Always on the hunt for staff, some rural hospitals have been trying a less common recruitment setting: K-12 classrooms.
The hospitals hope that by interesting local children in healthcare careers and investing in their education, the students will one day return to work as full-fledged providers.
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It’s a long game, but one that could help rural hospitals better compete for clinicians with urban health systems that have the budgets for higher salaries and bigger sign-on bonuses.
More than 98% of rural hospitals have experienced clinician shortages, with 30% reporting the understaffing has led to some suspension of services, according to a 2021 survey of 130 rural hospital leaders by healthcare advisory firm The Chartis Group.
This year, seven rural hospitals have closed due to financial hardships and other factors, according to data from the Cecil G. Sheps Center for Health Services Research. Another 18 facilities took on Rural Emergency Hospital designations to receive increased Medicare reimbursement for emergency department and outpatient services and avoid closure.
Because getting clinicians to relocate to rural areas can be a challenge, many systems find it easier to mold future physicians from a pool of K-12 students who were born and raised nearby, said Kylie Nissen, State Office of Rural Health director for North Dakota.
“We have found the most success in the grow your own [approach] and getting kids in school enticed by healthcare professions,” she said.
In North Dakota, dozens of remote school districts and rural facilities partner to host “scrubs camps” where 5th through 12th grade students in more than 100 towns can spend a day learning about various provider roles and becoming CPR-certified, Nissen said.
More than 11,500 students have participated in the program since it was started in 2009 with grants from the Center for Rural Health at the University of North Dakota School of Medicine & Health Sciences.
“By breaking into small groups and spending half an hour with different health professions and getting to do some hands-on activity that the provider would actually do, kids can see what they like,” she said. “They're making connections there and learning that [rural hospitals are] a welcoming place to work.”
At St. Luke’s Hospital-Miners Campus in Coaldale, Pennsylvania, doctors host an annual Future Physicians Dinner attended by 15 to 20 local high school juniors interested in practicing medicine.
The event, which started in 2009, allows students to talk with physicians about pursuing clinical careers and practicing medicine in a rural setting, said Micah Gursky, rural health clinic administrator at the 29-bed hospital.
The health system also has its own nursing school that graduates 150 nurses annually, 80% of whom remain at the health system, Gursky said. It created a family medicine residency program in 2018 and a psychiatry residency program in 2022.
“We've had several students who started with our future physicians dinner actually go through our medical school and a residency program and begin to work with us,” he said.
The hospital also offers a mentorship program that pairs high school seniors with a clinician who gives them advice, observation opportunities and educates them on their chosen healthcare role. “It's designed to create a true relationship between the student and somebody at St. Luke’s Miners,” Gursky said. “Somebody that they can go to, to talk and ask questions and get a job shadowing experience with.”
A few of the program's participants who have since graduated have returned to work per diem and part-time positions as patient care assistants for clinical experience during the summer, he said.
At Mahaska Health, a 25-bed facility hospital in Oskaloosa, Iowa, collaboration with local schools ranges from participating in middle school career fairs to offering job shadowing opportunities and $1,000 scholarships to high school students. It also offers tuition repayment assistance and a stipend to medical students before they start working for Mahaska Health.
Since 2018, the system has grown from 222 to 568 employees. A significant portion of the new hires engaged with Mahaska Health at some point during their schooling, said Amy Fernandez, the system’s chief of clinic operations.
College students can take advantage of numerous state-funded programs and federal financial incentives designed to attract clinicians to remote areas.
The National Health Service Corps, part of the Health Resources and Services Administration, offers loan repayment options for medical students in exchange for two years of service with a health system in an area determined to have a shortage of health professionals. Students specializing in primary care can also apply for scholarships through the corps if they agree to work in a rural setting.
Getting kids from rural areas into healthcare profession pipelines increases the chances they will return for work because their friends and family are there and they understand the community better, said Ryan Kelly, executive director of the Mississippi Rural Health Association.
“You can really make a major impact practicing in a rural facility because you may be one of two people doing the job versus one of 20 in an urban area,” he said. “You are vitally important because they can't survive without you.”
