By Marcia Horn Noyes, contributing writer for the Journal of ASPR
At the base of the Wind River Range stands a community of 7,500 residents. Located three hours from Yellowstone National Park, Lander, Wyoming is awash with outdoor opportunities. However, the state is among the country’s largest unfenced areas. It’s so rural that an I-80 traveler who exits the freeway must cross cattle guards that keep livestock off the freeway. Finding a physician to practice in such a remote area isn’t easy, yet sometimes family and familiarity win out.
Bruce Guyant, FASPR, is regional director of physician recruiting at Nashville-based LifePoint Health. Guyant recently recruited an orthopedic doctor for a position in Lander. “The only reason in my mind that we got him was because he grew up there and had family nearby. Getting a high-end, quality specialist for that area was a big win for us.”
Sometimes it’s an idyllic lifestyle that tips the scales. Guyant also found a family medicine physician without any ties to the area for one of their Utah hospitals. “This doctor, who is a mountain biker and climber, loved the red rocks of Utah. While other places paid more or perhaps were more competitive in other ways, our location won him over, even though Vernal, Utah is hours away from anything.”
Before a physician decides to live and practice in the city, considering the lifestyle to be enjoyed at one of the rural systems would be wise. Pennsylvania physician employment attorney Dennis Hursh of Hursh & Hursh, PC adds, “Not only will a physician likely receive more compensation than his or her brethren in the cities, but the cost of living is often much lower. The concept of a ‘rich doctor’ has not gone out of style; it has just moved to the country.”
Why the shortages exist
In all specialties, physician shortages persist across the board. According to an updated report from the Association of American Medical Colleges (AAMC) the projected shortfall will continue through the next decade. This updated physician workforce delta aligns with previous reports showing America will need 40,800 to 104,900 additional doctors to meet growing demands.
The results speak for themselves: With physicians having a higher caseload/workload than ever before, and rural areas hit especially hard, the most vulnerable will be at risk. As a result of shortages, physician recruiters are doing more searches with roughly the same body count. Benchmarking data from an Association of Staff Physician Recruiters survey show that responding organizations doubled average searches from 2012 to 2015, growing from 20 to 45 searches in three years. At the same time, the survey shows that the respondents employ a median of two in-house physician recruitment professionals (four on average). That number has remained the same, even though the number of physician searches has risen.
In the race to recruit physicians to rural areas, recruitment professionals face additional challenges — such as a limited pool of candidates, a choosier group of J-1 Visa Waiver physician candidates, isolation from other medical colleagues, and the need to find candidates with a broader set of skills in addition to any family assimilation concerns. Turning those deficits into positives is oftentimes the difference between obtaining a doctor/specialist for a rural community and foregoing critical patient care.
Despite the dire projections, Denver, Colorado-based Rural Physicians Group (RPG) has not seen the physician shortage get worse. Jeff Files, RPG vice president for recruitment, says the overall doctor shortage still has consequences. “Without our physicians in a rural community, [the hospital] might have to refer out a patient, which is no good for the community, the hospital, or the patient.” From as far back as 1995, the plight of rural hospitals has been a special concern to legislators. The perfect storm of higher numbers of elderly and economically-challenged people with chronic illness, plus declining populations in rural areas, often leaves communities in dire straits when a specialist is not available and referrals to doctors outside of the community are required.
Understanding specific obstacles
Reduced number of doctors
Guyant says that the challenge of filling 300 rural physician openings across its organization of 72 hospitals in 22 states remains sizable, especially with the bulk of candidates wanting to be in a metro or suburban area. “It’s safe to say that rural positions take longer to fill with an average of six to 24 months or longer in some cases. The numbers of those interested and willing to consider a rural environment are the minority,” Guyant explains. “Even before engaging with physicians, you are down statistically.” This leaves rural communities with a huge handicap in maintaining their workforce.
Hursh agrees with Guyant’s assessment. “Although physicians can often have a much higher standard of living in rural areas, they generally are not initially attracted to these positions.” Hursh adds that some physicians take a rural position with a mindset to work for two to three years and move on. At contract renewal, he says he surprisingly ends up representing them again at the same organization.
J-1 Visa Waiver challenges ahead
While once low-hanging fruit for physician recruiters, sponsored J-1 visa applicants are no longer a slam dunk. With prolonged H1-B visa and J-1 Visa Waiver lead times, the pool of available foreign national doctors may be shrinking. Combine that with the current US administration’s plan to reduce the influx of doctors holding special work visas and the situation could worsen. Guyant mentions that as yet, he’s not seen the supply in foreign nationals change, but points to one disturbing reality: “What we have seen is the J-1 visa physician becoming a bit more discriminating or particular in terms of what their expectations are in a position, as well as being choosy in the locations they will consider.”
Practice in isolation
Another common complaint among doctors considering rural area practice is the inherent isolation that comes with many of the positions. Without a ready group of peers to discuss patient treatment plans, doctors often see this as a deficit to their careers. For some hospitals, answers can be found in affiliation with a larger organization or academic institution. Even though a doctor’s office may be remotely located, being part of a group that has colleagues on their team bolsters the doctors’ confidence and collaboration needs.
The skills hurdle
Without colleague support, a rural doctor must rely more heavily on his or her medical training. In rural care, broader skill sets also trump specialized ones. Paul Aguillon, MD, who practices family medicine in Delaware’s rural Sussex County says, “Many of my family doctor colleagues [in metropolitan areas] don’t realize that basic medical skills such as putting on a cast and conducting minor surgery are even in the scope of practice anymore.”
While physician recruiting in rural areas comes with its own set of challenges, the rewards in finding a doctor for an underserved population are truly great. With each successfully hired rural physician, individual health outcomes have the potential to improve, communities can thrive instead of stagnate, and physicians can make a lasting impact on the lives of others.
Marcia Horn Noyes is a former television news reporter, newspaper and magazine journalist who writes about health, fitness, career, and frugality topics. Her broadcast work has appeared on CNN and ABC’s Good Morning America; her printed work has been published by the Journal of Urgent Care Medicine, Denver Post, Enlightened Woman and Southern Living. She also is a past contributor to Chicken Soup to Inspire the Body and Soul.
- Bruce Guyant, FASPR
LifePoint Health-Western Group
Regional Director of Physician Recruiting
2199 Jordan Way
Eagle Mountain, UT 84005
- Jeff Files
Vice President of Physician Recruitment
303-390-1922 or 214-289-0199
Rural Physicians Group
5575 DTC Parkway, Suite 225
Greenwood Village, CO 80111
- Paul Aguillon, MD (Family Medicine)
Sussex Medical Center
401 Concord Rd. Seaford, DE 19973
- Dennis Hursh, Hursh & Hursh, PC
60 N. Union St. Middletown, PA 17057
- American Association of Medical Colleges. 2017 Update - The Complexities of Physician Supply and Demand: Projections from 2015 to 2030.
- J-1 Visa Waiver program