Becker's Hospital Review

86 POPULATION HEALTH 86 CEO/STRATEGY Physician recruitment and retention: How 2 rural hospitals are overcoming the challenge By Kelly Gooch R ecruiting and retaining physicians poses a significant challenge for rural hospitals. In fact, a 2016 Merritt Hawkins whitepa- per cited 6,080 Health Care Professional Shortage Areas for primary care nationwide, 67 percent of which are in rural locations. ere are several reasons hospitals in rural ar- eas have trouble recruiting physicians. Many rural hospitals are in towns that may not be attractive to physicians, and they are oen in isolated geographic areas with a more limited local candidate pool. Becker's Hospital Review caught up with two rural hospital CEOs to discuss this particular challenge and how they are working to over- come it. UCHealth Yampa Valley Medical Center Frank May, CEO of UCHealth Yampa Valley Medical Center, believes location plays a large role in whether rural facilities are able to re- cruit and retain physicians. His 39-bed hospi- tal sits in the mountain resort community of Steamboat Springs, Colo. He says this makes it a desirable location for many physicians, while other rural facilities in the state may not offer the same surroundings. Mr. May says physicians who enjoy the out- doors and the isolation in northwest Colorado are drawn to YVMC. However, he says case vol- ume presents a bigger challenge for his facility. "Having a variety of physicians in the market is important to the delivery of primary and specialty care, having those services locally and being able to take care of your patient population," he says. "I also know the case volume of services we provide can drive how physicians are compensated — some might receive a salary, where others are better suited on some type of a production structure. at can also have influence on whether we can re- cruit and retain someone." Part-time subspecialists such as pulmonolo- gists and rheumatologists are particularly dif- ficult for YVMC to recruit, as patient volumes in those areas don't necessitate a full-time position. However, since the hospital joined Aurora, Colo.-based UCHealth, it expects im- proved access to those kinds of subspecialists. When recruiting new physicians, Mr. May says it's important to find candidates who are committed to the community they serve. "You can recruit someone under a two-or three-year contract, and if they're not happy and they leave, it really creates a cycle. Some- times you have to do that because you need particular services, but I think finding the right person who's committed to a communi- ty [long term] and understands the lifestyle, challenges and benefits is really important," he says. Mr. May also encouraged rural facilities to pay attention to telemedicine as a way for them to improve resources for patients. YVMC has looked at various opportunities in this area, including telemedicine services for the intensive care unit, and anticipates imple- menting telemedicine initiatives in the future as part of its new relationship with UCHealth. Island Hospital Like Mr. May, Vince Oliver, CEO of Ana- cortes, Wash.-based Island Hospital, believes location is a large part of physician recruit- ment and retention. But he says physicians' greater interest in shi work — something the 43-bed public hospital district and oth- er rural facilities can't typically offer — also plays a role. Instead of shi work, many orga- nizations offer an on-call schedule. "at means if they get a call at 8:00 or 9:00 at night, they are going to have to come in and admit that patient and it gets to be really difficult," says Mr. Oliver. "We have three OB- GYNs deliver 450 babies a year and require family physicians to be able to do a complete medicine package from cradle to grave." is kind of schedule and training is not al- ways attractive to candidates. Another challenge for IH is recruiting general surgeons, who are needed in rural areas due to their wide range of training and abilities. It recently took the hospital about a year to fill a general surgery position. Mr. Oliver says not having a needed general surgeon was costly and put a strain on surgical volume. Compounding the challenge is the need to compete with larger hospitals in urban areas and academic medical centers, which can of- fer incentives such as large signing bonuses and write-offs of school loans. It is also difficult for IH to recruit internal medicine physicians who want to practice in an outpatient setting. ese physicians see patients in their clinic and also work hospital shis, but many physicians don't desire both. To overcome these challenges, IH seeks to put together a full hospitalist program that pro- vides a physician in-house at all times, says Mr. Oliver. Building this type of program is expensive, and, since IH is not a critical ac- cess facility, it does not receive additional re- imbursement from CMS that could be used for the initiative. "But we may have to bite the bullet and find a way to fund a full 24-hour service and per- haps eliminate other services to help pay for it," he says. Mr. Oliver says the hospital's latest and most successful recruiting efforts have come through the new osteopathic medicine schools in the Anacortes area, which focus on recruiting students who want to stay in the state. e last five physicians hired by IH have been DOs from those schools and the residency program. e hospital has also had recruitment success working through a search firm. It keeps open positions and continually receives candidates. "We don't look to say this doctor will retire so let's open up that slot. Instead, we already have candidates, and we'll keep talking to them and try to keep them interested," says Mr. Oliver. "And, when these things pop up, I think we have good crop of candidates to look at. Some- times timing doesn't work, but it's been far more successful than just opening up a search." IH also does a physician needs assessment every three years to identify where more cli- nicians may be needed. at helps the hospi- tal develop a three-year recruitment plan and budget accordingly. Additionally, Mr. Oliver says community members, such as elected commissioners, city officials and education leaders, will help sell the area to a candidate when he/she visits. "All of those people give time in recruitment efforts, and I think candidates feel and get a great sense of this community. So when they leave and are considering this opportunity, it's not just the job and the package and the compensation, but they're considering com- ing into this community, and they've met a wide variety of people," he says. "We think it's successful, and some of our candidates who have come here have really appreciated it." n

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