When money isn't enough to lure rural docs

(Second in a three-part series on recruiting and retaining physicians for underserved communities.)

The struggle to attract and keep rural physicians has grown so intense that many communities are now starting as early as early as their second year of residency to recruit new physicians. They often send potential recruits dozens of glossy brochures advertising a town's nature trails, festivals and short flights to major metropolitan areas.

Why the lifestyle emphasis when starting salaries can seem tantalizingly high? Brock Slabach, senior vice president for member services at the National Rural Health Association, admits that incomes for rural physicians can reach into the top quartile for a given specialty. But those high salaries often come with significantly more work.

“They're very, very busy,” he says. In a shortage situation, “you have higher volumes typically.”

Rural facilities can often offer the higher salaries because they benefit from the CMS' reimbursement assistance for sole community or critical-access hospitals. A 2012 survey from Medscape, a medical information provider, found that physicians in the North Central part of the U.S.—Iowa, Kansas, Missouri, Nebraska and North and South Dakota—earned the highest average salaries in the country.

In contrast, physicians in the more-densely populated Northeast—from Maine to New York—earned the lowest. “Sometimes it does end up being a bit of a bidding war,” says Neil MacKinnon, director of the Center for Rural Health at the University of Arizona. “It comes down to supply and demand.”

But along with the money comes the daunting proposition of being a sole practitioner in an underserved area. That is compounded by changing expectations among medical school graduates, who no longer want to be tethered to their pagers around the clock. Work-life balance tends to be especially top-of-mind for women, who now account for about half of medical school graduates.

“A lot of providers aren't interested in being the 24/7 kind of docs” required in rural communities, says Robert Duehmig, director of communications at the Oregon Office of Rural Health at Oregon Health & Science University.

Moreover, moving to a rural community is often a family decision—with spouses' careers and children's educations to be considered. “When you're recruiting a provider, you're recruiting more than one person,” Duehmig says.

So hospitals are working to smooth the transition. Slabach notes that rural hospitals are increasingly employing doctors directly, which allows clinicians to focus on practicing medicine while hospital administrators handle administrative tasks such as billing and licensing.

He also points to two primary indicators of whether someone will practice in a rural area: being born and raised in a rural community and being trained there. “Those two areas alone can have very big predictive value,” he says.

With that in mind, some medical schools are giving preference to rural applicants. The Scholars in Rural Health program at the Kansas University School of Medicine even recruits college sophomores interested in serving rural communities, and offers them guaranteed admission if they complete program requirements. The applicants must have experience living in a rural area and intend to practice medicine in rural Kansas.

More communities are also participating in “physician shares”—an arrangement for joint contracts between hospitals to not only provide extra coverage but also help physicians feel less isolated. “I think that's probably going to increase,” says Joyce Grayson, director of Rural Health Education and Services at the University of Kansas Medical Center, Kansas City. “What we don't know is what that's going to look like on the back end if that physician leaves.”

Follow Beth Kutscher on Twitter: @MHbkutscher