The Coen Brothers displayed it in their movie, No Country for Old Men. James Stewart lived it in The Far Country. Heston sprawled out in The Big Country and James Earle Jones epitomized the love of nation in Cry, the Beloved Country. Even Star Trek ventured into the Undiscovered Country.
Those of us who are rural recruiters need to understand the importance of country. We have something we need to understand - a tool to be developed.
What I mean by country isn’t necessarily the wide-open spaces that are sung about or Western movies of the past; country is a lifestyle and, therefore, a key component in recruiting physicians and getting that signed contract.
The total compensation package is not just salary. If we are trying to lure physicians to our rural, often critical access hospitals, we need to understand the big picture. Family, lifestyle, work-life balance, call schedule, employment for spouse, housing and student loan forgiveness are all important strokes in the big picture we are painting.
Rural health has an advantage:
When putting together a total compensation package, a rural recruiter must have an understanding - even a cursory understanding - of how rural health care is reimbursed.
I am not a finance person, and if I am to be honest, spreadsheets make me itch. I would rather be talking to people and networking. Yet, I am thankful for those number-cruncher-spreadsheet-introverts because they assist in making all the money make sense. The RHC is a program intent on increasing access to primary care services in rural communities. To receive certification, a public nonprofit or for-profit facility needs to be in a rural, underserved area. The main advantage to having an RHS status is enhanced reimbursement rates for providing Medicare and Medicaid services.
When we rural recruiters look for possible physicians to join our organizations, we need to know our power. Money earmarked for recruitment dollars can take on a wide variety of forms: signing bonus, loan forgiveness, engagement of noncompetes, assistance with housing, and overall recruitment allowable expenses.
For instance, I hired a family practice provider who had very unique needs. I could offer the lifestyle she wanted, which included great schools, decent home prices, four-day clinic practice with limited call, and I knew the local school superintendents, so I was able to get her spouse’s information to them for a teaching position.
She had originally signed on to a big health care corporation her first three years out of residency. She admitted that when she signed that contract, she was focused on a sign-on bonus (which, ironically enough, was a one-third of what we would have offered). In my recruitment of her, I was able to show her I could use the recruitment funds as she needed them. Did she need a sign-on bonus? Did she want me to pay off her noncompete so she could live in a rural area instead of the metropolitan area she was in? I could guarantee, through our local bank, a down payment for a house, and I could provide her with a local Realtor.
She had a large sum in student loans that I could offer to pay off in five years. (She didn’t have to stay with us for five years, but if she left we stopped paying.) In addition, many rural health care organizations qualify for the National Health Service Corps, which gives an added source of loan repayment.
Another selling piece I can use in rural recruitment is the fact that the organization I work for is independent. If lifestyle is important to candidates, workstyle is equally a factor. I can add the value proposition of having a voice in the medical world. An independent organization offers autonomy for physicians; they are integral to the decision-making process. You will not get lost in the system; the system needs you!
Then, I hear those in metropolitan areas mention how rural call is grueling due to the limited number of partners a physician would have. Hmmmm ….. I guess I will need to check with one of my surgeons who takes call in his duck or deer blind or in his ice fishing house.
As far as salary goes, or RVUs (relative value units), for providers, don’t discount the rural experience. Location, location, location is key as most primary care and specialties tend to be paid higher in programs involved in different forms of payor reimbursements (RHC, Medicare/Medicaid). Also, create a strong connection with the person in your organization who does the cost report or the consultants your organization uses. Let them know that your job and theirs should work together to create a better contract experience for the candidates.
Recruitment is creative. It can get very creative in rural areas for sure. Don’t lose hope in what you have. The area you live in is the backdrop to your own experience and the experience you offer candidates. If you build it, they will come. Embrace the importance of country. Find your own medical recruitment Field of Dreams.
Susan Marco is a current health care recruiter for an independent, rural hospital in Minnesota lakes country. Her background is as a high school teacher for over 20 years, university professor, public speaker and published author. She was first drawn to health care when her mother was diagnosed at age 62 with early onset dementia. This encouraged her to learn as much as she could about memory loss, health care procedure and providers, and patient advocacy.
Susan Marco
