Dr. Poudel
Too often for urban hospitalists, he says, the next patient is just the next patient, whereas in a rural community, the odds are better than even that the doctor at least knows someone in the patient’s family. “That gives you a whole different perspective on the work.”
The Challenge: Recruitment
Despite the virtues of small towns for those who can appreciate them, rural hospitals face an uphill battle in attracting the desired complement of hospitalists to staff their programs. HM’s explosive growth means the field generally has benefited from a seller’s market, and rural communities have struggled to fill both inpatient and outpatient positions.
“Recruiting is tough in rural areas, even as some metro areas are starting to fill up with hospitalists,” Dr. Nelson says. Michael Manning, MD, a hospitalist at Murphy Medical Center in Murphy, the westernmost town in North Carolina (population 1,568), says it’s especially hard if the nearest airport is hours away. “A small hospital’s efforts to advertise just gets lost unless the candidate is actively looking for a rural setting to practice. Here we’ve got hunting and fishing. I came for the whitewater kayaking,” Dr. Manning says.
The challenge is to convince people who have never visited the area that a rural hospital is a great place to practice, says Brian Bossard, MD, FACP, FHM, director of Inpatient Physician Associates in Lincoln, Neb. “There are lots of barriers to address in order to negotiate a positive outcome. The more rural it is, the harder the job of recruiting. What more can we offer a recruit? Sometimes it’s money, a signing bonus, a benefit package. With many recruiting efforts, the spouse is part of the equation.”
Recruiting doctors to rural areas starts by leading with the hospital’s strengths, such as high-quality care, manageable workloads, or sustainable schedules, Dr. Bossard says. Recruiters also focus on the advantages of living and raising children away from the big city. International medical school graduates have long been a recruitment target of rural hospitals, but they present bureaucratic hoops that some hospitals are unwilling to jump through. (Visit the-hospitalist.org to learn why Foreign Medical Grads can bolster your HM group staffing.) Other hospitals employ recruiting staff, recruitment firms, paid advertising, and old-fashioned word of mouth—talking with anyone and everyone who might know a physician who could be interested.
Fannie Vavoulis, medical recruiter for Chatham-Kent Health Alliance in Chatham, Ontario, agrees that it can be difficult to recruit physicians to a setting like her predominantly agricultural community. But she has enjoyed recent success, in part due to the efforts of a 25-member community volunteer group of local business and health leaders who woo physician candidates. “We use the volunteers to show them around, help find opportunities for their spouses, and offering ongoing mentorship once they come here,” Vavoulis relates.
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A Little Like Home
Rapid City, S.D., with a population of 68,000, isn’t the most rural of settings, although Rapid City Regional Hospital (RCRH) also serves a large rural catchment area, with affiliated rural satellites. But the Black Hills are worlds away from places like Chicago or Dallas or New York City, where many future hospitalists do their residencies.
Pushpa Poudel, MD, came to 400-bed RCRH in 2010 following a residency at Wyckoff Heights Medical Center in Brooklyn, N.Y. “The people I met on my interview days were nice, but I was more attracted to the work environment and the dedication I found in the hospital here,” he says.
Dr. Poudel, who is from Nepal and attended medical school in Kathmandu, says the scenic Black Hills reminded him a little of home. After interviewing at RCRH, he went back to New York and talked two Nepalese physician friends into joining him there. Today, the multinational HM group at RCRH includes six hospitalists from Nepal, as well as others from India, Egypt, Costa Rica, and the Republic of Georgia. “We now have 28 hospitalists, and in the seven years since the program started, we’ve only lost one of them,” says Kristi Gylten, MBA, the service’s director.
All of the hospitalist group’s members meet candidates when they come for interviews. “They are the biggest sellers of the program,” Gylten says, although work-life balance, recreation in the Black Hills, and the reputation of the local school system are also draws. “Often the hardest part is just getting them to come out here. Once they come to Rapid City and see the community, it surprises them.”
—Larry Beresford