The 2008 Report to the Secretary: Rural Health and Human Services Issues, published by the National Advisory Committee on Rural Health and Human Services, identified several factors that contribute to continued rural work force shortages, including high caseloads, long hours on call, isolation from colleagues, lack of easily accessible continuing education and professional enrichment opportunities, limited professional opportunities for spouses, and heavy school debt loads.
The inability to offer a competitive compensation package, the lack of adequate housing, and poor-quality schools are other factors that often make it difficult to recruit physicians to rural communities.
One strategy rural hospitals and communities can use to position themselves favorably is to emphasize their strengths to counterbalance their weaknesses. In other words, rural hospitals should trumpet as many of the following characteristics as they can about their communities:
A second strategy is to establish ties with a medical school that has a history of training numerous physicians who practice in rural areas after graduation. Physicians who participate in rural rotations during medical school and residency training are more likely to practice in rural settings, so a hospital or health system that provides these educational opportunities will increase its chances of recruiting young physicians directly out of training programs.
A third strategy is to make optimal use of the multiple government programs that help rural communities recruit physicians. The three types of recruitment incentives include educational scholarships, with subsequent service paybacks; loan repayment for service in designated shortage areas; and J-1 Visa waivers for international medical graduates.
Rural areas have a significant percentage of National Health Service Corps placements. Community health centers located in rural areas are viewed as desirable practice opportunities during training. The J-1 Visa allows foreign citizens to enter the United States for graduate medical education and/or residency training programs.
Foreign physicians on J-1 Visa waivers who commit to practicing in a health professional shortage area (HPSA) or medically underserved area (MUA) for a three-year period are allowed to remain in the United States for three years after expiration of their visas. Because many HPSAs and MUAs are in rural areas, international medical graduates with J-1 waivers are an important source of physicians for rural communities.