Physician Recruiting About to Get Tougher for Rural Hospitals

When it comes to recruiting physicians, it's like this: Rural hospitals have to work harder, talk to more candidates, and expect more rejections.

Of course, this should come as no surprise to anyone familiar with recruiting clinicians to rural America. And the data backs it up. These concerns are detailed in the 2012 In-House Physician Recruitment Benchmarking report from the Association of Staff Physician Recruiters.

The report suggests that the increased demand for healthcare services, which are expected with the full implementation of the Affordable Care Act, is going to make recruiting doctors even more difficult for rural providers in the coming years.

"There is no indication whatsoever that rural recruiting is going to get any easier," says Shelly Tudor, chair of the ASPR Benchmarking Committee and member-at-large of the ASPR Board of Directors.

"In fact, the report shows that the cost of recruitment is going up, [which will make it] it harder for rural healthcare organizations to compete. A clear correlation exists between the facilities' population size and acceptance rates, with offers from organizations in larger populations much more likely to be accepted than those in smaller populations."

The ASPR benchmark shows that interview-to-hire ratios are much lower in urban areas than in rural areas. "In lots of respects, the process favors urban providers. Physicians are coming to urban areas and they are looking for jobs, whereas rural providers have to go out and target physicians that are likely to come to their area," Tudor says.

"Their interview-to-hire ratios are going to be much, much higher. Their sourcing-to-interview ratios are going to be much higher, too, because they have to filter through a lot of people to find the right one who is willing to come in and even look at the opportunity."

Further hampering rural hospitals' efforts to attract physicians is the potential distraction of overworked in-house recruiting officers wearing multiple hats.

"When you get in these rural areas, you are talking about small hospitals and the in-house recruiter might also be responsible for credentialing, and on-boarding, and administrative responsibilities, and any number of other things," Tudor says. "She may need help identifying candidates just to even look at."

For both urban and rural hospitals, the ASPR benchmark reaffirms larger nettlesome trends in physician recruitment. [The benchmark report includes data from 151 organizations representing 4,808 searches conducted in calendar year 2011.]

Between 2011 and 2012, there was an increase of 18% in positions unfilled.

Seven in 10 (71%) of searches are done by hospitals/integrated delivery systems, up 10% from 2011. Referrals and Internet job boards remain atop the sourcing list. However, 12% of candidates contacted hospitals directly through their websites, indicating the importance of an organization's online presence.

Median time-to-fill was 155 across all physician specialties (222 days on average) compared to a median of 120 days (208 days on average) from 2011.

Median time-to-fill for primary care physicians was 151 days compared to 125 days last year. Time-to-fill for advanced practice providers, such as nurse practitioners and primary care physician assistants, was only 90 days for both the 2012 and 2011.

A decline can be seen in the number of searches that were filled (51% in 2012 vs. 60% in 2011) and an increase in those that remained open at the end of the year (42% vs. 36% in 2011). Specialties that were least likely to be filled during 2011 were: med-peds, neurosurgery, dermatology, urology, and otorhinolaryngology.

Unfortunately for rural providers, there is no easy fix. "What is driving that is personal preference on the physicians' part," Tudor says. "The vast majority of physicians and their families want to be in areas where there is access to good schools and good entertainment. It's a lifestyle decision, at the end of the day."

Admittedly, the news from the benchmark is downbeat. But let's not forget that providing healthcare in rural areas has sublime appeals.

"One of them is satisfaction," Tudor says. "If you are inclined to that type of work there is a great deal of satisfaction from helping those people and their communities. They tend to be very grateful for the care they get, versus a metro area where we have certain expectations of what a physician should be. People in rural areas tend to be grateful that they even have a physician."

Rural hospitals can also provide financial incentives to recruit physicians using funding that is made available if they are designated as a healthcare workforce shortage area by the Health Resources Services Administration. "That can be a good incentive for someone who comes out of medical school," Tudor says.

"I spoke with someone the other day who is $400,000 in debt from her medical school training. So rural hospitals do have some advantages in that respect, but you still have to find the people who are willing to go out and explore those possibilities."