Recruiting doctors to rural hospitals in Arkansas is harder than ever, hospital CEOs and others say.
The hospitals are using every tool at their disposal: recruiting firms, competitive pay packages, signing bonuses, stipends. And still they struggle.
“We’re offering actually a more-than-competitive salary because we recognize that to get somebody to come to a rural community, you’re going to have to have some enticements that they’re not going to get in terms of money elsewhere,” said James Magee, CEO of Piggott Community Hospital.
“If they signed a contract to come here, then we would do a combination of signing bonus and monthly stipends while they’re still doing their training,” he said.
The reasons behind the dearth of doctors seeking to join rural hospitals are many, longstanding and, sometimes, structural.
They include a continuing physician shortage facing the entire country, the perceived lifestyle disadvantages of a small town or rural area, a lack of jobs for the doctor’s spouse or, if the physician is unmarried, a lack of potential partners.
Rural areas are increasingly competing with urban areas, said Phil Miller, vice president of communications at Merritt Hawkins of Dallas, a physician recruitment firm. When the firm was founded 27 years ago, it focused almost solely on placing doctors in rural areas. Now, Miller said, 40 percent of its work is for communities of 100,000 or more.
Rural hospitals “have to cast a wide net because it is a national market,” he said. “Typically, you’re not just recruiting against the hospital down the street or over in the next town. Physicians — particularly primary care doctors, who are in the most demand and the most needed in rural areas — they’re getting offers from everywhere.”
A recent Merritt Hawkins survey of final-year medical residents showed that almost half had received more than 100 job solicitations during their training, Miller said.
And medical residents just don’t want to move to smaller communities. That Merritt Hawkins survey also asked final-year medical residents about their practice preferences and pay expectations. It showed that only 1 percent wanted to live and work in a community of 10,000 or fewer, and only 6 percent were interested in a community of 50,000 or fewer.
Medical residents frequently seek to settle in the communities in which they trained or communities of similar size and character, and those are usually urban, Miller said.
However, Arkansas has a medical school and it is 33rd among the 50 states in the number of medical residents — future physicians — to population, he noted. But it ranks seventh in the percentage of residents that it retains, Miller said. “When the state is able to train doctors, it tends to hold onto them,” he said. “They stick around. They like it. So in a lot of rural recruiting, the challenge is just getting the doctor interested enough to come.”
Overcoming that challenge meant recruitment success for Debra Wright, CEO of Howard Memorial Hospital in Nashville, though she’s also experienced “some bumps in the road.”
“I recruited a physician through the J-1 visa waiver in Arkansas,” Wright said, referring to the process through which foreign graduates of U.S. medical schools can stay in the country if they practice in a medically underserved area. “He began in January, resigned in June and left in July. He did repay his sign-on bonus.”
However, Howard Memorial was able to attract a young resident who had previously worked in its emergency department. He had learned about the hospital through another resident, a young woman under contract to the hospital once she completes her residency. This woman, Wright said, “was so excited about the fact that she’s coming in August of 2016 that he said he just was kind of envious.”
The young male doctor opened his clinic Aug. 17 and is doing “extremely well,” Wright said.
In other words, positive word-of-mouth made a difference for the hospital. “If you had to sum it up, it’s just building those relationships and not burning any bridges,” Wright said.
The Arkansas Area Health Education Centers, or AHEC, also played a role in bringing that young doctor to Howard Memorial. The woman resident, headed to the hospital in 2016, participates in AHEC in Texarkana.
Piggott Community Hospital uses an outside recruiting firm but it also has an in-house program that focuses on the AHEC clinic in Jonesboro, Magee said. Several of those residents work in the hospital’s emergency room, “and we think we have potential success in trying to recruit some of those students who have not finished their training yet,” Magee said. “But there again, you still have to find somebody that wants to do rural medicine and has a desire to live in a rural community.”