Becker's Hospital Review

34 Physicians who are motivated by quality incentives, familiar and adept with technology and use an evidence-based approach to medicine are also sought after by hospitals and ACOs, according to the survey. The catch is that few hospitals or healthcare organizations currently employ physicians with these skill sets in the present day: Only 2.4 percent of survey respondents said all of their physician staff meets criteria they outlined as desirable. This suggests that while physicians may be seeking hospital employment in droves, hospitals — as employers — still need to identify the best hires who are compatible with the organization's plans for ACOs, patient-centered medical homes and other integrated delivery models. Urban versus rural markets To approach physician recruitment discussions as a one-size-fits-all subject is inexact, as strategy varies depending on a hospital's market and location. Rural areas are facing an especially challenging recruitment environment right now, since the nationwide physician shortage is exacerbated in markets or states that do not include major medical schools. That setback is compounded by the fact that fewer physicians consider rural areas attractive for work. In the most recent Residents and Fellows Survey, 32 percent of respondents said they would not consider practicing in a rural area. On the flip side, 95 percent said suburban communities were their first or second choice for a practice location, while 84 percent named a metropolitan area in their top-two locations.   Here are a few specific trends and challenges facing rural hospitals in their recruitment efforts. Physician-Hospital Relationships & ACOs Professional factors, however, did not rank as high. Fourteen percent of physicians cited the chance to buy a practice or become a partner as a factor, while 13 percent cited earnings potential and 8 percent mentioned recruitment strategies as "very important." Innovative recruitment strategies What are some recent developments in recruitment strategies from the past five or 10 years? Many hospitals have refined and retuned their strategies to become more business-savvy, aggressive and appealing to physicians just completing their training. Here are four tactics our experts have seen more of in recent years. Promotional tools. More hospitals and health systems are developing formal promotional documents to inform physicians about their hospital's culture, community and employment benefits. Hospitals are creating and distributing a document called a "practice opportunity prospectus," which outlines information about the practice opportunity, the physician's potential compensation, the hospital's medical staff and surrounding competition, the greater community, and other key points of consideration. Such promotional tools are a change from what used to be a more relaxed approach to recruitment, according to Mr. Halley. "It was more like, 'Give me your curriculum vitae and I'll tell you more about the practice. If we like one another, we'll chat and visit, and then maybe we'll give you an offer.' Now hospital recruiters are trying to truly understand what the physician is after, and do a better job matching those desires to what [the practice has] to offer," says Mr. Halley. Handling call. Compared to their urban counterparts, rural hospitals rarely have as large of a physician panel to handle call. This can hinder physicians' interest since it poses a threat to work-life balance. "No physician wants to be on call every other day. That's an infringement on their lifestyle," says Ms. Greeter. To overcome this, some rural hospitals hire locum tenens physicians to provide coverage on those days the recruited specialist cannot or will not be on call. Current recruitment efforts have also become a bit more slick and savvy, largely due to tools like social media and other technological perks. "We use everything," says Banner's Ms. Folger. "We use video-conferencing for interviews so we can have live discussions with [candidates]. We tap into residency programs around the nation. We use technology that allows us to identify physicians who may have family in a particular region and may want to return to it. It's a full-court press with all the technology available to us." Another less popular arrangement is when hospitals tell physicians outright that, upon employment, they are responsible for a specific number of days of call coverage, such as 10 days per month. Once the physician meets that responsibility, hospitals can send patients elsewhere for that specific specialty — something hospitals don't prefer to do, especially for surgical or other high revenue-generating services, according to Ms. Greeter. Recruiting in high schools. Connection is the keyword for rural hospitals' recruitment efforts. Does the physician have family in the area? Did the physician grow up nearby? Rather than retroactively trying to recruit physicians who moved away to complete their training, some rural hospitals and health systems begin recruitment efforts proactively and early — even when students are still in high school. Finding physicians connected to the area. Sourcing candidates is a fine art for rural hospitals, as physicians who have lived within 100 miles of its location or have regional experience with the hospital are more likely to relocate to and stay in the area. The challenge is in identifying these men and women, which Mr. Halley recommends be done proactively. "Some communities will say we can't recruit to our community and I'll say, 'Wait a minute. Where are all the medical students and residents from this region studying medicine today? Do you know where they are? What if we brought them home? Let's go get them,'" says Mr. Halley. "Some hospitals will go into the high school and say, 'Look, if you're interested, we'll support you if you come back and agree to work in the community," says Mr. Reiboldt. Hospitals will offer to fund a portion of students' medical school expenses if he/she agrees to return and practice in the community for an agreed-upon amount of time. "This will try to help motivate [students] to go all the way through medical school and then come back." Perception of quality of life. Compared to their urban counterparts, rural areas are generally perceived as less robust when it comes to schools, cultural diversity, entertainment and recreational opportunities. Isolated areas pose a significant barrier in physician recruitment efforts, but not all candidates are deterred from non-urban markets. Interestingly, some physicians' inherent attraction to rural areas can outweigh financial considerations when choosing a practice setting. In a survey, the Colorado Health Institute asked 711 rural physicians what factors they consider "very important" when choosing a practice setting. Respondents could choose more than one answer. Three of the top four responses related to lifestyle: 70 percent cited recreational and leisure activities as a very important factor, 55 percent said the setting must be a good place to raise children, 44 percent said opportunity for professional independence and 40 percent said the desire to retire in rural Colorado. Incubation models. Another recruitment strategy, known as the incubation model, has been implemented for a while in the healthcare community, but Ms. Greeter said it is picking up speed. Under this model, a physician is recruited to the community by the hospital or health system. The physician becomes an employee of that organization, but is placed in a group practice setting with other physicians who are, oftentimes, not hospitalemployed. The hospital then leases the space and pays the other physicians a management fee for overseeing the newly recruited physician. After the recruited physicians complete the incubation period, which typically lasts two to three years, they still have to work off a commitment to the community, which is often another two or three years. In that time, the physicians have an option to continue practicing in the group setting in which they completed their incubation period. This model is attractive to hospitals and health systems, as they will essentially recoup what it spent on the physician recruitment through a committed provider and the increased stability of the service line.

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