Motivations for choosing rural practice
By Sepi Ansar, Resources Director, Fidelis Partners/Medestar, Dallas, TX
It’s no secret that one of the greater challenges we face in physician recruitment is filling rural searches. The country faces a physician shortage, which is only exacerbated in rural designated areas. Challenges with rural recruitment and retention are projected to continue well into the future. As recruiters and members of the health community, what do we have to offer to address this issue? Insight. Every day we speak to physicians to understand the reasons for their job seeking decisions. We do this to gain insight into the candidates’ real needs and goals. Improving and enhancing our current abilities will help us to better present a job in order to appeal to a physician’s true aspirations.
I recently read a study conducted by a team of UC Berkeley, UC Davis, and UCSF researchers, titled, “Why doctors choose small towns: A development model of rural physician recruitment and retention.” This study showed that by applying methods of sociology, psychology, and some old-fashioned research methods, we can understand what motivates physicians to take jobs in small town, USA. Previous studies, and our general assumptions on rural recruitment, tend to focus on candidates’ connections to the area to determine whether they will be a good fit. Basically, we presume a physician with rural ties (i.e. had a rural upbringing or trained in a rural area) will be more likely to accept a job in a rural town. This can be true, however, a study conducted in 2004 in Virginia found that “74% of rural physicians were not raised in rural settings...some other experience or ‘component’ of a rural upbringing influenced their decision”.1 So what is motivating more than two-thirds of the physicians in rural Virginia to be in rural practice? For most, what we experience or define as “rural” can be different. Ultimately, recruiting is sales, and the most successful salespeople understand the psychology behind decision making. The goal in screening physicians is to see beyond the obvious connections, and delve deeper into a candidate’s true motivation.
Researchers in this study conducted 22 interviews with primary care physicians in rural Northeastern California and Northwestern Nevada. It is important to point out that only half of the physicians who participated made equal to or above the MGMA median for family practice and internal medicine in the western region (based on the 2009 physician compensation data.) Rural physicians in this study chose and stayed in rural practice for four main reasons: familiarity, community, sense of place and self-actualization.
Thirty-two percent of respondents “stated that they chose rural practice primarily because they wanted to live in a familiar natural or social environment.” For these respondents, their familiarity did not necessarily stem from growing up in a small town or even training there. Notably, only one respondent claimed to gravitate toward rural practice because of training in a rural area, even though most had some experience with rural training. This means something other than actually living there was familiar.
How to find this physician: As recruiters, we can find out about childhood memories and draw on those experiences. We can then use those experiences to sell our location. For example, a physician who grew up in Los Angeles has fond memories of camping trips with his family. What about those camping trips did he love? That’s what we sell. Making a “rural tie” out of a memory is a great way to draw the candidate in.
Forty-one percent of respondents cited a “desire to work in a community with a large underserved population, or a desire for continuity and close relationships with patients and staff.” This type of physician might gravitate toward community service or enjoy tight-knit group activities. This 41 percent is drawn to a community where everyone knows each other, where their nurse is also a close friend and maybe fellow church member.
How to find this physician: During a screen, ask not only what activities a physician or spouse is involved in, but why they like them. Do they like the friends they made participating in these activities? Do they like getting to know their neighbors and colleagues better?
Sense of place
Twenty-seven percent cited sense of place as a motivating factor for choosing rural practice. This is the nature lover, the outdoorsman. One respondent described it best, “I realize that 99 percent of the US comes here on vacation, and I live here, and that’s worth a lot. I’m always going to earn less than my peers. Always. But the view out my back window is worth about $15,000 to me.” This category of rural physician also enjoyed the idea of exploring a new area. These physicians cited a stronger sense of “health and wellbeing” than any other physician.
How to find this physician: This one is a little easier to spot than others. He or she will have numerous outdoor recreational interests and hobbies. They will express an importance of quality of life as it relates to the environment. The skill in recruiting these physicians is convincing them that our town offers the connection with nature that they seek.
Thirty-two percent of respondents chose rural practice because they felt it offered more fulfillment in their lives. This type of physician needs his or her job to fill an existential need for comfort and success. He or she is looking for a place to settle down, raise a family, and make a life for himself/herself. The job offers meaning, a sense of purpose. One respondent said, “We’re saving people’s lives out here because if we weren’t here there would be nobody”. This physician is describing how he has solidified a place or purpose for himself in life, and he can feel good about it too.
How to find this physician: This physician might be the hardest to pinpoint. He or she will either be forward with this need (“I need my life to have meaning through helping others”) or might not know what he or she wants yet or what’s missing. During a screen, be sure to get at what provides the candidate with the most happiness in life. Is it knowing he has provided for his family in the best way possible? Or that she isn’t just punching the timecard, but saving lives?
Based on these four pathways to rural practice, one can conclude that most physicians chose rural practice because of a common desire to create a new life for themselves. Getting to understand the factors that affect a physician’s decision comes solely from thorough screening.
It is important to understand what keeps existing residents there and reflect that same sense of community to the candidates you meet. Those communities successful in retaining the physicians they recruit were also successful in integrating the physician in the community from the beginning of the interview process. We can integrate the physician from the first phone call.
1. Christine Hancock, Alan Steinbach, Thomas S. Nesbitt, Shelley R. Adler, Colette L. Auerswald. Why doctors choose small towns: A developmental model of rural physician recruitment and retention. Social Science & Medicine, Volume 69, Issue 9, 2009, Pages 1368-1376.