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Rural Kansas Hospital Recruits Physicians with a Mission

 |  By John Commins  
   June 06, 2012

There is no shortage of strategies to recruit physicians to rural America.

With varying degrees of success, enticements have included student loan debt relief, homey pitches touting country living, membership at the local country club, a house, a car, no ED call, great schools for the kids, a cushy job for the spouse, and for foreign docs, a fast-track to U.S. citizenship.

For all the effort, however, physician recruiting and retention remains one of the most challenging issues in rural healthcare.

One critical access hospital in tiny Ashland, KS (pop. 855) may have found the answer. Rather than attempting to sway physicians with amenities, the 24-bed Ashland Health Center in the southwestern part of the Jayhawk State has instead appealed to physicians' sense of mission.

For the past two years Ashland Health has recruited—and retained—two physicians and three nurses by offering them up to eight weeks of paid time away from the hospital each year.

The clinicians may use that time as they wish. However, Ashland Health makes it clear in the recruiting process that the hospital encourages and supports using that time to provide care for the poor and destitute in the world's most impoverished countries.

Ashland Health CEO Benjamin Anderson believes that the opportunity to make the world a better place is what has brought clinicians on board and kept them there.   

"The program was born out of desperation," he says. "Two years ago we had no doctors living in this community. Furthermore, the facility had been through 11 providers in 18 years. The approach that was taken previously wasn't effective, and we knew we had to try something different."

Ashland Health Center needed a recruiting tool that would set it apart from the scores of rural hospitals in small towns in every state that were looking for clinicians.

"There are a thousand communities in America that boast good schools with small classrooms and low crime and people help each other and [there are] beautiful landscapes and a low cost of living. These physicians get four or five mailings a week on opportunities like that," Anderson says.

"Before, this community focused on those things. But what the clinicians really want to see is opportunities to serve," he says. "They want to know that there is an unmet need and that by choosing to come here that unmet need will go away. So we are focusing on the things that a traditional recruiting approach would avoid."

Anderson, who will make his third service trip to Africa later this month, worked in physician recruiting before becoming a hospital administrator. He says there are "four types of providers" in rural healthcare. "The first one is the local kid who grew up there and is coming back to practice. The second one is the problematic doctor who doesn't work well with others. It maybe a character flaw or a personality issue so he can't make with his colleagues and he goes out to a small community where he is the only physician."

"Then you have the J1H1 foreign doctors. I don't want to discount them, but trends show they fulfill their obligation in an underserved area for three to four years and then get to an urban area as quickly as they can, so it is not a long-term fix," he says.

"And the fourth is the missionary doctor. The further away from Starbucks, the better it is for these doctors. They aren't going there for gourmet coffee, or Nordstrom's, or fine dining, or gated communities. They are going there to serve."

Serendipitously, Anderson found that the focus on commitment to a mission also serves as a vetting tool that attracts "people who are motivated by service and who are inclined to work for a cause that is greater than themselves."  

At first, the board of directors at Ashland Health Center raised concerns about the cost of providing two months of paid time off, which combines vacation, sick days, and personal days. Anderson says most clinicians would get that much time off as part of a compensation package without the optional international service program. "The alternative is to pay locums to cover you shift by shift," he says. "That isn't good for care or continuity. It's not a good model. It is unsustainable."

There was also concern that the call to missionary work was creating religious requirements for the publicly funded hospital. But Anderson says there are no demands placed upon clinicians' paid leave.
"It can't be faith-based because we are not a faith-based hospital," he says. "We are telling them you can use it however you want. It just so happens we are meeting quite a few people that are faith-focused, and that is OK. If that is what motivates them and the results are excellent, compassionate care, great. Go for it."

Anderson says any rural hospitals can copy the Ashland blueprint if it has a "mission-focused CEO."

"I don't say that lightly. That is often the missing link," he says. "For administrators it isn't as simple as paying somebody for time off. We want to quantify things. What is the cost for me? There is an intrinsic cost and certain intrinsic or intangible benefits. An administrator has to get it and if they don't when they recruit these people they aren't going to stay. Doctors have to know the administration is as committed to the mission and the organization as they are."

Once that happens, Anderson says, hospitals can recruit staff whose personal mission matches the organizational mission.

"But if you don't understand your own personal mission or vision, or that mission or vision is to stay open another day, that isn't exciting," he says. "Doctors don't run to 'I want to stay open another day.' They want to do it for something bigger than just staying alive."

The program at Ashland Health has been so successful that all of the hospital's 90 or so full-time employees—from doctors to dishwashers—have the opportunity to serve overseas. 

"There is a direct parallel. So the more people in our facility that we can get over to see those things before their hearts are changed and the more our local culture is enriched," Anderson says.

Even though Kansas is a world away from Africa, Anderson says all humans share a need for compassionate and accessible care.

"I am fascinated by what serving orphans and widows and people in poverty in Africa does to open our eyes and ears and hearts to needs of orphans and widows and people in poverty here," Anderson says. "It's transforming the culture inside our walls."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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