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4 Strategies to Address Clinical Staff Shortages at Rural Hospitals

Analysis  |  By Christopher Cheney  
   September 18, 2019

Recent research highlights the difficulty of maintaining adequate clinical team staffing at rural hospitals. Four recruitment tactics could help change that.

Staffing clinical teams at rural hospitals can be a daunting human resources challenge, but there are effective strategies to address the problem.

Retirements and a declining number of young physicians choosing to practice in rural areas of the country is graying the rural physician workforce, according to U.S. Census data. From 2000 to 2017, the total number of rural physicians grew 3%, but the number of doctors under age 50 fell 25%. In 2017, more than half of rural doctors were 50 or older, and more than a quarter were at least 60.

Recently published research highlights the difficulty of maintaining adequate clinical team staffing at rural hospitals.

An article published in The New England Journal of Medicine includes a dire forecast for the rural physician workforce:

  • From 2000 to 2017, the rural physician workforce was stable at approximately 12 doctors per 10,000 population in rural communities. But the rural physician workforce is expected to decline 23% by 2030.
  • Nearly all of the expected decline is attributed to a drop in the number of rural physicians who are currently 45 or older because many of these doctors are likely to retire by 2030.
  • In contrast, the number of nonrural physicians is expected to drop slightly over the same time period—from 30.7 doctors per 10,000 population in 2017 to 29.6 doctors per 10,000 population by 2030.

The co-authors of the NEJM article call the forecast for the rural physician workforce troubling. "In 2030, residents of rural areas will have access to one third as many physicians per capita as their suburban and urban counterparts will. Yet rural residents are likely to be older, poorer, and in worse health than city dwellers, with a lower life expectancy, and they are more likely to be uninsured," they wrote.

Recruiting physicians at rural healthcare organizations

A survey report published by Alpharetta, Georgia–based Jackson Physician Search also includes a gloomy view of the rural physician workforce. "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," the survey report says.

The survey report, which is based on data collected from more than 150 physicians and 105 rural health system administrators, says four factors were found to be particularly effective in the recruitment of doctors in rural areas.

1. Autonomy: The survey found 43% of physician respondents consider autonomy as a significant goal in their careers. The physician survey respondents say they value practicing medicine without undue influence from executives. "Healthcare professionals—both nurses and physicians—want to have their voices heard, especially when it comes to issues affecting their practice of medicine. Rural hospitals have the advantage here when compared to a large bureaucratic health system," Tony Stajduhar, president of Jackson Physician Search, tells HealthLeaders.

2. Team-based culture: Physician survey respondents say they enjoy working at healthcare organizations that have strong teamwork and collaborative decision-making. "Culture and fit are widely discussed as important factors for physicians in feeling engaged in the workplace," the survey report says.

3. Recruit the family: Physician and administrator survey respondents say a family-friendly environment is a desirable aspect of a healthcare 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," the survey report says.

4. Administrator role in recruitment: With physicians ranking culture high as a desirable attribute at healthcare organizations, rural hospital CEOs and other top administrators can be a decisive factor in the recruitment of doctors, Stajduhar says.

"Based on our survey, a well-designed, on-site visit that makes the physician and their family feel welcome and highlights the community culture is the No. 1 factor in picking a practice location. They need to be able to see themselves as part of an active and vibrant community, and to enjoy working in the organizational environment. Painting a picture of the vision of the organization and how they fit into building the future is essential. The senior leadership of the organization must be involved and take a lead role in the process," he says.

Avoiding recruitment and retention perils

On the other hand, Stajduhar and Lucy Skinner, lead author of the NEJM study and a rural health scholar at Dartmouth College's Geisel School of Medicine in Hanover, New Hampshire, say there are several pitfalls to avoid when trying to recruit and retain clinical team members.

Financial incentives may be helpful in recruiting but not necessarily in retention, Skinner says.

"One thing we have been focusing on is economic incentives such as signing bonuses and loan forgiveness, which can be effective in recruiting physicians to work in a rural area, but the problem is retention. Often, physicians will take these incentives then only stay for a few years—if they don't feel integrated into the community, they leave."

Particularly during the recruiting process, physicians and their family members should never feel unwanted or unwelcomed at rural hospitals, Stajduhar says. "They never meet the hospital president, CEO, board members, or senior medical leadership. You have a lot of no-shows at the physician dinner, or the staff is not friendly or welcoming during their visit. In addition, the family is largely ignored or forgotten."

The interview process for clinical team members must be well-orchestrated, he says. "Clinicians often leave an interview experience feeling that the organization doesn’t care whether they join them or not. They have unanswered questions or vague answers that don't inspire confidence in making a major life decision."

Christopher Cheney is the CMO editor at HealthLeaders.


Researchers are forecasting a 23% reduction in the rural physician workforce by 2030, mainly due to retirements.

Retaining clinical staff in rural areas of the country depends largely on how integrated the professionals and their families feel within the community.

To successfully recruit clinicians in rural areas, active participation of an organization's top leaders in the interview process is a must.

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