitate broader understanding of important issues related to physician recruitment and retention to rural and underserved areas.

PARTICIPANTS

  • Critical Access Hospitals in Idaho, Wyoming, North Dakota, Wisconsin, Alaska, Indiana, Utah, Montana.
  • Community Health Centers in Idaho, Maine.

QUESTIONNAIRE

  • Assesses a community’s capability to recruit and retain physicians.
  • Questions in five classes: geographic, economic, scope of practice, medical support, hospital and community support. Each class contains 10 factors.
  • Answers compiled over a two-year period to provide a real time assessment score of a community’s ability to develop and execute action plans for improvement.

Sources: Boise State University, Family Medicine Residency of Idaho

Brock Slabach, MPH, FACHE, senior vice president of the National Rural Health Association, calls Anderson a “rock star.”

“He identified a niche of physicians that have a different heart about them,” Slabach said.

Slabach previously worked as a CEO at a rural hospital in southwest Mississippi for 20 years, giving him decades of experience luring providers to rural areas. Recruiting there is a daunting task, considering the increase in doctors retiring and the drop in medical school graduates choosing primary care. The Association of American Medical Colleges has reported that the U.S. is expected to experience a shortage of between 40,800 and 104,900 physicians by 2030.

“It doesn’t leave a whole lot of prospects for the number of positions that are open in rural areas that need filling,” he said.

A key to success, he said, is an approach that looks at the most enticing and attractive elements of a community and deciding how to present them in a way that is most persuasive.

“You need to have all of the stakeholders in a community participating in the process, because it’s not just recruiting someone to work, you are also recruiting them to live,” Slabach said.

Slabach has used the Community Apgar Program to aid in this process. The program aims to assist rural hospitals identify the strengths and challenges to recruiting PCPs to their communities. It can help administrators form a strategy and pinpoint and address gaps in current programs.

For Slabach, this tool has been especially helpful when working with community members.

“Sometimes it helps to have that third party come in and provide that fresh look,” he said. “It gives some insights in terms of what is required and what can be done. It also helps to communicate with your stakeholders, so it’s not just you saying these things.”

For Anderson, now the CEO at Kearny County Hospital in Lakin (population 3,977) about two hours northwest of Ashland, a community approach has also been instrumental for recruiting residents “in bulk” to rural Kansas.

RELATED: Training New Doctors Right Where They’re Needed

In collaboration with nearby hospitals, Anderson has been involved in a program that uses a chartered jet to pick up residents and fly them to Kansas, and coordinates with the local community hosting them for the weekend. Their visits have included steak dinners hosted by the local farm bureau and visits from government officials.

RELATED: Recruiting Candidates and Their Families Is Best Way to Close Deal

The first two of these trips, called “focus weekends,” resulted in 12 physicians signing contracts with six hospitals, Anderson said. Several more are considering a move next summer.

Another "focus weekend" is slated for January 2019.

“If even one of them signs a contract, it’s worth it,” Anderson said.

Hannah O. Brown is a freelance journalist based in Florida.

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