According to the National Institute of Health (NIH), 80% of the landmass in the United States is considered rural or frontier and is home to approximately 50 million people, making up roughly 15% of the nation’s population in 2012 (World Bank). Rural residents experience a variety of disparities, including those in economic growth, income, and the poverty gap compared to urban or metropolitan communities. In addition to these disparities, healthcare providers are few and far between, leaving both patients and providers to travel long distances to get to an office, clinic, home, or a hospital. In addition to the distance barrier, many rural residents do not have access to transportation, and seeing as public transport is not common in rural regions, many simply lack the means and resources to access the healthcare they need (NIH; RHIhub).
A large contributing factor to the lack of healthcare access in rural United States is the shortage of healthcare workers in those regions. In metropolitan regions, there are 33.3 physicians for every 10,000 people. In nonmetropolitan, or rural regions, there are 12.7 physicians for every 10,000 people (RHIhub). Additionally, there are 92.4 registered nurses for every 10,000 people in metropolitan areas compared to 64 per 10,000 people in nonmetropolitan areas.
In 2015, 95.1 out of 100,000 people in nonmetropolitan areas died from cancer in New York State, compared to 71 per 100,000 people in metropolitan New York. There is also data that shows that death due to heart disease in New York State is much more prevalent in nonmetropolitan areas than in metropolitan.
According to peoplescout.com, of all the rural counties in the United States, 77% of them are suffering from a primary care physician shortage. In addition, they also share that 60% of the nursing shortage is occurring in rural regions.
There is clearly a high need for more healthcare providers in rural areas. Unfortunately, successful recruitment and retention initiatives are lacking. There are a number of reasons many healthcare providers choose not to practice in rural settings but there are just as many, if not more, misconceptions about rural work and lifestyle. It is clear that recruitment strategies need to address both the true concerns and misconceptions in order to successfully bring an adequate number of healthcare providers into rural communities. Recruitment efforts need to be multi-tiered; peoplescout.com says, “Economic, educational, professional and cultural dynamics affect the clinical talent shortages in rural areas.” All of these areas, and others not listed, also need to be addressed.
There are a number of recruitment strategies organizations implement now. Some of them include:
- Loan-repayment assistance for recent graduates
- Having rural healthcare representatives present at conferences, networking events, and trade shows
- Promoting rural communities and rural lifestyles
- Boosting benefits and incentives packages
- Promoting rural college healthcare programs (this includes bringing in students as well as staff)
This is a very small sampling of current recruitment strategies, however, there are many more out there and more are being developed and implemented today. In a survey conducted by Jackson Physician Search, “Community Culture” was the top reason physicians participating in the survey chose to work in a rural setting. “Compensation” came in as the second highest reason. It is clear that studies like this one are invaluable to actualizing recruitment strategies. Emphasizing the enhanced quality of work in rural healthcare settings due to their unique culture should not be overlooked as a useful strategy. Compensation as a player in recruitment is clearly an obvious shoo-in with great potential for success.
Loan-repayment assistance for recent graduates can be an incredibly successful recruitment strategy. Many students, particularly with medical or healthcare degrees, graduate in a lot of debt. Money can be a great incentive and the possibility of alleviating loan-repayment stress can be a deciding factor. Peoplescout.com shares three well-known loan-repayment assistance programs:
Representing rural healthcare at various events can be a great way to educate others who may not be aware of the high need for rural healthcare providers. It is entirely possible that many healthcare workers haven’t even considered employment in rural communities. More directly, rural representatives can, in person, promote their own organization and community. Building connections and expanding networks can also be beneficial in the long run for bettering rural funding, favorable policy changes, and addressing misconceptions through word-of-mouth. Representatives can also meet medical students and build a good rapport, putting rural on their radars. There are a lot of studies that support the claim that face-to-face interactions are far more successful than any other interaction (e.g. email, social media, etc.) This Washington Post article says, “Organizational behavior experts argue that face-to-face meetings are the best way to capture a person’s full attention, cutting through the multi-task tendency that focuses on too many things at once.” Having rural healthcare representatives at these networking events and conferences can be highly successful because it’s more direct and engaging, and thus, more memorable.
There are a number of ways to promote rural lifestyle. Many recruiters know that in order to successfully promote a job (in this case, rural healthcare), the community and lifestyle also need to be addressed. There are a lot of negative associations with rural America. High poverty rates, high obesity rates and other health concerns, “brain-drain” (skilled professionals moving out of rural areas and into urban centers en masse), lack of public transportation, fewer local amenities, and small-town social dynamics. While all of these elements should be seriously considered, there are so many positive characteristics of rural life. Some include having a closer relationship to nature and outdoor activities (running, swimming, hiking, camping, horseback riding, etc.), raising a family in a home with a yard, benefits of local farms (farmer’s markets, fresh food, farm-to-table restaurants, and harvest events such as pumpkin patches and apple picking), and tight-knit communities where impact is more easily seen. Some studies, like the one referenced in this article say that while high school graduates may leave their rural towns and go into cities, many return in their later years. The article says that in one Minnesota study, many “newcomers” moving into rural areas were professionals, “who were moving to smaller towns to improve their quality of life.” For those looking to live a quieter, and in some ways slower, lifestyle, rural is a good match. Promoting rural lifestyle strategies can range from boots-on-the-ground classroom visits at schools, digital and social media efforts, college programs highlighting rural opportunities, face-to-face discussions at networking events, and partnering with tourism agencies and Chambers of Commerce.
Similar to the loan-repayment assistance strategy, there are other benefits and incentives packages that could be promoted in strategic ways. This includes rural healthcare employers promoting various sign-on bonuses, relocation assistance, insurance benefits, assisting in paying for continuing education, retirement packages, sick leave, and low-interest home loans to name a few. Many rural hospitals and healthcare facilities are providing benefits and incentives like these. However, it is important to note that this strategy alone will not solve the rural healthcare shortage (medicaleconomics.com).
Promoting healthcare programs in rural colleges is another great recruitment strategy. Students who train in rural settings are more likely to stay rural. This is due to the fact that rural practices tend to differ from urban practices. Professionals who train in rural settings know what to expect and how to navigate the rural healthcare field with less of a learning curve than their urban counterparts. Similarly, healthcare professionals who grew up rurally and went to school in an urban setting are more likely to return to their hometown or another rural community (medicaleconomics.com). Another approach to increasing students in rural healthcare programs is to shift admissions focus, which tends to lean toward accepting the elite, or “best of the best” into medical programs, to accepting students with rural backgrounds and others who possess characteristics that would fit well in a rural healthcare setting (RHIhub; medicaleconomics.com). Some of these characteristics include: adaptability, resilience, reflective practice, and collaboration. With the combination of expanding who “fits” into a medical program and promoting rural programs, this will bring more rural students into these programs, which will then lead to a higher likelihood of those students returning to rural communities for work.
Rural health recruitment strategies not discussed in this article are still worth considering. Any efforts made to recruit healthcare providers into rural communities are extremely important. The need for healthcare workers in rural America is dire and only expected to get worse. A good approach for combating this shortage is to implement more than one strategy at once. Health WorkForce New York specializes in recruitment and retention initiatives. Our mission is to improve the quality of healthcare in underserved and under-represented communities. Our strategies are multi-pronged, combining boots-on-the-ground strategies with digital media, pipeline programs, regional campaigns, and rural immersion programs. If you’re interested in rural recruitment solutions and strategies, please don’t hesitate to contact us.
