factors to market your community health center
TRANSCRIPT
A publication by
Factors to Market YourCommunity Health CenterIdentify & Communicate StrengthsInvest in Challenges
I About 3RNet 4
II About this Training 5
III Geographic Factors 6-7 Access to larger community 8 Demographics: Underserved/Payor mix 9 Housing(availabilityand/oraffordability) 10 Schools 11 Socialnetworking 12 Recreationalopportunities 13 Spousalsatisfaction 14 Shoppingandotherservices 15 Climate 16 Perceptionofcommunity 17
Table of Contents
IV Economic Factors 18-19 Part-timeopportunities 20 Loanrepayment 21 Salary(amount) 22 Signingbonus/Movingallowance 23 Lengthofcontractflexibility 24 Perceivedfiscalstability 25 Productionincentive 26 Retirementpackage 27 CMEbenefit 28 Competition 29
V Scope of Practice Factors 30-31 Obstetrics:Prenatalcare 32 Obstetrics:Deliveries/C-section 33 Inpatientcare 34 Emergency/Stabilizationcare 35 Minortrauma(casting/suturing) 36 OfficeGYNprocedures 37 Mentalhealth 38 Mid-levelsupervision 39 Teaching 40 Administration 41
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VI Medical Support Factors 42-43 Perception of quality 44 Stability of physician workforce 45 Specialist availability 46 Nursingworkforce 47 Mid-level provider workforce 48 Ancillarystaffworkforce 49 Pharmacyservices 50 Alliedmentalhealthworkforce 51 Languageservicessupport 52 Call/practicecoverage 53
VII Facility & Community Support Factors 54-55 Physical plant and equipment 56 Plans for capital investment 57 Electronicmedicalrecords(EMR) 58 CHC leadership 59 Televideosupport 60 Communityneed/supportofphysician 61 Welcomeandrecruitmentprogram 62 Medicalreferenceresources 63 Delegated physician patient services 64 Moonlighting opportunities 65
VIII Conclusion 66
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About 3RNet3RNetisanonprofitorganizationfocusedonpeople.Ourmembers connect professionals searching for jobs in rural or underservedareaswithhealthcarefacilities.
3RNetismadeupofmemberorganizationssuchas:
•StateOfficesofRuralHealth•PrimaryCareOffices•AreaHealthEducationCenters•Universityprograms•State-basednon-profitorganizations•PrimaryCareAssociations
Theseagencieshelpphysiciansandhealthprofessionalsfindyourdreamopportunityinaruralorunderservedcommunity.
Asanon-profitagency,ourinterestisnotinplacingyousomewhereforacommission.Ourgoalistomatchyourintereststoacommunity’sneeds.You’veworkedhardforyourprofession–webelievefindingajobyouenjoyshouldbeeasy!
3RNet Mission3RNetworkstoimproveruralandunderservedcommunities’access to quality health care through recruitment of physiciansandotherhealthcareprofessionals,developmentofcommunitybasedrecruitmentandretentionactivities,andnational advocacy relative to rural and underserved health care workforceissues.
3RNet Vision3RNetisthenationalleaderforcommunity-basedhealthprofessionalrecruitmentandretention,usinginteractivetechnologiesandcommunication.
“ ”3RNet works to improve rural and underserved communities’ access to quality health care through recruitment of physicians and other health care providers
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Where did these factors come from?The factors used in this book were adapted from the CHC CommunityApgarQuestionnaire.ThisquestionnaireisavalidatedresearchtoolimplementedanddevelopedbyDr.EdBaker,BoiseStateUniversityandDr.DaveSchmitz,IdahoFamilyMedicineResidency.Thefactorsarecategorizedintofiveclasses;geographic,economic,scopeofpractice,medicalsupport,andhospital/communitysupport.
Theadvantages,challenges,andsolutionspresentedinthisbookarenotbasedonanyspecificresearch,butinsteadaredrawnfrom3RNet’s20yearsofpracticalexperienceinruralrecruitmentandretention.TolearnmoreabouttheCommunityApgarProgram,[email protected]@FMRIdaho.org.
Training Objectives•IntroducekeyfactorsinrecruitmentandretentionforCommunityHealthCenters.•Describekeyfactorsandwhytheyareimportant.•Identifyhowcommunities/facilitiesmayhaverecruitingadvantagesrelatedtoeachkeyfactor.•Explorehowcommunities/facilitiesmayhaverecruitingchallengesrelatedtoeachkeyfactor.•Discusspossiblesolutionstorecruitingchallengesforeachkeyfactor.
How to Use This TrainingThis training is meant to help recruitment stakeholders explore the key factors of recruitment to Community Health Center in rural,urbanandunderservedareas.Byexploringeachfactorand conceptualizing how that factor applies to your community andfacility,youwillbebetterabletoidentifyandcommunicatestrengths,andinvestinchallenges.
About this Training
Dr.EdBaker Dr.DaveSchmitz
GeographicFactors
Section III
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Geographic FactorsForanycareer,whereyouliveisparamounttoalmosteveryaspectofyourday-to-daylife.Drivingacrosstowntoeatataspecificrestaurantorvisitagrocerystoreismuchdifferentthandriving90milestoaccessthosesameservices.Theaccessleveltoshopping,dining,cultural,entertainment,andreligious opportunities can be a major consideration for many health care professionals who are used to easy access to theseamenities.
Similarly,familysupportisakeyconsiderationofthegeographicfactors.Doesyourcommunityhaveopportunitiesforthespousetobeemployed(ifneeded)?Ifthehealthprofessionalhaschildren,isthereaccesstoqualityschoolsandactivitiessuchasballet,pianolessons,orothers?
Being knowledgeable about what geographical advantages and challenges your community has is a top priority when communicatingtocandidates.
How geographic factors relate to different health professional candidates•Strengthinthesefactorsmaybemoreimportantto candidates with a spouse or children as opposed to a candidatethathasadultchildrenornosignificantother.•Strengthinthesefactorsmaybemoreimportantto candidates who have been raised in areas where access toserviceswasneveranissue(urbanareas)asopposedto candidates who grew up in areas where certain services may nothavebeenreadilyavailable.•Strengthincertaingeographicfactors(recreationopportunities,climate)maystronglyappealtocandidateswhoareinterestedinoutdooractivitieslikehunting,fishing,snowmobiling,orothers.
Geographic Factors
1.Accesstolargercommunity2.Demographics:Underserved/Payormix3.Housing(availabilityand/oraffordability)4.Schools5.Socialnetworking6.Recreationalopportunities7.Spousalsatisfaction8.Shoppingandotherservices9.Climate10.Perceptionofcommunity
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What does this factor mean?Theabilitytoaccessoreaseofaccesstoalargercommunity.
Why is it important?Accessing a larger community often means access to specializeddining,entertainment,shopping,cultural,andreligiousopportunities.
Example: a candidate likes to regularly attend professional sportingevents.
Potential Facility/Community AdvantagesIf your community has easy access or is a short commute to a largecommunity,candidatesmayseeanadvantageofbeingabletobenefitfromasmallcommunitybutstillhaveeasyaccesstotheconveniencesofalargecommunity.
Example: a candidate is looking for loan repayment and outdooropportunitieswhichyourcommunityoffers,andonceaweektheycaneasilytravel40milestoalargecityforanyconveniencestheymayneed.
Access to Larger Community
Potential Facility/Community ChallengesIf your community doesn’t have easy access or is a long commutetoalargecommunity,candidatesmayseeachallengeofgettingspecializedservices.
Example:acandidateenjoysAsiancuisine,buttheclosestoriental restaurant or grocer is a two hour drive (which in winter becomeseventougher).
Ideas for Solutions to ChallengesOffercandidateeveryotherFriday/Saturday/Sundayoffsotheycantakeanextendedtriptothelargercommunity.
Offerorleverageexistingsharedtransportationoptions(bus,van,etc…)socandidatesandtheirfamiliescanenjoythelargercommunitywithouthavingtocommutethemselves.
Sponsor or promote online access to specialized services (AmazonPrime,deliveredspecialtyfood,etcetera).
Have cultural night events where specialty cuisine and culture is sampled (a local university or college may be a good partner).
SummaryKnow what your community has easy access to and if the candidateneedssomethingthatyourcommunitylacks,findcreative solutions within your control that make it easier for themtoobtain.
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What does this factor mean?The demographics of patients in the community including abilitytoaccessrecommendedorrenderedcare,age,gender,raceorother.
Why is it important?Accesstoadiversedemographicofpatients,orconversely,accesstoaspecificnicheofpatientsmaybeintegraltohowthecandidatewishestopractice.
Example: Candidate is trained to Family Medicine and enjoys seeingpatientsranginginagefrompediatricstogeriatrics.
Potential Facility/Community AdvantagesIf your community has a diverse demographic patient mix that coversmanygroups,candidatesinterestedinworkingwithavarietyoftypesofpatientsmayviewthatasanadvantage.
Conversely,ifyourcommunityhaspredominatelyonedemographic,acandidatewhospeciallywantstotreatthatdemographicmayviewthisasanadvantage.
Example:YourcommunityhasasignificantNativeAmericanpopulation and you are interviewing a candidate who has previously volunteered abroad and published research on the healthdisparitiesNativeAmericansface.
Demographics: Underserved / Payor Mix
Potential Facility/Community ChallengesIfyourcommunityhasasmalldemographicpatientbase,candidates who are interested in working with a variety of patientsmayviewthatasachallenge.
If your community has a large demographic patient base that thecandidatedoesn’tfeeladequatetocarefor,thismaybeviewedasachallenge.
Example:Yourcommunityhasamostlyelderlypopulationandthe candidate is interested in caring for a variety of age groups (specificallyenjoyspediatrics).
Ideas for Solutions to ChallengesBeupfrontwithinformationrelatedtopatientdemographics.Thiswillhelpnegateanyproblemslater.
Target providers who may have a specialized interest in your demographicgroup.
Ifyourpatientbaseisn’tdiverseenough,connectwithapartnering facility and allow your candidate to practice there a fewtimesamonth.
Havesupportavailableoroffertrainingifanewcandidateisuncomfortable with treating a certain demographic (example – advancedtrainingincaringforelderlypatients).
SummarySome candidates have an interest in having access to certain demographicsofpatients.Knowyourpatientdemographics,and be prepared to relate them to the candidate and their practice.
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What does this factor mean?Theavailabilityandaffordabilityofdesirablehousingasviewedbyphysician,spousesorfamily.
Why is it important?Accesstoaffordableanddesirablehousingisapriorityformostphysicians,spousesandfamilies.
Affordablehousingisoftenmoreavailableinruralcommunitiesasopposedtotheirurbancounterparts.
Example: A candidate with a family asks about your housing market.
Potential Facility/Community AdvantagesIfyourcommunitytendstohavealowercostofliving,allowing the physician to get a more desirable home for less moneythantheycaninotherareas,thismaybeviewedasanadvantage.
Ifacandidatedoesn’twantalongcommute,andtherearedesirablehousingoptionslocatednearyourfacility,thismaybeviewedasanadvantage.
Example: A candidate has narrowed down their search to your clinic,andanurbanbasedhospital.Workingwitharealtor,youlocate and show the candidate an available home that sits on 20acresandis15minutesfromyourfacility.Thecandidatelikestheideaofahobbyfarm,andsignswithyourclinic.
Housing (Availability and/or Affordability)
Potential Facility/Community ChallengesIfyourcommunity,hasalackofavailablehousing,orlimitedoptionsfornewconstruction,thismaybeviewedasachallenge.
Ifyourcommunityhaslimitedaffordablehousingoptions,thecandidatemayviewthisasachallenge.
Example:Candidateislookingtorelocatetoyourcommunity,butduetoahighrateofseasonaloilworkers,isunabletofindadequatehousing.
Ideas for Solutions to ChallengesEstablishrelationshipswithlocalrealtors,bankersandChamber of Commerce to assist with the housing market in yourarea.
During the on-site visit be sure to leave time in the schedule for the candidate to view homes and neighborhoods of interest witharealtor.
Seekhousingarrangementswithlocalpartners,suchaslocalhospitals or businesses that have housing they use for their ownemployees.
SummaryEveryone needs somewhere to live and housing/land are often more available in rural markets as opposed to their urban counterparts.Knowwhatthecandidateandtheirfamilyarelookingfor,workwithcommunitymembers,andfocusonsellingthequalityoflifeyourcommunityoffers.
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What does this factor mean?Adequacyofschoolsfortheprovider’schild(ren).
Why is it important?Healthcare professionals are very well educated and typically place a high value on the importance of education for their children.
Small,ruralcommunitiestendtotakealotofprideintheirschools,sports,clubs,etc.
Schools are often a factor where rural communities have a competitiveedgeoverurban.
Example: Candidate with three school-aged children is interested in your community and asks you about the quality of theschoolsystem.
Potential Facility/Community AdvantagesIfyourcommunityproudlysupportstheirschools,especiallyifyouonlyhaveoneschoolforeachsegment(primary,middle,highschool)candidatesmayseethisasanadvantage.
Ifyourcommunityhassmallclasssizes,andallkidscanparticipateinextracircularactivitieslikesportsandmusic,thecandidatemayviewthisasanadvantage.
Example:Duringtheironsitevisit,thecandidatenoticesmany signs and banners prominently displayed around town supportingthelocalhighschoolathleticteams.
Example:Duringtheonsitevisit,youareabletoshowthecandidate data on the schools in regards to performance and classsize,andscheduleaschooltourwiththelocalprincipal.roadwaysforwalking/running,greatparks,localproduce,andtheabilityforthecandidatetohaveagarden.
Schools
Potential Facility/Community ChallengesIfyourcommunityschoolsareoldandneedphysicalupdating,or if your schools have trouble with large class sizes or poor teachers,thecandidatemayviewthisasachallenge.
Ifyourcommunityschoolsdon’tofferanactivitythecandidate’schildhaspreviouslyparticipatedin,thecandidatemayviewthisasachallenge.
Example: Candidate has children that play hockey and are in advancedclasses,butyourschoolsofferneither.
Example: Candidate tours local school and sees old building andpoornutritionalprograms.
Ideas for Solutions to ChallengesEmphasizecommunitysupportofschools,activitiesavailable,andsmallclasssizes.
Offertohelpthecandidategetchildrenenrolledinschools,andhaveinformationondaycareoptions.
Ifachallengeispresent(e.g.schoolneedsupdating,ornohockeyteam)engagethecandidateandspouse/partnerinthepossibilitythattheycouldhelpaddresstheneed.
Check out distance learning programs in your state that may beanoptionforadvancedclasses.
SummaryChildren are often one of the top considerations for candidates consideringruralliving.Schoolsareafactorthatruralcommunities often take tremendous pride in and can evoke a sense of belonging for the candidate and their family into the community.
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What does this factor mean?Opportunitiesoreaseofsocializingforthephysician.
Why is it important?Ruralcommunitiesareoftenverytight-knit.Healthcareprofessionals typically have high stress jobs and socializing outsideofworkcanbeahealthy,rewardingwaytorelievestress.
When candidates start to feel like they belong in the community,orareinvestedinthecommunity,thismayleadtogreatercareerstabilityandretention.
Example:Acandidate’sschedulewouldrequire40-60hourworkweeks,butyourfacilityisabletoallowthecandidatesomeflexibilitytoattendweeklymeetingsofalocalnonprofitwhichthecandidateisextremelyactivein.
Potential Facility/Community AdvantagesIf your community has a strong social network and activities thatrelatetothecandidate,thecandidatemaybeabletoeasily integrate into the community and view that as an advantage.
If your community can identify and recruit candidates who are local,astrongsocialconnectionandfamiliaritymayalreadyexist.
Example:Acandidatehasahistoryandinterestinmusic,andthroughlocalconnections,youareabletohelpthemfindavolunteermusicteachingpositionatthelocalhighschool.
Social Networking
Potential Facility/Community ChallengesIfthecandidateyouarerecruitingisfromadifferentculturethanthepredominatecultureinyourcommunity,itmaybetoughertofullyintegratethatcandidateintothecommunity.
If you’re recruiting to a large rural community it may be tougher to get candidates fully integrated and invested in the communityastherearemorepeopleandlayersofactivity.
Example:YourcommunityisrecruitinganInternationalMedicalGraduatefromIndia,butyourcommunitylacksinfrastructuretosupportthecandidate’ssocialinterests.
Ideas for Solutions to ChallengesConnect the candidate with social contacts during their onsite visit.Knowingacouplefriendlyfaceswhencomingtoanewcommunitycangoalongway.
If you are recruiting a candidate who may have trouble integratingintoyourcommunity,especiallyanInternationalMedicalGraduate,trytorecruittwoormorecandidateswhohavesimilarinterestsorcomefromsimilarareas.
Visit with local high school and college students to develop a workforcepipeline.
Hostmonthlysocializingevents,andconnectthecandidatewithlocalgroups(YoungProfessionals,KnightsofColumbus,etc…).
SummaryEverybodyneedsasocialoutletoutsideofwork.Byknowingyourcandidates’interestsandbackground,youcanhelpthemmakecommunityconnectionsthatbenefiteveryone.
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What does this factor mean?Opportunitiesforlocal,enjoyable,non-worktimeactivities.
Why is it important?Candidates have hobbies and with their dedicated work schedule,havingeasyaccesstotheirhobbiescanprovideenjoymentwhilereducingstressandburnout.
Some recreational opportunities are more readily available in ruralareas,givingyouacompetitiveadvantagewithsomecandidatesoverurbanareas.
Example: Candidate grew up on a farm where wildlife was always abundant along with opportunities to participate in outdooractivities.
Potential Facility/Community AdvantagesIf your community has access to the type of recreational opportunitiesthecandidateprefers,thatcandidatemayviewthatasanadvantage.
Ifyouofferadequatetimeoffsoacandidatecanparticipateinrecreationalactivities,thecandidatemayviewthatasanadvantage.
Example: Candidate is choosing between your rural location andamoreurbanone.Thecandidatelovestheoutdoors,andyourcommunityhasaccesstogreathunting,fishing,andsnowmobiling,allofwhichwouldrequiresignificanttravelfromtheurbanlocation.
Example: Candidate enjoys walking/running and maintaining ahealthylifestyle.Yourcommunityoffersextremelysaferoadwaysforwalking/running,greatparks,localproduce,andtheabilityforthecandidatetohaveagarden.
Recreational Opportunities
Potential Facility/Community ChallengesIf your community lacks recreational opportunities the candidateenjoysorisusedto,thecandidatemayviewthatasachallenge.
If your community has the recreational opportunities the candidateprefers,butthecandidateisunabletoaccessthem,thecandidatemayviewthisasachallenge.
Example:Candidateenjoysyoga,andyourcommunitydoesn’thaveayogastudio.
Example:Candidateenjoysyoga,andyourcommunityhasayogastudio,butitisonlyopenduringthehoursthecandidateisworking.
Ideas for Solutions to ChallengesTarget candidates interested in recreational opportunities your communityoffersbyplacinganadinanoutdoorsorhunting/fishingmagazine.
Connect and expose candidates to recreational opportunities yourcommunitydoesoffer.
Use technology to connect candidate to recreational opportunitiesthatarenotavailableinyourcommunity.
SummaryAccesstorecreationalopportunities,especiallyoutdooractivities,isoftenastrengthforruralcommunitiesbutcandidatesneedthetimeanddesiretoaccessthem.
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What does this factor mean?Overall satisfaction of the spouse/partner in regard to local communitylivingsuchaseducation,work,andingeneral.
Why is it important?Ifacandidatehasaspouse/partner,youarerecruitingbothofthemtoyourcommunity.
Whenconsideringpossiblepracticelocations,candidatestypicallyheavilyrelyoninputfromtheirspouse/partner.
Ruralcommunitiescanespeciallyhavedifficultywithspousalsatisfaction.Inanurbanarea,theretypicallyarealotmoreoptionsforthespouse/partner.
Example:Candidateisinterestedinpracticingrural.Spouse/Partner grew up in a metropolitan area and has a PhD in English.
Potential Facility/Community AdvantagesIfyourcommunityhasmanyemployment,education,andrecreationalopportunitiesforacandidate’sspouse/partner,thecandidatemayviewthatasanadvantage.
Example:Candidateisinterestedinyourcommunity,andyouareabletoshowcasedesirablehousing,employment,andrecreationaloptionstothespouse/partner.
Spousal / Partner Satisfaction
Potential Facility/Community ChallengesIfyourcommunitylacksemployment,education,andrecreationalopportunitiesforacandidate’sspouse/partner,thecandidatemayviewthatasachallenge.
Example:Candidateisinterestedinyourcommunity,butspouse/partnerworksinmarketing,andyourcommunitydoesn’thaveanymarketingfirms.
Example:Candidateisinterestedinyourcommunity,spouse/partnerdoesn’tneedemployment,butfeelslikehe/shewillbeisolatedandlonelywhilecandidateisworking.
Ideas for Solutions to ChallengesTreat recruitment of the spouse/partner as importantly as recruitmentofthecandidate.
Find ways to get the spouse/partner engaged in the community (volunteering,socializing).
Ifyourcommunitylacksemploymentoptionsforthespouse,findoutifjobsareavailableregionallyorviatelecommute.
Have monthly or biweekly gatherings for provider’s spouses/partners.
SummarySpousal/Partner satisfaction is one of the most important factorswhenrecruitingacandidate.Findoutwhatthespouse/partnerneeds,andsellyourcommunityasmuchtothespouse/partner,asyoudotothecandidate(andmakesurethespouse/partnergetsinvolvedinthecommunity!).
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What does this factor mean?Adequacy of local access to shopping or services for provider andfamily.
Why is it important?Rural communities can often lack specialized services and shopping.Acandidate’sperceptionofthisshortagecanbeabighurdletoovercome.
Healthcarecandidatestypicallyhavesignificantbuyingpower,and having options for them to make purchases can be viewed asamajorbenefittoqualityoflife.
Example:Candidateisbeingoffereda$240,000contractrightoutofresidency.Yourcommunityhastwogasstations,threebars,achurch,andadiner.
Potential Facility/Community AdvantagesIf your community has conveniences such as specialized diningoptions,qualitygrocerystores,departmentstores,oran“allinone”shop,acandidatemayviewthisasanadvantage.
Example: Candidate has lived in an urban center for the last threeyearsduringresidency.Theybelievegoingtoaruralcommunitymeanshavingnoaccesstoshopping.Duringyourinitialconversations,youhighlightyourcommunity’ssupperclub,golfcourse,andshopping.
Example:YourcommunityhasalocalChineserestaurant,afewfastfoodoptions,twogrocerystores,andan“allinone”departmentstore.
Shopping and Other Services
Potential Facility/Community ChallengesIfyourcommunitylacksaccesstoshopping,dining,andotherservices,acandidatemayviewthisasachallenge.
Example: Candidate is used to being able to get everything theyneedwithinatenminutedrive,butmostpeopleinyourcommunitymakeweeklytripstoacity40milesawaytodotheirshopping.
Ideas for Solutions to ChallengesPromoteonlineshoppingoptions(eBay,AmazonPrime,etc…).
Offeraweeklyshuttleforprovidersand/ortheirfamiliestothenearestshoppingcenter.
Beflexiblewithtimeoffandtravelforcontinuingeducationcredits.
Ifacandidatehasspecialdietaryneedsorwants,workwiththe local grocery stores to see if they could get the items in stock.
SummaryAccess to shopping and services can be a big challenge for ruralcommunities.However,withonlineshoppingandotheroptions,almostanythingcanbefoundordeliveredtoaruralcommunity.Whenspeakingwithcandidates,focusonwhatisavailablelocally,regionally,andonline.
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What does this factor mean?Theweatherinyourcommunity.
Why is it important?Weather,especiallyincoldareas,isoftenthefirstthingthatcomestomindaboutaparticularregion.
Candidates who haven’t lived in your climate before may be apprehensiveaboutdoingcertaintasks(drivinginsnow,etc…)
Example:Youflyaverysolidcandidateinforanonsiteinterview.Theygetofftheplanewearingalightjacket,anditis10degreesbelowzeroandwindyout.
Potential Facility/Community AdvantagesIfyourcommunityhasamoderateclimate,candidatesmayviewthisasanadvantage.
If you are recruiting a candidate that comes from a similar climateasyourcommunity,thecandidatemayviewthatasanadvantage.
Example:YouarerecruitingacandidatewhogrewupinMinnesota,andyourcommunity(whilecold)hasgreatsnowmobiling,hockey,andicefishing.
Potential Facility/Community ChallengesIfyourcommunityhasanextremeclimate,especiallyifit’scold,attractingcertaincandidatesmaybeachallenge.
Example:Youraveragetemperatureinwinterisrightaround10degrees.Candidatesoftenareinterestedintheotheraspectsofyourcommunity,butfeelitistoocold.
Climate
Ideas for Solutions to ChallengesPromoteconveniencesthathelpmitigatetheweather;forexample,heatedgarages,remotecarstarters,in-groundpools,engineblockheaters,etc…
Offercandidatesareservedparkingspotrightnexttothedoorofyourfacility.
Work with the local snow plow service to see if your provider’s streetscanbeplowedfirst,especiallywhentheyareoncall.Promoteallthedifferentseasonsyouhave,andthepositivefactorsaboutyourclimate.
Don’t constantly reference the climate when a candidate is visiting.Ifyoudon’tmakeabigdealoutofit,it’slikelythecandidatewon’teither.
Compareextremes;SometimesinMinnesotaitistoocoldtogooutsideduringthewinter,butsometimesinArizonaitistoohottogooutsideduringthesummer.
SummaryClimateisafactorcompletelyoutsideyourcontrol.Thebestyou can do is communicate the positive aspects of your climate,anddiscussandmitigatethedownsides(heatedgarage,carstarters,privateparking,etc…).
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What does this factor mean?Perception of the community overall by someone not from the community.
Why is it important?Rural communities are often thought of by outsiders as isolated,remote,andrundown.Ifacandidate’sfirstimpressionofyourcommunityreinforcesthis,itcanbehardtoovercome.
Candidatesgettheirfirstimpressionofyourcommunityinanumberofways.Oftentimesitstartsoutonlinethroughyourwebsite,orawebsitepromotingyourcommunity.Anothercrucialtimeisthecandidate’sfirstvisittotown,andfirstglimpseof“MainStreet”.
Example:Candidatefindsyourjobpostingonyourwebsite,becomesinterested,andexploressomeofyourlinkstoothercommunitywebsites.Candidatelikeswhattheysee,and decides to drive through town on the weekend with their spouse/partner.
Potential Facility/Community AdvantagesIfyourcommunityhasafresh,strongonlinepresenceandyourfacilityusesvibrantmarketingmaterials(flyers,jobpostings,video)candidatesmayhaveaninitialpositivereactiontoyourcommunity.
Ifyourcommunityiswellmaintained,includinghouses,businesses,and“MainStreet”acandidatemayseethatasanadvantage.
Perception of CommunityExample: Candidate and their spouse/partner like the idea oflivinginasmallertown,butareconcernedaboutfeelingisolated.Theysearchonlineandfindveryattractiveandup-to-dateinformation.Shortlyafter,thecandidateschedulesanonsiteinterview,andisimpressedbytheupkeepandfriendlinessofyourcommunity.
Potential Facility/Community ChallengesIf your community has outdated online and/or marketing material,acandidatemayhaveanegativefirstimpressionofyourcommunity.
Ifyourcommunityhasrundownhousing,oremptybuildingson“MainStreet”acandidatemayhaveanegativefirstimpressiontoyourcommunity.
Example: Candidate sees your job posting and searching for yourcommunityonlinetoseewhatcomesup.Thefirstresultisa website built for tourism in your community that hasn’t been updatedin10years.Candidatehasabadfirstimpressionanddoesnotcontactyou.
Ideas for Solutions to ChallengesKeepyourmarketingmaterial(pictures,videos,print)up-to-dateandengaging.
Work with stakeholders in your community to ensure your tourism(orother)websitesareupdated,andyourtownlookswellmaintained.
SummaryNegativefirstimpressionsaretoughtoovercome.Manycandidateswillfirstconnectwithyourcommunityonlineorthroughyourmarketingmaterial;keepitfreshandeye-catching.
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EconomicFactors
Section IV
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Economic FactorsHow much money a provider makes is likely one of the most important things they will consider when making a decision onwheretopractice.However,traditionaltakehomepayisn’ttheonlyimportanteconomicfactor.Someprovidersmaybewillingtoacceptlesspayifitmeansmoreschedulingflexibility.Forsomeproviders,loanrepaymentorasigningbonusmaybecrucial.Knowingwhatyouhavetoofferandwhatthecandidate is looking for is critical when it comes to talking dollarsandcents.
How economic factors relate to different health professional candidates•Strengthinthesefactorsmaybemoreimportantto candidates with a stay at home spouse or children as opposed to a candidate that has adult children or no significantother.•Strengthinthesefactorsmaybemoreimportantto candidates that are right out of training as they haven’t had a lifetimeofearning,andmayhavehighstudentloandebt.•Strengthincertaineconomicfactors(loanrepayment,start-up/marketingcosts)maygiveruralcommunitiesacompetitiveadvantageoverurbancounterparts.
Economic Factors
1.Part-timeopportunities2.Loanrepayment3.Salary(amount)4.Signingbonus/Movingallowance5.Lengthofcontractflexibility6.Perceivedfiscalstability7.Productionincentive8.Retirementpackage9.CMEbenefit10.Competition
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What does this factor mean?Whether or not a desire for part-time work status is available or supported.
Why is it important?Healthcareprofessionals,especiallyphysicians,aren’ttypicallyworkingasmanyhoursastheyhavebeeninthepast.Many demographics of healthcare professionals have an interestinparttimeemployment.Examplesmayincludecandidates(maleorfemale)thathaveyoungchildrenorareplanningtostartafamily,candidatesthatareclosetoretirement,andothers.
Example:Candidateisinterestedinworking.6FTEinyourcommunity,butyouarehiringfulltime.
Potential Facility/Community AdvantagesIfyourfacilityiswillingtoconsiderparttimeoptions,candidatesmayviewthisasanadvantage.
Ifyourfacilityoffersfamilyfriendoptionslikeextendedmaternityleaveandjobsharing,candidatesmayviewthisasanadvantage.
Example:Youareworkingtoreplacearetiringphysicianwhoworkedfulltime.Youfindagreatcandidate,buttheyareonlyinterestedinworkinghalftime.Yourfacilityisabletohirethisphysician,andrecruitanotherhalftimephysiciantoreplacethefulltimeretiree.
Part-time Opportunities
Potential Facility/Community ChallengesIfyourfacilitydoesn’tofferparttimeoptions,candidatesmayviewthisasachallenge.
Example: Husband and wife are both physicians and interested inyourcommunity.Husbandwouldliketoworkfulltimeasageneralsurgeon,butwifeprefersahalftimepositioninfamilymedicine.Worriedthatotherphysicianswillstarttorequestparttime,youofferbothcandidatesfulltimeoptions,andcandidateschooseanotherlocation.
Ideas for Solutions to ChallengesBeasflexibleasyoucanwithscheduling,timeoff,andparttimeoptions.
Ifyoudon’thavetheabilitytoofferparttime,considertryingtorecruittwohalftimepositions.
Be knowledgeable about what scheduling options your competitorsprovide,andifyoucan’tmatchtheirflexibility,trytotargetproviderswhopreferfulltimeemployment.
SummaryInpreviousgenerations,itwasnotuncommonforcandidatestoexpecttoworkmorethanafulltimeschedule.However,datasuggeststhatcandidatesnowvalueflexibleschedulingandtimeoffjustasmuchascompensation.Thisisespeciallytrueforcertaingroupsofcandidates(eg–young,female,etc…).
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What does this factor mean?Whether or not loan repayment is available for qualifying physician.
Why is it important?Loanrepaymentisoftenoneofthefirstbenefitscandidatesthinkofwhentheyconsiderpracticinginaruralarea.
Many candidates come out of training with a huge burden of debt.
Federal and state programs exist that communities may be abletoleverageforlittleornocost.
Example:Candidatehas$200,000ofstudentloandebtuponfinishingmedicalschoolandislookingforassistanceinpayingthemoff.
Potential Facility/Community AdvantagesIf your facility is eligible for state and/or federal loan repayment options,candidatesmayviewthisasanadvantage.
Ifyourfacilityoffersitsownstudentloanrepaymentprogram,candidatesmayviewthisasanadvantage.
Ifyouhavestaffwithinyourfacilitythatareknowledgeableaboutstateandfederalloanrepaymentprograms,candidatesmayviewthisasastrength.
Example:Candidateisinterestedinloanrepaymenthelp,butdoesn’tknowmuchaboutit.Youareabletodetermineandexplain to the candidate that they would be eligible to apply for loan repayment through a state program while working in your community.
Loan Repayment
Potential Facility/Community ChallengesIf your facility isn’t eligible for state/federal loan repayment optionsanddoesn’tofferitsownprogram,candidatesmayviewthisasachallenge.
Example:Candidateisinterestedinworkinginaruralarea,partlybecauseofloanrepaymentprograms,butyourfacilityhasn’tbeenapprovedasaneligiblesiteforloanrepayment.
Ideas for Solutions to ChallengesBecome knowledgeable about loan repayment options byreviewing3RNet’sguidetoloanrepaymentoptionsforhealthcareprofessionals.
ContactyourstatePrimaryCareOfficetodetermineyourHealthProfessionalShortageArea(HPSA)score,andifyouare(orcouldbe)eligibleforstate/federalprograms.
Explain to candidates their total compensation from your facility.Ifyouofferahighersalaryorretentionbonuses,youmaybecompetitiveevenwithoutloanrepayment.
SummaryLoanrepaymentisoftenatremendousbenefitforruralcommunities.KnowwhatyouqualityforbydevelopingagoodrelationshipwithyourstatePrimaryCareOffice.
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What does this factor mean?The competitiveness of the overall end-of-year physician earnings.
Why is it important?Salaryisthemostvisiblebenefitforpotentialcandidates.
Candidates may have preconceived notions that community healthcenterspaylessthanothertypesofpractices.
Dependingonthecandidate’srisktolerance,theymaypreferonetypeofcompensationpackage(e.g.-salariedemployment)overanother.
Example: A candidate is interested in your facility but assumes theycouldmakemoreatthelocalhospital.
Potential Facility/Community AdvantagesIfyourfacilityoffersacomparableorslightlyhigherbasesalaryto other competing clinics in your community this may viewed asanadvantage.
Ifyourfacilityhasflexiblecompensationpackagesdependingontherisktoleranceofthecandidate,thismaybeviewedasanadvantage.
Example:Youarerecruitingacandidaterightoutofresidencywhohasalargestudentloandebt,andyouareabletoofferacompetitive,guaranteedsalaryforthefirstthreeyears.
Salary (Amount)
Potential Facility/Community ChallengesIf your facility is unable to compete with local competitor salary levels,thiscouldbeviewedasachallenge.
Ifyourfacilityonlyoffersonetypeofcompensationpackageregardlessofthecandidate’sexperienceorrisktolerance,thismaybeviewedasachallenge.
Example:AFamilyPracticecandidatewithover15yearsofexperienceandisinterestedinyourfacility.AllyourotherFamily Practice physicians have less than three years of experience.Theexperiencedphysicianwantsacompensationpackagebasedmoreheavilyonproduction,butbecauseyourfacilitydoesn’tdothatwithotherphysicians,astandardbasesalaryisofferedandrejected.
Ideas for Solutions to ChallengesParticipateincompensationsurveysconductedbyNACHC,local PCAs or Hospital Associations to make sure you are stayingcompetitive.
Communicate compensation as an entire package with the basesalaryasapieceoftheoverallcompensationofferedtothecandidate,includinguniquebenefitsthatonlyyouoffer.
Beflexiblewithproviderstoallowthemtoearnextramoneybymoonlighting,workatalocalERdepartment.
SummaryKnowwhatthecandidateexpects,whatthecurrentmarketvalueisandwhatyourfacilitycanafford.Useallavailableresourcestohelpyoumakeacompetitiveoffer.Showcompensation as an entire package with base salary as a piece ofthepackagenotasastandaloneitem.
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What does this factor mean?Whether or not a signing bonus is available for new physician and whetherornotamovingallowanceisavailablefornewphysician.
Why is it important?Signingbonuseswereoncethoughtofasabonus,butduetointenserecruitmentcompetition,candidatesareincreasinglycomingtoexpectasizablesigningbonus.
Changingjobsandmovingtoanewareaisverystressful.Somecandidates may not have the resources or the time to coordinate movingalltheirpossessions.
Example: Candidate is interested in relocating their family to your communityfromabout800milesaway.Candidateisconcernedaboutcoordinatingapotentialmovethatfar.
Potential Facility/Community AdvantagesIfyourfacilityofferscompetitivesigningbonuses,candidatesmayviewthatasanadvantage.
Ifyourfacilityofferssigningbonusestohealthcareprofessionalsthatotherfacilitiestypicallydonot(registerednurses,ancillarypositions,etc…)candidatesmayviewthisasanadvantage.
Ifyourfacilityoffersamovingallowance,candidatesmayviewthatasanadvantage.
If your facility contacts with a moving company that takes care ofthemoveforthecandidate,thecandidatemayviewthatasanadvantage.
Example: Candidate is interested in moving across two states to yourruralcommunity.Youcontractwithalocalmovingcompanythatwouldhandlealllogisticsofthemoveforthefamily.
Signing Bonus / Moving Allowance
Potential Facility/Community ChallengesIfyourfacilityisunabletooffercompetitivesigningbonuses,candidatesmayviewthatasachallenge.
Ifyourfacilitydoesn’tofferamovingallowance,candidatesmayviewthatasachallenge.
Example: A candidate is looking at four competing rural communitiesinyourstate.Yourfacilityhasaverycompetitivelongtermcompensationpackage,butthecandidateisluredtoanothercommunitybecauseofabigupfrontsigningbonus.
Ideas for Solutions to ChallengesStay up to date and knowledgeable about current signing bonus levels.
Work with stakeholders in the community to see if money can be raisedforabonus,orifotherincentivescouldbeoffered(helpwithhousing,etc…).
Exploreworkingwithprofessionalmovingcompanies.Oftentimes,facilitiescanfindonecompanyandcontractwiththemforrelocations.
Be familiar with Stark regulations on relocating so you know what youcanandcannotreimburseforthecandidate.
Ifyoudon’tspecificallyofferamovingallowance,makesuretostressotherupfrontfinancialbenefits(signingbonus,etc…).
SummarySigningbonusesareoftenaveryflashyfactorinthemindsofincomingcandidates.Eveniftheycanmakemoremoneyoverthelongrunatyourfacility,itmaybehardtopersuadethemtoacceptasmallsigningbonusthanisbeingofferedelsewhere.Helpingwithrelocationisfairlycommon.Ifyoudon’tmaketheprocesseasy,youmayendupmissingoutoncandidatessimplybecausetheycan’thandlerelocationalone. 23
What does this factor mean?Whetherornotaphysiciancanexpectflexibilitywithregardtothelengthintermofworkingagreementorcontract.
Why is it important?Thecontractdefinesthelengthoftherelationshipbetweenthecandidateandthefacility.
Dependingonthecandidate’srisktolerance,theymayprefermoreorlessflexibilityinregardtothelengthofthecontract.
Example:Acandidateislookingtoretireinyourcommunity.Candidate is interested in having only one employer until retirement and is only looking for jobs with a multi-year contract.
Potential Facility/Community AdvantagesIfyourfacilityisflexibleinthelengthofthecontractaphysicianisobligated,candidatesmayviewthisasanadvantage.
Example: A candidate coming to practice in a rural community forthefirsttimeandwantstheoptiontoleaveafterayear.Youwritethecontractasayearlycontractwiththeoptionforanautomaticannualrenewal.
Length of Contract Flexibility
Potential Facility/Community ChallengesIfyourfacilitydoesn’thaveflexibilityinthelengthofcontract,candidatesmayviewthisasadisadvantage.
Example: A Family Medicine resident is interested in your facility,eligiblefortheNationalHealthServiceCorploanrepaymentprogram,andisseekingatwo-yearcontract.Youremploymentcontractisaminimumofthreeyears,andyourCEOisnotwillingtobudge.Thecandidatedeclinesyouroffer.
Ideas for Solutions to ChallengesUnderstand what the candidate’s risk tolerance is and be flexibleandcreativeincontractlengthoptions.
Research and understand what your competition is doing and whatnationalandstatestandardsare.
SummaryHistorically,itwascommonpracticeforafacilitytoofferthesamecontractlengthtoeveryphysician.Candidatesarenowseekingmoreflexibilityinlengthofcontractbasedonthecandidate’sindividualrisktolerance.
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What does this factor mean?TheperceivedfinancialstabilityofthehiringCHCFacility.
Why is it important?Candidates want to feel secure in the future of the facility they areworkingfor.
Candidates may have a preconceived notion about community healthcenters,thattheirfundingandrevenuearen’tasstableasotherhealthcareentities.
Example:Candidateisinterestedinyourcommunity.Thecandidatehasanofferfromyouandthelocalhospital,andasksaboutyourgrantfunding.
Potential Facility/Community AdvantagesIfyourfacilityactivelyseeksavailablefundingstreams,andhasatrackrecordofsecuringadequatefunding,thismaybeviewedasanadvantage.
If your facility has open and direct communication about the facility’sfiscalstability,thismaybeviewedasadvantage.
Example: Candidate asks about the potential of your grant fundingbeingcontinued.Youshowthecandidatenon-confidentialfinancialinformationthatshowsthebreakdownyourrevenueandexplainsthestabilityofthefacility.
Perceived Fiscal Stability
Potential Facility/Community ChallengesIfyouareunabletospeaktoyourfacility’sfinancialwellbeing,thismaybeviewedasachallenge.
Ifyouareencouragedtobeindirectorhidefinancialinformationabouttheorganization’sfiscalstabilityfrompotentialcandidates,thismaybeviewedasachallenge.
Example: Candidate reads about federal funding for community health centers being decreased and ask about it duringtheinterview.YourCFOwon’tallowyoutodiscussfinancialmatterswithanyoneoutsidethefacility.Thecandidate’s concerns are not addressed and they do not take theoffer.
Ideas for Solutions to ChallengesSharerelevant,non-confidential,financialdataineasydigestedformats such as pie charts or graphs so the candidate can understand funding and income in relevance to the overall financialhealthoftheorganization.
Outline in detail the candidate’s responsibility in contributing to thefiscalstabilityofthefacility.
Share information about the philosophy and importance of CommunityHealthCenters,andtherationaleofwhytheyarefunded.
SummaryCommunityhealthcentersdorelyonfederalfunding.Don’tglossoverthisfactorotherfinancialinformationbutbetransparent when discussing the challenges and advantages of thefinancialhealthoftheorganization.
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What does this factor mean?The existence and favorability of a production incentive for physicianworkandincome.
Why is it important?Total revenue earned is one of the most basic and important factorstoanycareer.Includingaproductionincentivewillhelpdetermineoverallrevenueforthecandidate.
Example: Candidate is looking for opportunities in your community.Youincludelanguageaboutyourproductionincentiveinyouropportunitylisting.
Potential Facility/Community AdvantagesIfyourfacilitycanofferacompetitiveproductionincentivebonus compared to competitors in your area this may be viewedasanadvantage.
Ifyourfacilityoffersacandidateflexibilitytodeterminetheirtotalcompensation(eg–seemorepatientsformorepay),candidatesmayviewthisasanadvantage.
Example:Candidateisinterestedinyourgeneralarea,andlovesworkinginafastpacedenvironment.Youhavetheabilitytoofferthecandidateabasesalaryplusproductionincentivethat rewards them for working more hours and taking more call.
Production Incentive
Potential Facility/Community ChallengesIfyourfacilitycan’taffordtoofferashighofaproductionincentivebonusascompetitors,candidatesmayviewthisasachallenge.
Example:Candidateisinterestedinyourcommunity,butafacilitya100milesawayoffersahigherproductionincentivetothecandidate.
Ideas for Solutions to ChallengesNotallhealthcarecandidateschoosejobssolelyformoney.Ifyouareunabletocompetewithahighperformancebonus,stresswhatyoudooffer(moretimeoffer,bettercallschedule,qualityoflife,etc.).
Beawareofthecostoflivinginyourcommunity.Ifanotherfacilityispayingmorethanyou,buthousingpricesare30%higherthere,theincreasemaybenegated.
SummaryTotalearningsisalwaysgoingtobeanimportantfactor.However,itisnottheonlyimportantfactor.Manycandidatesvalueflexibility,qualityoflife,andfeelingappreciatedjustasmuchastotalearnings.
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What does this factor mean?The existence and favorability of a physician retirement packageorprogram.
Why is it important?Many candidates are coming out of training with a huge debt andacquiringfinancialfreedomisanimportantfactorintheiremploymentdecision.Aretirementpackagemaybeanimportantpartinthatgoal.
Established candidates may prefer the security of knowing that aretirementplanisoffered.
Example:Candidateislookingforaplacetofinishtheircareerandasksaboutyourretirementpackageintheinterview.
Potential Facility/Community AdvantagesIf your facility can invest in a retirement plan for your employees that will show a vested interest in their future this maybeviewedasanadvantage.
Example: Candidate is interested in your state and has job offersfromthreeotheremployers.Yourfacilityhastheonlyofferthatincludesaretirementpackage.
Retirement Package
Potential Facility/Community ChallengesIfyourfacilitydoesn’tofferaretirementpackage,oryourpackageisn’tcompetitive,thismaybeviewedasachallenge.
Example: Candidate is interested in retiring in your community andseekingopportunitieswithyouandanotherfacility.Yourfacilitydoesn’tofferaretirementpackageasabenefit.
Ideas for Solutions to ChallengesSchedulecandidateswithafinancialplannertohelptalkthroughadvantagesofyourfacilities’plan.
Thereareanumberofplansavailable,503c,401k,SEP,etc…Researchwhichoneyourfacilitycanfinanciallyengagein.
Research what national and state benchmarks are by participatingincompensationsurveys.
SummaryRetirementplanscanbetailoredbyemployeetype,sizeoffacility,andtypeoffacility.Researchaplanthatworksforyouand take advantage of this opportunity to recruit and retain youremployees.
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What does this factor mean?The existence and favorability of a Continuing Medical Educationbenefitand/orprogram.
Why is it important?CMEisrequiredforphysicianlicensurerenewals.
Asmedicineisconstantlychanging,physiciansneedtobelifelong learners to keep up to date with new trends and evidencebasedprocedures.
CME is often viewed by physicians as a chance to get away fromtheircommunitytorefocusandunwind.
Example:Acandidateisinterestedinyourruralcommunity,butdoesn’tseeyourCMEpolicyaddressesinthejobdescription.
Potential Facility/Community AdvantagesIfyourfacilityoffersaflexibleandadequateCMEpackage,candidatesmayviewthisasanadvantage.
Example:Acandidateisinterestedinyourruralfacility,andtwoothersimilarfacilities.Thethreeopportunitiesarelargelycomparable,butyourfacilityofferstimeoffandagenerousCMEallowanceforphysicians.Thecandidatechoosesyourfacility.
CME Benefit
Potential Facility/Community ChallengesIfyourfacilitydoesn’tofferacompetitiveCMEallowance,candidatesmayviewthatasachallenge.
IfyourfacilityoffersacompetitiveCMEallowance,butmakesithardforproviderstogettimeofftotravelforCME,candidatesmayviewthatasachallenge.
Ideas for Solutions to ChallengesBring in Locum Tenens or other temporary providers and encourageyourphysiciantousetheirCMEtotravel.Inadditiontoeducation,thismayhelpthemrelaxandrechargeaswell.
Bring in associations from around the state to provide CME on-siteforphysicians.
OfferondemandCMEoptions(recordedvideoservices,etc…)forphysicianstoutilize.
SummaryCME is important to physicians as it pertains to licensure andstayingcurrent.However,CMEcanalsobevaluableasitallowsphysicians’facilitysponsoredtimeawaytolearn,relax,andrecharge.
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What does this factor mean?The sense of competition amongst primary care providers for patients.
Why is it important?Collegialitybetweenprovidersisparamount.
When providers can help other providers with patient questions or are willing to take additional patients to cover another provider’stimeoff,itcanmaketheworkenvironmentmuchbetter.
Example:Yourfacilityhasagreatgroupofprovidersthatworktogetherandhelpeachotherasneeded.
Potential Facility/Community AdvantagesIfyourfacilityisabletokeepallprovidersatafullschedule,candidatesmayseethisasanadvantage.
If your facility has a good of providers that work well with one another,acandidatemayseethisasanadvantage.
Example:Duringasitevisit,yourcandidateinteractswiththeotherproviderstheywouldbeworkingwith,andfeelsasenseof collegiality between them as they often help each other with diagnosesandcovertimeoffwhenneeded.Thecandidateleavesfeelingliketheycouldworkwiththegroupverywell.
Competition
Potential Facility/Community ChallengesIf your facility has a provider or group of providers who are territorialordon’tworkwellwithothers,acandidatemayviewthisasachallenge.
Example:Youarerecruitingafulltimeprovidertosupportyouroneexistingfulltimeprovider.Yourexistingproviderhasbeencritical of the need to hire another provider while putting up roadblocksforeverycandidateyoubringin.Whencandidatesareontheironsitevisit,theyoftenleavefeelingunwelcomedbyyourcurrentproviderandultimatelygoelsewhere.
Ideas for Solutions to ChallengesWork with hospital leadership to gain support for your recruitmentefforts.Ifanexistingproviderismakingrecruitmentmoredifficult,itpaystohaveleadershiponyourside.
Host monthly social events during or outside of work hours to helpprovidersdeveloprelationshipswithoneanother.
Don’tletanexistingproviderdisruptyourrecruitmentefforts.Alotofproviderswhoareatfirstresistanttobringinginanotherprovider,becomeyourbiggestsupportsoncethenewprovidergetsupandrunning.
SummaryEveryonewantstoworkwelltogetherwiththeircolleagues.Forproviders,thiscanoftenbeamakeorbreakissue.Whenconductingyouronsitevisit,prepyourexistinggroupofproviderssotheyknowwhattoexpect.
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Scope of PracticeFactors
Section V
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Scope of Practice FactorsForaproviderinaruralfacility,coveringtheclinic,emergencyroom,nursinghome,inpatientcare,andprovidingmentalhealthcanrightfullyseemoverwhelming.Ontopofthataddsupervisingmid-levels,teaching,andadministrationandit’sawonderruralphysicianshavetimetosleep!
A large scope of practice and the chance to get involved with all aspects of a facility is a core reason many physicians choosetopracticerural.Forthecandidatethatislookingforachallenge,andthechancetodosomethingdifferenteveryday,whatcouldbebetterthanpracticingrural?
However,scopeofpracticecanbecomeoverwhelmingforphysicianswhentheytakeontoomuch,ordon’thaveaninterestincertainscopeofpracticefactors.Beingflexiblewithphysicians on scope of practice is key to not only recruiting acandidate,butbeginningtheprocessofonboardingandretainingthatprovideraswell.
How Scope of Practice factors relate to different health professional candidates:•Alargescopeofpracticemaybeviewedasastrengthforprimarycareprovidersconsideringruralasopposedtourban.•Scopeofpracticefactorscanoftenbemakeorbreakissuesforcandidates.Theyeitherverymuchwanttodosomething,orwon’tdoit(OB,C-sections,endoscopy,etc…)•Newlytrainedphysiciansmaybemoreeasilyoverwhelmedwithalargescopeofpracticethanexperiencedphysicians.••Planningworkdutiesaccordinglyinlieuofthecandidate’spriorexperienceiscrucial.
Scope of Practice Factors
1.Obstetrics:Prenatalcare2.Obstetrics:Deliveries/C-section3.Inpatientcare4.Emergency/Stabilizationcare5.Minortrauma(casting/suturing)6.OfficeGYNprocedures7.Mentalhealth8.Mid-levelsupervision9.Teaching10.Administration
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What does this factor mean?The impact of whether or not prenatal care obstetrics is an option,notanoptionormandatory.
Why is it important?EspeciallyforFamilyMedicinephysicians,mostprovidersfeelverypassionateaboutdoingornotdoingprenatalcare.
Example: A Family Practice candidate is interested in performingprenatalcareandasksifyourfacilityoffersprenatalcareduringtheinterview.
Potential Facility/Community AdvantagesIf your facility gives Family Medicine physicians the choice whetherornottodoprenatalcare,candidatesmayseethisasanadvantage.
Ifyourfacilitydoesn’tofferprenatalcareandthereforedoesn’trequireFamilyMedicinephysicianstoactivelyofferprenatalcare,candidatesmayviewthisasanadvantage.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunity.Asyourfacilitydoesn’tdoObstetrics,youfindthatyourpotentialcandidatepoolislarger.
Obstetrics: Prenatal Care
Potential Facility/Community ChallengesIf your facility requires prenatal care coverage for all Family Medicinephysicians,candidatesmayviewthisasachallenge.
Ifyourfacilitydoesn’tofferprenatalcare,candidatesthatwishtodoObstetricsmayviewthisasachallenge.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunity.Youfindagreatlocalcandidate,buttheywishtopracticeprenatalcare,andduetofinancialconstraints,yourfacilitynolongerhasanObstetricsdepartment.
Ideas for Solutions to ChallengesBeasflexibleasyoucanwithObstetricsrequirementsforFamilyMedicinephysicians.
Ifyoudon’tofferObstetricsandarerecruitingaphysicianwhowishesto“keepuptheirskills”,explorepartnershipswithregionalfacilitiesthatdoofferObstetricsorlookatProjectECHOforthosecandidatesthatwishtopracticeObstetrics.
SummaryTypically,ObstetricsissomethingFamilyMedicinephysiciansfeelverystronglyabout.MaintainingObstetricsinaruralfacilitycanbetough,butifyoucan,youmaybeabletoattractphysiciansasitisrelativelyrareinruralareas.Ifyoudon’trequireObstetrics,yourcandidatepoolforFamilyMedicinephysicianswilllikelybelarger.
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What does this factor mean?The impact of whether or not normal deliveries and/or C-Sectionsisanoption,notanoption,ormandatory.
Why is it important?EspeciallyforFamilyMedicinephysicians,mostprovidersfeelvery passionate about doing or not doing normal deliveries and/orC-Sections.
Increasingly,FamilyMedicinephysiciansareexpressingadesiretonotdonormaldeliveriesand/orC-Sections.
Example:Yourruralfacilitydeliversbabies,andislookingtoreplace a retiring physician that had been your primary normal deliveriesand/orC-Sectionsprovider.
Potential Facility/Community AdvantagesIf your facility gives Family Medicine physicians the choice whetherornottodonormaldeliveriesand/orC-Sections,candidatesmayseethisasanadvantage.
Ifyourfacilitydoesn’tofferObstetricsandthereforedoesn’trequireFamilyMedicinephysicianstoactivelydeliverbabies,candidatesmayviewthisasanadvantage.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunity.Asyourfacilitydoesn’tdonormaldeliveriesand/orC-Sections,youfindthatyourpotentialcandidatepoolislarger.
Obstetrics: Deliveries / C-Section
Potential Facility/Community ChallengesIf your facility requires Obstetrics coverage for all Family Medicinephysicians,candidatesmayviewthisasachallenge.
Ifyourfacilitydoesn’tofferObstetrics,candidatesthatwishtodoObstetricsmayviewthisasachallenge.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunity.Youfindagreatlocalcandidate,buttheywishtopracticeObstetrics,andduetofinancialconstraints,yourfacilitynolongerhasanObstetricsdepartment.
Ideas for Solutions to ChallengesBeasflexibleasyoucanwithObstetricsrequirementsforFamily Medicine physicians and look for options to cover deliveries and C-sections while still having an obstetrics program.
Ifyoudon’tofferObstetricsandarerecruitingaphysicianwhowishesto“keepuptheirskills”,explorepartnershipswithregionalfacilitiesthatdoofferObstetrics.
SummaryTypically,ObstetricsissomethingFamilyMedicinephysiciansfeelverystronglyabout.MaintainingObstetricsinaruralfacilitycanbetough,butifyoucan,youmaybeabletoattractphysiciansasitisrelativelyrareinruralareas.Ifyoudon’trequireObstetrics,yourcandidatepoolforFamilyMedicinephysicianswilllikelybelarger.
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What does this factor mean?The impact of whether or not inpatient hospital care is an option,notanoption,ormandatory.
Why is it important?Increasingly,FamilyMedicinephysiciansareexpressingadesirefor“outpatient”onlyoptions.
Hospitalist programs are becoming very common across the nation,eveninsmallerhospitals.
If your candidate is coming to your rural facility from a larger facility,theymaynothavemuchexperiencewithinpatientcare.
Example: A Family Medicine physician is interested in your ruralfacility.Yourequireyourphysicianscoverinpatientcare.
Potential Facility/Community AdvantagesIfyourfacilityoffersaninpatientcareoptiontoproviders,butdoesn’trequireit,candidatesmayviewthatasanadvantage.
Ifyourfacilityrequiresinpatientcarepractice,buthaveotherdedicatedstafftoassist(Hospitalists)acandidatemayviewthatasanadvantage.
Example: A Family Medicine physician is interested in the wide scopeofpracticeofferedbyyourruralfacility.Theyfollowupwiththeirinpatients,butmostinpatientcareisprovidedbyaHospitalistrotation.
Inpatient Care
Potential Facility/Community ChallengesIfyourfacilityrequiresextensiveinpatientcare,candidatesmayviewthatasachallenge.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunityandrequireinpatientcare.Yousourceagoodnumberofviablecandidates,butmostareinterestedinoutpatientonly.
Ideas for Solutions to ChallengesBeasflexibleasyoucanwithoffering/requiringinpatientcarepracticetopotentialcandidates.
Utilizedifferentstaffingmodels(Hospitalists,etc…)toalleviatetheburdenfromyourFamilyMedicinephysicians.
SummaryFamilyMedicinephysicianshavedifferentlevelsofcomfortwithinpatientcare,butoverall,thetrendseemstobethattheyarepreferringlowlevelsifany.Researchstaffingmodelstoaccommodategrowingtrendsandphysicianpreference.
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What does this factor mean?The impact of whether or not emergency or stabilization and transfercoverageisanoption,notanoption,ormandatory.
Why is it important?Requiring high volume emergency/stabilization care coverage may be intimidating for recently trained providers as they may nothaveasmuchexperience.
Example:Yourruralfacilityhasthreeprimarycareproviders,and requires each to share emergency/stabilization care coverage.
Potential Facility/Community AdvantagesIfemergency/stabilizationcoverageisoffered,butnotrequired,candidatesmayviewthisasanadvantage.
Ifyouremergency/stabilizationcarevolumeisverylow,candidates adverse to emergency/stabilization coverage may viewthisasanadvantage.
Example:Yourruralfacilityhasanemergency/stabilizationclinic the provider may have the option to cover (they get paidbythehourforcoverage).Acandidateyouarerecruitingappreciatestheflexibilityandtheabilitytomakeextramoney.
Emergency / Stabilization Care
Potential Facility/Community ChallengesIf your facility requires providers to cover the emergency/stabilityclinic,candidatesmayviewthatasachallenge.
Ifyourfacilityhasahighvolumeemergency/stabilizationcare,candidates that lack experience in the emergency/stabilization butstillwishtohavesomeresponsibilities,mayviewthatasachallenge.
Example:Yourruralcommunityhasahighvolumeemergency/stabilizationcareduetothelocaltruckingindustry.YouarerecruitingaFamilyMedicineresident,buttheyarewaryoftheamountofemergency/stabilizationcarecoveragerequired.
Ideas for Solutions to ChallengesExplore compensation models that allow your providers to take emergency/stabilizationcoverageforadditionalpay.
Lookintotele-emergencyroomoptions.Optionsareavailablethatconnectruralareastospecialists,translators,andmore.Anything you can do to help providers feel less isolated will makeapositivedifference.
ProvideadditionalCEtrainingfortraumaprocedures.
SummaryEmergency/stabilization coverage can be a heavy load for providersinaruralcommunity.Ifyoudon’thavetheluxuryofhavingspecializedemergency/stabilizationclinicstaff,makesuretohavesupportavenues(telehealth,etc…)fortheproviderasmuchaspossible.
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What does this factor mean?The impact of whether or not minor trauma care such as castingorsuturingisanoption,notanoption,ormandatory.
Why is it important?Minortrauma,suchassuturingandcastingisoftensomethingthat may be necessary in small rural facilities with few providers.
Example:Yourfacilityhasaminortraumaclinicandrequireseachprimarycarephysiciantosharecoverage.
Potential Facility/Community AdvantagesIfyourfacilityofferstraumacare,butitisnotrequired,candidatesmayviewthisasanadvantage.
Ifyourfacilitydoesn’tofferminortrauma,butiswillingtoconsideritfortheexperiencedprovider,acandidatemayviewthatasanadvantage.
Example:Yourruralfacilitydoesn’trequirecoverageintraumacare,butgivesproviderstheoption(theygetpaidadditionalforprovidingservices).Acandidateyouarerecruitingappreciatestheflexibilityandtheabilitytomakeextramoney.
Minor Trauma (Casting / Suturing)
Potential Facility/Community ChallengesIf your facility requires providers to cover trauma care or you havehighvolumetraumacare,candidatesmayviewthatasachallenge.
Example:Yourruralcommunityhasahighvolumetraumacareduetothelocallumbermillindustry.Youarerecruitingaproviderthatisnotconfidentintraumacareandiswaryoftheamountofcoveragerequired.
Ideas for Solutions to ChallengesExplore compensation models that allow your providers to take traumacarecoverageforadditionalpay.
ProvideadditionalCEtrainingfortraumaprocedures.
SummaryTraumacarecanbeanimportantserviceforyourcommunity.Ensure providers have the support avenues they need as much aspossible.
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What does this factor mean?TheimpactofwhetherornotofficeGYNproceduressuchascolposcopyand/orLEEPisanoption,notanoption,ormandatory.
Why is it important?OfficeGYNproceduresareoftennecessaryinmanyruralfacilitieswithfewproviders.
EspeciallyforFamilyMedicinephysicians,mostprovidersfeelverypassionateaboutdoingornotdoingGYNprocedures.
Example:YourruralfacilityoffersGYNprocedures,andislooking to replace a retiring physician that had been your primaryGYNprocedureprovider.
Potential Facility/Community AdvantagesIf your facility gives Family Medicine physicians the choice of whetherornottodoofficeGYNprocedures,candidatesmayviewthisasanadvantage.
Example:YouarerecruitingaFamilyMedicinecandidatethatisinterestedinpracticingofficeGYNProcedures.YourfacilityoffersofficeGYNprocedures.
Office GYN Procedures
Potential Facility/Community ChallengesIf your facility requires Family Medicine physicians to perform inofficeGYNprocedures,candidatesmayviewthisasachallenge.
Example:YouarerecruitingaFamilyMedicinephysiciantoyourruralcommunity.YoustatethatyourequireGYNprocedures when sourcing candidates and your pool of applicantsisimpactednegatively.
Ideas for Solutions to ChallengesBeasflexibleaspossibleasyoucanwithofficeGYNproceduresrequirementsforFamilyMedicinephysicians.
Ifyoudon’tofferofficeGYNproceduresandarerecruitingaphysicianwhowishesto“keepuptheirskills”,explorepartnershipswithregionalfacilitiesthatdoofferGYNprocedures.
SummaryOfficeGYNproceduresaresomethingFamilyMedicalphysiciansfeelstronglyabout.Beingaccommodatingtoproviders that wish to do these procedures (but not requiring everyprovider)canbebeneficial.
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What does this factor mean?The impact of whether or not mental health care by the physicianisanoption,notanoption,ormandatory.
Why is it important?The amount of mental health that a Family Medicine physician is comfortable providing varies greatly from candidate to candidate.
Rural areas often have disproportionately high incidents of mentalhealthconditions(depression,substanceabuses,etc…)
Inruralareas,FamilyMedicinephysiciansmaynothaveaspecializedmentalhealthprovidertoreferto.Thiscanleadtophysiciansfeelingoverwhelmedandisolated.
Example: If your rural community there are no specialized mentalhealthproviders,somentalhealthconcernsareoftenseenbyyouroneFamilyMedicinephysician.
Potential Facility/Community AdvantagesIf your Family Medicine physicians aren’t required to provide mentalhealthcare,andcanrefertoinhousementalhealthproviders,candidatesmayviewthatasanadvantage.
Example:Duringanonsitevisit,acandidateexpressesangstabout potentially treating patients with serious mental health issues.Youareabletoexplaintothecandidatethatinadditiontoseveralalliedmentalhealthproviders,yourfacilityalsohasatele-psychiatryprogram.
Mental Health
Potential Facility/Community ChallengesIf your Family Medicine physicians are required to provide substantialmentalhealthcare,anddon’thaveinhousementalhealthproviderstoreferto,candidatesmayviewthatasachallenge.
Example:Whenreviewingdataonyourcommunity,acandidate notices and inquires about high suicide and substanceabuserates.Thecandidatealsoinquiresaboutyourfacilitieslackofmentalhealthproviders,andfeelsuneasyabout the potential of being the only provider that can help patientswithmentalhealthissues.
Ideas for Solutions to ChallengesExploreoptionsintele-psychiatry.
Recruit mental health providers (allied mental health professionals,PsychiatricNursePractitioners,etc...)tohelpyourFamilyMedicinephysician.
Speak with your nurses and encourage them to look at virtual trainingoptionsfordegreesinPsychiatricNursePractitioner.
SummaryFamilyMedicinephysiciansoftendon’tfeelqualifiedtoprovidesubstantialmentalhealthcare.Inruralcommunitieshowever,they are sometimes required to because of the lack of other providers.
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What does this factor mean?The impact of whether or not mid-level supervision by the physicianisanoption,notanoption,ormandatory.
Why is it important?Mid-levelproviders(NursePractitioners,PhysicianAssistants,etc…)areacrucialpieceofhealthcaredeliveryinruralareas.
Dependingonstateregulations,mid-levelprovidersrequireavaryingdegreeofphysicianoversight(chartreviews,etc…).
Example:Youarerecruitingaphysiciantoreplacearetiringprovider.ThisnewphysicianwillhavetosupervisetwoNursePractitionersandonePhysicianAssistant.
Potential Facility/Community AdvantagesIfyourfacilityoffers,butdoesn’trequiremid-levelsupervision,candidatesmayseethisasanadvantage.
If your facility has very experienced and stable mid-level providers,acandidatethatwillpotentiallyhavetosupervisethem,mayviewthisasanadvantage.
Example: A Family Medicine physician is interested in your ruralfacility.Duringtheironsitevisit,thecandidatemeetswithyour mid-level providers and is very impressed with the team basedcaremodelyourfacilityuses.
Mid-Level Supervision
Potential Facility/Community ChallengesIfyourfacilityrequiressignificantmid-levelsupervision,candidatesmayseethisasachallenge.
Ifyourfacilityhasconstantturnoverofmid-levelproviders,candidatesthatpotentiallyhavetosupervisethem,mayviewthisasachallenge.
Example: A Family Medicine physician is interested in your ruralcommunity.Theyhaven’thadtosupervisemid-levelprovidersinquitesometime,andoverthelastthreeyears,yourfacilityhashadalotofmidlevelturnover.
Ideas for Solutions to ChallengesKnowthemidleveloversightregulationsinyourstate.Ifyouhavemultiplesites,besuretoknowhowtechnologyisaddressedinoversightregulations.
Let your midlevel providers practice to the full scope of their license.Incertainstates,NursePractitionershavetheabilitytopracticeindependently.
Holdteambuildingexerciseswithyourproviderworkforce,andbe sure to have a retention plan for both midlevel providers andphysicians.
SummaryMost rural facilities would struggle to operate without midlevel providers.Oftentheyareeasiertorecruitthanphysicians,andstillprovidehighqualitypatientcare.However,beawarethat physicians can sometimes view midlevel oversight as a burden,anditmaytakethemawhiletofullyrealizethebenefitsofworkingwithmidlevelproviders.
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What does this factor mean?The impact of whether or not teaching residents or medical studentsbyphysiciansisanoption,notanoption,ormandatory.
Why is it important?Everylicensedphysicianhasatsomepoint,trainedunderanotherphysician.
Manyphysicianshadgreattrainingexperiences,andwishto“giveback”byhelpingeducatefuturephysiciansthemselves.Example:Aphysicianisinterestedinyourcommunity,andhas a long history of helping your state’s medical school with studentrotations.
Potential Facility/Community AdvantagesIfyourfacilityallows,butdoesn’trequirephysicianstoparticipateinmedicalteaching,candidatesmayviewthisasanadvantage.
If you have a provider that likes to get involved with medical student/residenttraining,thismaybeagreatwaytodevelopafutureworkforcepipelineforyourcommunity.Oftentimesresidents ultimately choose to practice in a community they hadvisitedduringtheirtraining.
Example: A physician in your community really likes to supervisemedicalstudentsduringtheir3rdand4thyearrotations.Yourfacilityencouragesthiseventhoughthephysicianisabletoseelesspatientsduringthesetimes.Youstayincontactwiththetraineesthatcomethroughyourfacility,andhavebeenabletorecruitafewofthemaftertheirtraining.
Teaching
Potential Facility/Community ChallengesIf your facility doesn’t allow or have access to get involved with medicaltraining,candidatesmayviewthatasachallenge.
If your facility requires physicians to participate in training medicalstudents,candidatesmayviewthatasachallenge.
Example:Aphysicianisinterestedinyourruralcommunity.They are coming from a large urban center where they spenttwodaysaweekteachingatthemedicalschool.Thecandidate would like to continue to be involved in medical education,butyourfacilityhasneverhostedstudentsorresidents.
Ideas for Solutions to ChallengesReach out to the medical schools and residency programs in your state to learn about what options may be available to you forhostingstudents.
Whenstudentsdospendtimeinyourfacility,maketheirexperienceaspleasantandfulfillingaspossiblebygettingthemintegratedintothecommunity,helpingwithtemporaryhousing,etc…
Contactyourstate’sAreaHealthEducationCenters(AHECs)tolearn about opportunities for your facility to get involved with medicaleducation.
SummaryManyphysicianshavefondmemoriesoftheirtraining,especially when it comes to a physician mentor they may have had.Encouraging,butnotrequiringyourphysicianstoteachcanprovidethemachancetogiveback,andgetyourfacilityadditionalexposuretothenextgenerationofphysicians.Additional,studieshaveshownthatteachingcanplayasignificantroleinjobsatisfactionandretentionofphysicians.40
What does this factor mean?The impact of whether or not administrative duties for the physicianisanoption,notanoption,ormandatory.
Why is it important?Physicianstendtohavealotofresponsibilities,especiallyinruralcommunities.
Physiciantimeisprecious,soadministrativedutieslikeservingoncommitteesorworkingwithhospitalleadership,mayoverburdenaprovider.
Conversely,physicianswanttofeelliketheyhaveavoiceinadministration.Ifaproviderfeelsliketheirvoiceisn’tbeingheardonimportantissues,theymaydevelopresentment.
Example:Youemployonephysicianinyourruralfacility.TheyaretheChiefMedicalOfficer,andhavenumerousadministrativedutiesinadditiontotheirclinicresponsibilities.
Potential Facility/Community AdvantagesIf your facility allows physicians to have a voice in administrationwithoutoverburdeningthem,acandidatemayseethisasanadvantage.
Example: A newly trained physician is interested in your rural community.Inspeakingwiththemaboutadministrativeduties,youlayoutaplanthatisflexibleandallowsthephysiciantoget accustomed to their clinical practice while getting involved withadministrationattheirownpace.
Administration
Potential Facility/Community ChallengesIfyourfacilityrequiresphysicianstospendasignificantamountoftimeinadministration,orhasanenvironmentwherephysicianfeelliketheydon’thaveavoice,candidatesmayviewthisasachallenge.
Example: An experienced physician is interested in coming toyourruralfacility.Theywouldbringalotofgoodideasandknowledgefromtheirpreviousexperiences,butyourfacilitydoesn’t typically include physicians in administrative decision making.
Ideas for Solutions to ChallengesHave physician representation at your facility board of directorsmeetings.
Useafeedbacksystemwhereproviders(andallemployees)canbringforthideasandhavequestionsanswered.
Communicationiskey.Makesureyourphysiciansareinformedandnotcaughtoffguardaboutmajorfacilitydecisions.
SummaryProvidersgotoschooltotakecareofpatients,nottobeanadministrator.However,beingsuchacriticalpieceofyourfacility,physiciansmustfeelliketheyhaveavoiceinmajorissueswhilenotfeelingtoooverburdenedbyadministration.
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Medical SupportFactors
Section VI
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Medical Support FactorsPhysicianswanttobeabletodotheirjobwell,buttheyneedassistance.Whenaphysicianhasaccesstoaqualityteamofotherhealthcareprofessionals,theyfeelmoreconfidentandsupported.Nurses,alliedmentalhealthprofessionals,mid-levels,andancillarystaffallcanmakeaphysician’slifemucheasier(inadditiontoenhancingpatientcare).
Inruralareas,havingadequatestafftofullysupportaphysiciancanbetough.Oftentimes,ruralfacilitiesmaynothave the need for full time providers in certain specialties and professions.However,havingtheseprofessionalsavailable(thoughanymeans)mayhelpyourecruitandretainfamilymedicinephysicians.
Access to quality medical support cuts back the feeling of isolation for physicians and allows them to provide better overallpatientcare.
How medical support factors relate to different health professional candidates•Strengthinthesefactorsmaybeimportanttophysiciansthatareusedtohavingaccesstoabundantmedicalsupportstaff.•Strengthinthesefactorsmaybeimportanttonewly trained candidates that lack experience working completely independently.•Candidatesoftenhaveaperceptionthatruralareaslack medical support so it is important to emphasize the support youhavetoallcandidates.
Medical Support Factors
1.Perceptionofquality2.Stabilityofphysicianworkforce3.Specialistavailability4.Nursingworkforce5.Mid-levelproviderworkforce6.Ancillarystaffworkforce7.Pharmacyservices8.Alliedmentalhealthworkforce9.Languageservicessupport10.Call/practicecoverage
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What does this factor mean?The overall reputation for quality of medical care for this communityasseenbysomeonenotfromthiscommunity.
Why is it important?Physicians want to work in facilities that are viewed as providinghighqualityhealthcare.
If your community perceives your facility to not provide quality care,thatperceptioncanhaveanegativeimpactonrecruitingandretainingpotentialphysicians.
Example:Whileontheirsitevisit,acandidatemeetsmanypeoplefromyourcommunity.Eachcommunitymemberhasareaction when the candidate informs them they are applying to yourfacility.
Potential Facility/Community AdvantagesIf your facility is perceived by the majority of your community toprovidequalitycare,acandidatemayviewthatasanadvantage.
Example: A candidate is interested in relocating to your ruralcommunity.Theirspouseisfromthearea,andwhendiscussingthepotentialmovewiththespouse’sfamily,theyhave many positive stories about the quality of care at your facility.
Perception of Quality
Potential Facility/Community ChallengesIf your facility is perceived by the majority of your community tonotprovidequalitycare,acandidatemayviewthatasachallenge.
Example:Whilevisitingyourcommunitywiththeirfamily,acandidate speaks to numerous people with bad experiences at yourfacilitythatwouldindicatealowerqualityofcare.
Ideas for Solutions to ChallengesUsingavailablepromotionaltools(socialmedia,website,etc…)findandpromotepositivestoriesfrompeopleyourfacilityhascaredfor.
Ifyourfacilityparticipates,beawareofyourHCAHPSscoresand speak to those people in your facility that are responsible formonitoringthem.
Hold events in the community that promote the good work yourfacilitydoes.Localhealthcareaccessinruralcommunitiesissomethingtobeproudof!
SummaryCommunity members can often hold a grudge against healthcarefacilitiesforsomethingthathappenedlongago,orthatwascompletelyoutsideyourfacility’scontrol.Workinghard to know how your facility is perceived by the community andaddressingconcerns,cangoalongwaysinattractingproviders.
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What does this factor mean?The stability of the physician workforce and longevity of the retainedphysicians.
Why is it important?Physicians are often wary about coming into a facility that has beena“revolvingdoor”forotherphysicians.
Inruralareas,physicianscanoftenfeelisolated.Havinga stable physician workforce can cut down of feelings of isolationfornewproviders.
Constantly having to replace leaving physicians is expensive and can negatively impact the continuation of care for patients inruralareas.
Example:Yourfacilityhasateamoffourfulltimephysiciansandthreeofthemhavebeenwithyourfacilityforoverfiveyears.
Potential Facility/Community AdvantagesIfyourfacilityhasastablephysicianworkforce,candidatesmayviewthatasanadvantage.
Ifyourfacilityonlyemploysoneortwophysicians,butyouhaveastablemidlevelandadministrativeworkforce,candidatesmayviewthatasanadvantage.
Example: A candidate is interested in your rural community but isnervousabouttheperceptionofbeingisolated.Duringtheironsitevisit,thecandidatehaslunchwithyourlongtenuredmedical director who is able to greatly ease the candidate’s concerns.
Stability of Physician Workforce
Potential Facility/Community ChallengesIf your facility has had trouble retaining physicians for over threeyears,candidatesmayviewthatasachallenge.
Example: A newly trained physician is interested in your rural facility.Overthelastfiveyears,yourfacilityhasturnedovertheentire physician workforce and relied heavily on Locum Tenens coverage.Thecandidateassumesyoumusthaveinternalissueswithkeepingproviders,andtakesapositionelsewhere.
Ideas for Solutions to ChallengesWhenspeakingtocandidatesaboutworkforcestability,considerallfacetsofyourfacilityworkforce;nursing,administrative,mid-levels,ancillary,etc...
Develop a physician retention program that starts as soon as yourphysiciansarerecruited!
Speak to the provider as if they will become the stable physicianyourcommunityneeds.Manyphysiciansliketheidea of a facility that is willing to support and build around their practice.
SummaryThe importance of physician retention cannot be overstated formanyreasons.Oneofwhichisthatyourinabilitytoretainphysiciansmaydecreaseyourabilitytorecruitphysicians.Communicate with your existing physicians and make sure issuesareaddressedbeforetheyreachacriticaljuncture.
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What does this factor mean?The availability of specialists and sub-specialist for patient care;eitheronsiteorbyothermeans.
Why is it important?Beingaruralprimarycarephysiciancanfeelveryisolating.Havingaccesstoanonsite,visiting,orvirtualspecialistcanprovidephysiciansafeelingofcomfortandsupport.
Having specialist availability allows you to provide more healthcarelocally,andmayincreaseyourpositivereceptionbythecommunity.
Example:Yourfacilityisstaffedbytwoprimarycarephysicians,buthaveanumberofvisitingspecialiststhatcomeonsiteacoupledaysamonth.
Potential Facility/Community AdvantagesIfyourfacilityhasonsite,visiting,orvirtualaccesstospecialists,candidatesmayviewthatasanadvantage.
Example: a candidate is apprehensive about being the only physician in your rural facility because of the emergency departmentimplications.However,yourfacilityhasaccessthrough telemedicine to a service that provides assistance to theproviderforemergencyroomcare.
Specialist Availability
Potential Facility/Community ChallengesIfyourfacilitydoesn’thaveonsite,visiting,orvirtualaccesstospecialists,candidatemayviewthatasachallenge.
Example: A candidate is used to have specialist access to beabletoaskquestionsandgetsecondopinions.Withoutaccesstokeyspecialists,thecandidatecan’tseethemselvesworkinginyourfacility.
Ideas for Solutions to ChallengesInvestigate what options for telemedicine services are available inyourarea.Eveniftheyaren’tarevenuegenerator,theymayhelpyourrecruitandretainphysicians.
Workwithregionalfacilitiestosetupvisitingspecialists.Ifpartofalargersystem,worktodeveloprelationshipsbetween your local provider and specialists in the larger system.Sometimes,asimplephonecalltoaspecialistcangreatlyassistaphysician.Speaktotheserelationshipswhenrecruitingacandidate.
SummaryMedical care is complicated and often requires multiple providersworkingasateam.Ruralareasmaynotbeabletosupportanonsitespecialistforeveryneedthatarises,butmake sure specialist support is available to your physicians as bestyoucan.
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What does this factor mean?The adequacy of nursing workforce for both quantity and quality.
Why is it important?Having enough quality nurses helps ensure physicians in your facilityhavethesupporttoproperlycarefortheirpatients.
Proper communicate between nurse and physician can help alleviatepotentialbarriersfromthephysician’scare.
Example:Acandidatetoursyourfacilityduringtheirsitevisit,observesthenursingstaff,andmeetswithyourdirectorofnursing.
Potential Facility/Community AdvantagesIfyourfacilityhasadequatenurses,inbothquantityandquality,candidatesmayviewthatasanadvantage.
Example:Acandidateisinterestedinrelocatingtoyourfacility.Duringtheirsitevisit,theyareimpressedwithyounursingstaff,theircommunicationskills,andoverallhelpfulness.
Nursing Workforce
Potential Facility/Community ChallengesIfyourfacilityhasgoodnurses,butnotenoughofthem,candidatesmayviewthisasachallenge.
Ifyourfacilityhasenoughnurses,buttheyareinexperiencedorhaveotherissues,acandidatemayviewthisasachallenge.
Example:Yourfacilityhadtraditionallyhadtroublesrecruitingandretainingenoughqualitynurses.Duringtheirsitevisit,acandidateinteractswithyournursingstaffandisn’timpressed. Ideas for Solutions to ChallengesThink of your nurse recruitment/retention as being just as importantasyourphysicianrecruitment/retention.
Provide training and career development options for your nurses.
Work with your local nursing education programs to see if you can set up rural experiences at your facility for nursing studentsduringtheirtraining.
SummaryHaving enough quality nurses impacts all facets of a healthcare facility,includingphysicianrecruitmentandretention.
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What does this factor mean?The adequacy of mid-level provider for both quantity and quality.
Why is it important?Most rural facilities would have a hard time meeting patient demand without nurse practitioners and physician assistants (mid-levels).
Mid-level providers can free up your physicians to focus on the moreextensiveorcomplicatedpatients.
Physicians and mid-levels must work closely together to effectivelycareforpatients.
Example:Acandidateisinterestedinyourruralfacility.Iftheychoosetoacceptyouroffer,theywouldbeworkingwithtwophysicianassistants,andonenursepractitioner.
Potential Facility/Community AdvantagesIfyourfacilityhasenoughqualitymid-levelproviders,candidatesmayviewthatasanadvantage.
Example: A candidate is interested in your rural facility but worriesaboutbeingtheonlyonsitephysician.Thecandidatemeets your mid-level provider group which greatly eases their concernaboutpatientload,support,andcallschedule.
Mid-Level Provider Workforce
Potential Facility/Community ChallengesIfyourfacilitydoesn’thaveenoughqualitymid-levelproviders,candidatesmayviewthatasachallenge.
Example: A candidate is interested in your rural facility but worriesaboutbeingtheonlyonsitephysician.Yourfacilityhashadtroublesretainingmid-levelproviders,soyouareconstantlyhiringnewgraduateswhichworriesthecandidate.
Ideas for Solutions to ChallengesIdentify nurses in your facility that may wish to continue their educationtobecomeanursepractitioner,andhelpthemsupportthetime/cost.Thisgivesyoutheabilitytosupportnursesthathaveconnectionstothecommunity,arestable,etc…
Havearetentionplaninplaceformid-levelproviders.Use mid-level providers to help address gaps in what your physicianlikes/doesn’tliketodo.
SummaryMid-level providers are a big asset to rural facilities and typicallyeasiertorecruitthanphysicians.Havinggoodmid-levelproviderscanhelpkeepyourcommunityhealth,andyourphysicianshappy.
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What does this factor mean?Theadequacyofancillarystaff(suchaslaboratory,x-raytechnician,respiratorytherapy,physicaltherapy,occupationaltherapy)workforceforbothquantityandquality.
Why is it important?Ancillarystaffholdmanyimportantroleswithinafacility.Havingenoughqualityancillarystaffensuresthatphysiciansare able to provide treatments that are in the best interest of thepatient.
Example:Acandidateisinterestedinyourruralfacility.Yourfacilityhasgreatancillarystaff–yourx-raytechnicianhasbeenwithyourfacilityforover30years.
Potential Facility/Community AdvantagesIfyourfacilityhasenoughqualityancillarystaff,candidatesmayviewthatasanadvantage.
Example:Whiletouringyourfacility,acandidateisveryimpressed with the capacity and turnaround of your ancillary staff.Thecandidatefeelscomfortedthattheancillarystaffareinplacetomaketheirjobeasier.
Ancillary Staff Workforce
Potential Facility/Community ChallengesIfyourfacilitydoesn’thaveenoughqualityancillarystaff,candidatesmayviewthatasachallenge.
Example:Acandidateisinterestedinyourfacility.Yourfacilityhas recently had turnover in a few key ancillary areas which makesroutineoccurrences(gettinganx-raydone,physicaltherapy,etc…)muchtougher.
Ideas for Solutions to ChallengesRecognizethegoodworkyourancillarystaffdoes.Everybodylikestofeelappreciated.
Work with your local ancillary training programs to see if you can set up rural experiences at your facility for students during theirtraining.
Workwithyourlocalhighschoolandoffertohelpeducatetheirstudentsaboutgreatcareersintheancillaryhealthcareerfield. SummaryWhileitisoftentakeforgrantedbyphysicians,beingabletoaccessqualityancillaryservicesiscrucialtopatientcare.Withoutqualityancillarystaff,physicianswillquicklyrealizetheirjobbecomesmuchtougher.
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What does this factor mean?The availability and adequacy of pharmacy services for CHC patients.
Why is it important?The ability to improve their patients’ health through a key strategy of medication management is a primary concern for mostcandidates.
Candidates may have a preconceived notion that rural and underservedareasmaylackpharmacyservices.
Example: A candidate is interested in your facility and ask aboutyourpharmacyservicesduringtheinterview.
Potential Facility/Community AdvantagesIfyourfacilityofferspharmacyservices,candidatesmayviewthisasanadvantage.
Example: A newly trained candidate is nervous about access topharmacyservices.However,yourfacilityhasaccesstofunding through a local charity and has a strong pharmacy servicesprogram.
Pharmacy Services
Potential Facility/Community ChallengesIfyourfacilityisunabletoofferpharmacyservices,candidatesmayviewthisasachallenge.
Example:Acandidateisinterestedinyourruralfacility.Duringtheirsitevisit,theybecomeconcernedwhentheylearnyoudonotofferpharmacyservices.
Ideas for Solutions to ChallengesSeek out partnerships and funding with local charities to supplementmedicineforpatientswhocan’taffordit.
Explore partnerships in the community and work to develop a pharmacyservicesprogramornetwork.
Ifeligible,participateinthe340BprogramofferedthroughHRSA.
SummaryPhysicians may feel cautious about working where they can’tprovidetreatmentbasedontheirprescribedcare.Workwith your community to develop pharmacy services so your providerwillfeelconfidentwhenprescribing.
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What does this factor mean?The adequacy allied mental health workforce for both quantity andquality.
Why is it important?The amount of mental health coverage a family medicine physician has to provide can be a big obstacle for both recruitmentandretention.
Mentalhealthisoftenamajorissueforruralcommunities.Family Medicine physicians typically don’t feel comfortable providingmentalhealthcare.
Alliedmentalhealthworkforce(socialworks,counselors,etc…)cangreatlyhelpphysiciansfeelmorecomfortableandsupportedinyourruralcommunity.
Example: A family medicine candidate is interested in your facility.Yourcommunityhashighincidentsofdepressionandsubstanceabuse.
Potential Facility/Community AdvantagesIfyourfacilityhasonsitealliedmentalhealthworkforce,candidatesmayviewthatasanadvantage.
Example: A candidate interested in your facility is worried about their ability to help with your community’s substance abuseproblems.Youareabletoeasetheirconcernswhenyou introduce the candidate to your onsite substance abuse counselor.
Allied Mental Health Workforce
Potential Facility/Community ChallengesIf your facility doesn’t have onsite allied mental health workforce,candidatemayviewthatasachallenge.
Example:Acandidateisspeakingwithyourexistingprovider.The existing provide details their struggles with having to be aphysician,socialworker,counselor,andmore.Theexistingprovider explains that many of the patients in your facility have healthissuesgreatlycompoundedbymentalhealthproblems.
Ideas for Solutions to ChallengesMakethecaseforrecruitingalliedmentalhealthworkforce.Evenatparttime,alliedmentalhealthproviderscangreatlysupportaphysician.
Offerresourcesandtrainingtohelpyourphysiciansfeelmorecomfortable working with patients that have mental health issues.
Work with your county public health department to address the social determinants of health that lead to the mental health issuesinyourcommunity.
SummaryMentalhealthisahugeissueinruralcommunities.Toadequatelyhelp,yourfacilitymayneedmorethanfamilymedicinephysicians.Recruitstaffandofferresourcesandtrainingtohelpsupportyourphysicians.
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What does this factor mean?The availability and adequacy of language support services for CHCpatients.
Why is it important?Patient to provider communication is fundamental when providingcare.Providersmustbeabletocommunicatewiththepatientstheyareserving.
Many CHCs in rural and underserved areas have a patient populationthatmayrequirelanguagesservicessupport.
Example:YourfacilityhasalargepatientpopulationthatuseEnglishasasecondlanguage.
Potential Facility/Community AdvantagesIfyourfacilitycanofferlanguagesupportservices,candidatesmayviewthisasanadvantage.
Example:YoufacilityhasalargepatientpopulationthatspeaksSpanish.YourfacilityemploystwoRNsthatarefluentinSpanishtoactasinterpreters.
Language Services Support
Potential Facility/Community ChallengesIfyourfacilityisunabletoofferlanguageservicessupport,candidatesmayviewthisasachallenge.
Example: Candidate learns during the interview process that they will be seeing a patient population that doesn’t speak Englishandyourfacilitydoesn’tofferanylanguagesupportbutreliesonpatient’srelatives.
Ideas for Solutions to ChallengesActivelyseektohirebi-lingualstafffromyourpatientpopulation.
Engage in state sponsored programs that provide telephone assistedinterpretationservices.
Develop relationships in the community to create a group of volunteerstohelpwithinterpreting.
SummaryOvercoming the language barrier to provide medical care is a necessityinmostCHCfacilities.Physiciansmayfeelcautiousiftheycan’tcommunicatecourseoftreatmenttotheirpatients.Seek out solutions available in your area so the provider will feelmoreconfident.
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What does this factor mean?The adequacy of call coverage and practice coverage for physicianleave,holidaysandvacationforbothquantityandquality.
Why is it important?Nexttosalary,callscheduleisoneofthefactorsofmostimportancetophysicians.
There is a perception that call schedule will often be higher in ruralareasbecauseofthelackofproviders.
Toomuchtimeoncallcanburnaphysicianout,andmakethemfeeltootiedtoyourfacility.
Moreandmore,youngerprovidersareexpressingthedesireforlesscallandmoreflexibilityfortheirlifeoutsideofmedicalpractice.
Example:Acandidateisinterestedinyourruralfacility,andisconcerned about how the potential call schedule would impact theirfamily’squalityoflife.
Potential Facility/Community AdvantagesIfyourfacilityoffersafavorablecallschedule,candidatesmayviewthatasanadvantage.
Ifyourfacilityallowsphysicianstotakecall,butdoesn’trequireit,candidatesmayviewthatasanadvantage.
Example: A newly trained physician is interested in your movingtheirfamilytoyourruralcommunity.Inreviewingajobopening at your facility they see that call schedule is available forphysicians,butnotrequired.
Call / Practice Coverage
Potential Facility/Community ChallengesIf your facility requires physicians to take a demanding call schedule,candidatesmayviewthatasachallenge.
Example:Acandidateisinterestedinyourruralfacility,butdoesn’tapplyduetothe1:3callschedule.
Ideas for Solutions to ChallengesInvestigate your compensation model for physician call schedule.Couldyouincentivizecalltomakeitmoreattractivetoproviders?
Utilizearemotenursefirstcallresponsesystemtofiltercallstoonlythemostinneedofphysicianattention.
Bring in Locum Tenens providers to cover occasional weekends for your providers to help alleviate call schedule burden.
Makesureyourphysiciansfeelliketheycan“getaway”.Often,physicians in rural areas feel like they can’t relax because they mightgetcalledinatanytime.Encourageyourproviderstohavetimeaway.
SummaryCall schedule adds a layer of unpredictability to a physician’s life.Somephysiciansarewillingtoacceptthisforincreasedcompensation,butotherphysicianspreferthestabilityandfreedomofanocallrequiredschedule.Requiringnocallinaruralareacanbetoughtodo,butifyoucanitmaysetyouapartandofferlongtermbenefitsinphysicianretention.
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Facility & Community Support Factors
Section VII
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Facility & Community Support FactorsManyphysiciansgointomedicinewithadesiretoserve,andoften rural and underserved committees are where physicians areneededmost.Inurbanareasaphysicianmayhaveaccesstomoreshoppingandotherconveniences,butinaruralareatheymightgetdeliciouscookiesfromapatient,orhomemadesoupwhentheyaresick.Thegoodnewsforruralcommunities?Onephysician’smoneyandshopping,areanotherphysician’ssoupandcookies.
Whenruralcommunitiesvalueandappreciatetheirproviders,itcanbeadistinctadvantageforrecruitmentandretention.
How facility and community support factors relate to different health professional candidates•Strengthinthesefactorsmaybeimportanttophysiciansthathaveadesiretoserveorgiveback.•Strengthinthesefactorsmaybeimportanttophysiciansthatarelookingtobeheavilyinvolvedinthecommunity.•Ifacandidateisinterestedinthesefactors,thatmayindicatealong-terminvestmentintothecommunitybythecandidate.•Facilitiesthathavestrengthinthesefactorstypicallyhaveastrongvisionforthefuture.
Facility & Community Support Factors
1.Physicalplantandequipment2.Plansforcapitalinvestment3.Electronicmedicalrecords(EMR)4.CHCleadership5.Televideosupport6.Communityneed/supportofphysician7.Welcomeandrecruitmentprogram8.Medicalreferenceresources9.Delegatedphysicianpatientservices10.Moonlightingopportunities
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What does this factor mean?The current adequacy of the hospital and clinic physical plant andequipment.
Why is it important?Workinginacurrentmedicalfacility,andhavingaccesstoup-to-date equipment helps physicians in their day to day practice.
Many candidates have the perception that rural facilities lack importantmedicalequipment.
Having a rundown facility can increase the perception of physicianisolation.
Example: A candidate sees the front of your hospital on your website,marketingmaterial,andtheirsitevisit.Immediatelytheyhaveareactiontowhatsortoffacilityitis.
Potential Facility/Community AdvantagesIf you have a well-kept medical facility and access to current medicaltechnology/equipment,candidatesmayviewthisasanadvantage.
Example: When speaking to the candidate during their phone interview,youdescribeandimpressthecandidatewiththemedicaltechnologyavailableatyourfacility.
Physical Plant & Equipment
Potential Facility/Community ChallengesIfyourfacilityisoldand/orrundown,candidatesmayviewthatasachallenge.
If your facility doesn’t have access to current medical technology/equipment,candidatesmayviewthisasachallenge.
Example:Yourfacilityisfairlyold,andisn’tconnectedtootherkeymedicalfacilities(nursinghome,clinic,etc…).Acandidatewhowastrainedinanurbancenter,toursyourfacilityandcan’tpicturethemselvesworkingthere.
Ideas for Solutions to ChallengesPay attention to the aesthetics of your facility (inside and outside).Oftenlowcostimprovementslikepaint,furniture,andlightingcanhelpimprovethefeelofafacility.
Exploreoptionsforobtainingmedicaltechnology/equipment.Sometimesmobileoptionsareavailable(mobileCTscanner,etc…)oryoucanfindusedequipmentorevendonationsfromotherfacilities.
Workwithgroupsinthecommunity(economicdevelopment,etc…)todiscusswaystofundimprovementstothefacility.Make the case of how important the facility is to the community when addressing community-wide solutions (increaseinsalestax,etc…).
SummaryHaving a nice facility and current medical technology is a great waytoinitiallyattractcandidates.Workinginaplacethatismodern,convenient,efficient,andaestheticallypleasingmakesaphysician’slifemucheasier.
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What does this factor mean?The adequacy of the hospital plans for capital investment in thehospitaland/orclinic.
Why is it important?Many physicians desire to be part of something that is growing andimproving.Reinforcingthatyourfacilityhasexpansionand/orimprovementplanssupportsthisidea.
Newmedicaltechnologyandequipmentisalwaysbeingdeveloped.
Plans for capital investment can be especially important if your currentfacilityisolderorlackscurrentmedicalequipment.
Example: A candidate is looking at your website and sees a linkthathighlightsyourfacility’s5yearexpansionplan.
Potential Facility/Community AdvantagesIf your facility has conceptualized expansion/improvement plansforthefuture,acandidatemayseethisasanadvantage.
If your facility has concrete plans expansion/improvement plansforthefuture,acandidatemayseethisasanadvantage.
Example:Duringasitevisit,youbringtheblueprintofyourexpansionplantolunchwiththecandidate.Thecandidateisable to see concrete plans and feels excited that they could be partofthem.
Plans for Capital Investment
Potential Facility/Community ChallengesIf your facility lacks conceptualized plans for improvements or expansion,acandidatemayviewthisasachallenge.
If your facility lacks an organized vision of the future of your facility,acandidatemayviewthisasachallenge.
Example:Yourfacilityissobusy“puttingoutfires”thatplansforthefuturearerarelyformallydiscussed.Acandidateasksaboutplanstoimplementmoretechnologyinthefuture,andyourfacilityhasnoplanorsolutionstodiscuss.
Ideas for Solutions to ChallengesHave a budget each year to save for new medical technology andfacilityrenovations.Workwithproviderstoprojectwhatthey might need/want in the future and make sure they know youareworkingtogetit.
Ifyouhaveconcreteplans(timelines,budgets,blueprints,etc…)makesuretoshowthemtothecandidate.
Form a facility improvement committee that makes recommendationstotheboardofdirectors.Althoughtheyhavenoformalpower,havingacommitteecanhelporganizeandprovidelegitimacytofuturegoals.
SummaryFormanycandidates,ifyourfacilityisn’tgrowing,itisdying.Having written plans or goals for expansion and improvements canexciteacandidateaboutafuturewithyourfacility.
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What does this factor mean?The existence and adequacy of electronic medical records in thehospitalandclinic.environments
Why is it important?Many newly trained physicians have likely never practiced withoutusingelectronicmedicalrecords(EMR).
SomephysiciansmaystruggleorresistusingEMR,orusinganewEMRsystem.
HavinganEMRthatisn’twidelyusedinyourarea,orhasn’tbeen well implemented by your facility can be very frustrated forphysiciansregardlessoftheircomfortlevelwithtechnology.
Example: A candidate appreciates the fact that your facility wasanearlyadopterofEMR,andhasachievedmeaningfulusestagetwo.
Potential Facility/Community AdvantagesIfyourfacilityhasawell-establishedEMRsystem,candidatesmayviewthatasanadvantage.
If you have good technical support and an on-site “champion” ofyourEMRsystem,candidatesmayviewthatasanadvantage.
Example:AnewlytrainedcandidateusedadifferentEMRsystemduringresidency,butfeelsliketheycouldpickupyourfacility’s well-established system quickly because of the onsite supportandtechnicalassistanceavailable.
Electronic Medical Records
Potential Facility/Community ChallengesIfyourfacilityisstrugglingintransitiontoanEMRsystem,candidatesmayviewthisasachallenge.
Ifyourfacilityhasusedonesystem,butisplanningtochangetoanotherEMRsystemsoon,candidatemayviewthisasachallenge.
IfyourfacilityusesanEMRthatisn’twidelyusedinyourstate,anddoesn’thavesupportfromyourfacility’sprovidersorstaff,acandidatemayviewthisasachallenge.
Example:YourfacilitypurchasedanEMRsystemtwoyearsagothatnooneelseinthestateuses.Thecompanydoesn’tprovidegoodsupport,andprovidersandstaffdreadusingit.A candidate interested in your community asks about EMR implementationduringtheirphoneinterview.
Ideas for Solutions to ChallengesIfyoudon’thaveonealready,developanon-site“champion”ofyourEMRsystemanduse.
Use a train the trainer model to develop technical capacity on-siteforyourEMRsystem.Contactingsomeonedownthehall,asopposedtocallingan800numbercanmakefrustrationsaloteasiertodealwith.
SummaryLearning how to use a new EMR system can be challenging for providers.Thischallengeiscompoundedifyourfacilityhasanunorganized implementation plan or lacks support/capacity to assistwithquestionsontheEMRsystem.
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What does this factor mean?TheadequacyofCHCleadershipincludingtheCEO,CFOandCHCboardfunctions.
Why is it important?CHCleadershipmakethefinancialdecisionsthatgreatlyimpactaphysician’spractice.
Whenphysiciansareconfidentinandsupportedbytheirfacility’sleadership,theyfeelvaluedandempowered.
Whenfacilityleadershipdoesn’tcommunicateeffectivelywithphysicians,physicianscanfeelliketheyarenotbeingsupportedorheard.
Example:YourfacilityhasalongestablishedCEO,andmostfeelveryconfidentintheirleadershipability.
Potential Facility/Community AdvantagesIfyourfacilityhaswellestablishedeffectiveleadership,candidatesmayviewthisasanadvantage.
Example:Duringtheironsiteinterview,acandidatemeetswithyourCEO,CFO,andafewmembersoftheboard.Thecandidateleavesthemeetingfeelingveryconfidentintheabilityandstabilityofyourfacility’sleadership.
CHC Leadership
Potential Facility/Community ChallengesIfyourfacilitydoesn’thavewellestablishedoreffectiveleadership,candidatesmayviewthisasachallenge.
Example:YourfacilityhashadthreedifferentCHCCEOsoverthelastfiveyears.ThenewCEOviewsthepositionasasteppingstonetoalargerfacility,andthiscomesacrosswhentheymeetwithnewcandidates.
Ideas for Solutions to ChallengesIfyouhavefrequentturnoverintoplevelleadership,communicate where leadership may be more stable (director of nursing,boardmembers,communityleaders,etc…).
Make sure the board is knowledgeable about how frequent turnoverinleadershipimpactsphysicianrecruitment/retention.
Investintrainingandeducationformiddlemanagement.Thesestaffmaybecomeyournextleaders.
SummaryRuralandunderservedfacilitieswillstruggleinmostareas,includingphysicianrecruitmentandretention,withoutstrongtoplevelleadership.Developleaderswithconnectionstoyourcommunitythatcanprovidestableandeffectiveleadershipforincomingphysicians.
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What does this factor mean?The existence and adequacy of televideo capability in the communityforpatientcareorothercommunications.
Why is it important?Televideo(ortelemedicine)availabilityhelpsphysiciansconnecttootherprovidersanddecreasesfeelingsofisolation.
Having televideo available can allow your physicians to have access to specialists and subspecialists that aren’t available on-site.
TelevideocanalsobeutilizedbyphysiciansforCMEcredits.
Example:Yourfacilityonlyemploysoneprimarycarephysician,butyouhaveanumberoftelevideooptionsforthatphysiciantoconnectwithotherprovidersasneeded.
Potential Facility/Community AdvantagesIf your facility has televideo capability for physicians to connectwithotherproviders,candidatesmayviewthisasanadvantage.
Example:Acandidateisinterestedinyourruralfacility.Theyareworriedbeingtheonlyphysicianinthecommunity,especiallyintheemergencydepartment.However,youareableto show the candidate how your emergency department would connect them with a service of emergency physicians that are abletoprovidesupport24/7.
Televideo Support
Potential Facility/Community ChallengesIf your facility doesn’t have televideo capability for physicians toconnectwithotherproviders,candidatesmayviewthisasachallenge.
Example:Acandidateisinterestedinyourruralfacility,butisnervousaboutbeingtheonlyphysicianinthecommunity.Theyultimately decide to go elsewhere as you have been unable to convince your facility’s board to invest in televideo technology becausetheydon’tseerevenuepotential.
Ideas for Solutions to ChallengesWorkwithyourfacility’sleadershiptoinvestintelevideo.Communicate to them that televideo helps keep physicians supported,inadditiontohelpingwithpatientcare.
NetworkwithyourStateOfficeofRuralHealthtoidentifyifanyassistanceisavailablefordevelopingtelevideocapacity.
SummaryIn rural communities physicians can often feel isolated and aloneinmakingpatientcaredecisions,especiallyintheemergencydepartment.Havingondemandtelevideoaccessso physicians can connect to other providers for support can helpcombatburnoutandisolation.
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What does this factor mean?The perceived sense of need for and/or community support of anewphysician.
Why is it important?Physicians that choose rural family medicine often could have chosenahigherpayingspecialtyorareatopractice.
Feelingneeded,supported,andappreciatedbyacommunitycan be much more rewarding to physicians that additional money,etc…
Example: A candidate interested in your community is doing their site visit and will be meeting with numerous stakeholders intown.
Potential Facility/Community AdvantagesIf your community supports your facility and appreciates your providers,acandidatemayviewthatasanadvantage.
If your recruitment process involves support from key local stakeholders,candidatesmayviewthatasanadvantage.
Example:Acandidateisinterestedinyourruralfacility.Yourrecruitment process is a community initiative and involves communitymembers,localbusinesses,andmore.Duringtheirrecruitment,thecandidategetssupportfromthelocalschool,bank,andhelpfindingtheirspouseajob.Thecandidatefeelsneededandappreciated.
Community Need / Support of Physician
Potential Facility/Community ChallengesIf your community members have mixed feelings about yourfacility,andfrequentlytraveltogotootherfacilities,candidatesmayviewthatasachallenge.
If your community is large enough to have a number of healthcarefacilitiesandproviders,candidatesmaynotfeelasneededandviewthatasachallenge.
Example:Yourruralfacilityislocated20milesawayfromanotherhospital.Becauseoftheirdissatisfactionwithpreviousproviders,manycommunitymemberstraveltogetcarefromtheneighboringfacility.
Ideas for Solutions to ChallengesAllrecruitmentislocal,butthisisespeciallytrueinruralcommunities.Getkeystakeholdersinvolvedinyourrecruitmentprocess!
Target providers interested in living in your rural community (asopposedtocommutingfromalargerarea).Whenprovidersdon’tliveinyourcommunity,communitysupportcansuffer.
Capture real life stories about how your community appreciates theirprovidersandsharewithincomingcandidates.
SummaryInurbanareas,physiciansareoftenjustanothermemberofthecommunity.Forsomefamilymedicinephysicians,thechance to be needed and appreciated in a rural community canbemoredesirablethanmoneyandotherconveniences.
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What does this factor mean?The existence and adequacy of any recruitment plan and/or welcomeforaninterviewingornewlyrecruitedphysician.
Why is it important?Competitioninphysicianrecruitingisextremelyhigh.Ifyouaren’tfollowingthroughwithacandidate,anotherfacilitysurelyis.
Recruitingaphysicianisallabouttheprocess.Theteaminvolvedmusthavespecificduties,andbeabletofollowthroughasneeded.
Ruralfacilitiesoftenlackdedicatedrecruitingstaff.Thereisalsousuallyasmallerpoolofcandidatesinterestedinrural.
Example:Yourruralfacilitydoesn’thaveaninhouserecruiterorformalizedrecruitmentplan,andmostrecruitingdutiesfallonyourCEO.
Potential Facility/Community AdvantagesIfyourfacilityhasdedicatedrecruitmentstaff,candidatesmayviewthisasanadvantage.
Ifyourfacilityhasaformalrecruitmentplan/process,candidatesmayviewthisasanadvantage.
Example: A candidate is interested in your rural community afterreceivingoneofyourmarketingmailings.Theyareeasilyabletofindthejobonyourwebsite,andapplyformoreinformation.Afterapplying,theyarecontactedthenextday,andalwaysgetinformationquicklyastheyrequestit.
Welcome and Recruitment Program
Potential Facility/Community ChallengesIfyourfacilitydoesn’thavededicatedrecruitmentstaff,candidatesmayviewthatasachallenge.
Ifyourfacilitydoesn’thaveaformalrecruitmentplan/process,candidatesmayviewthisasachallenge.
Example: A candidate is interested in your rural community afterseeingyourjobpostedonline.Theyleaveamessageforthecontactlisted,whoisonvacation.Whenthecontactreturnsandcallsbacktwoweekslater,thecandidatehasalreadyacceptedapositionelsewhere.
Ideas for Solutions to ChallengesTry to identify holes in your process by asking simple questions about your recruiting process such as “who returns calls if the primaryrecruitmentcontactisonvacation?”and“howlongdoes it take us to make contact with a candidate after they are sourced?”
Form a recruitment committee and establish a written recruitmentprocess.
Leverage existing resources on the recruitment process like 3RNet’sRecruitmentforRetentionmanual.
Considerjoining3RNetasanAssociateMember,and/ortheAssociationofStaffPhysicianRecruiters(ASPR).
SummaryYourfacilitymayhaveagreatpracticeopportunityavailable,but if you don’t have a written recruitment process or timely followupwithcandidates,itisgoingtobeveryhardtosuccessfullyfindaphysician.
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What does this factor mean?The adequacy and quality of medical reference resources for physicianuseinpatientcare.
Why is it important?Asmedicineisconstantlychanging,physiciansneedtohaveup to date references with new trends and evidence based procedures.
Technology has largely changed the way physicians consume medicalresources.
Example: A newly trained Family Medicine candidate is nervous about having medical reference resources available andaskaboutyourresources.
Potential Facility/Community AdvantagesIfyourfacilityoffersqualitymedicalreferenceresources,candidatesmayviewthisasanadvantage.
Example:Acandidateisinterestedinyourruralfacility,andtwoothersimilarfacilities.Thethreeopportunitiesarelargelycomparable,butyourfacilityoffersahighqualitymedicalreferenceresourceforphysicians.Thecandidatechoosesyourfacility.
Medical Reference Resources
Potential Facility/Community ChallengesIf your facility does not provide a source of medical reference resources,orthesourceisoutdated,candidatesmayviewthisasachallenge.
Example: A newly trained candidate is interested in your facility but when they discover your facility don’t have medical referenceresourcestheyarenolongerinterested.
Ideas for Solutions to ChallengesResearch and invest in purchasing an online medical reference resourcesuchasMedscape.
Be sure your internet isn’t prohibitive to the use of online medicalresources.
Build relationships with local or state associations that can offerresourcesatadiscountedrate.
SummaryPhysiciansneedtostaycurrentonmedicalissues,providinga medical reference resources will ensure quality of care and allow the physician to perform their services to the best of their ability.
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What does this factor mean?The adequacy and quality of task performance when physiciansappropriatelydelegateanaspectofpatientservice.
Why is it important?Havingenoughqualitysupportstaffensuresthatphysiciansare able to appropriately provide treatments that are in the best interestofthepatient.
Candidatesaretypicallytrainedinateambasedcaresetting,andwillexpectthesameintheirpractice.
Example:Acandidateisinterestedinyourruralfacility.Yourfacilityhasgreatsupportstaff–yournursingstaffhasacombinedyearsofservicewithyourfacilityofover30years.
Potential Facility/Community AdvantagesIfyourfacilityhasenoughqualitysupportstaff,candidatesmayviewthatasanadvantage.
Example:Whiletouringyourfacility,acandidateisveryimpressed with the capacity and turnaround of your support staff.Thecandidatefeelscomfortedthatthesupportstaffareinplacetomaketheirjobeasier.
Delegated Physician Patient Services
Potential Facility/Community ChallengesIfyourfacilitydoesn’thaveenoughqualitysupportstaff,candidatesmayviewthatasachallenge.
Example:Acandidateisinterestedinyourfacility.Yourfacilityhas recently had turnover in a few key support areas which makesroutineoccurrences(gettinglabworkentered,physicaltherapyscheduled,etc.)muchtougher.
Ideas for Solutions to ChallengesRecognizethegoodworkyoursupportstaffdoes.Everybodylikestofeelappreciated.
Workwithyourlocalsupporttrainingprograms(i.e.LPN,MAprograms)toseeifyoucansetupruralexperiencesatyourfacilityforstudentsduringtheirtraining.
Workwithyourlocalhighschoolandoffertohelpeducatetheirstudentsaboutgreatcareersintheancillaryhealthfield.
SummaryWhileitisoftentakeforgrantedbyphysicians,beingabletoaccessqualitysupportservicesiscrucialtopatientcare.Withoutqualitysupportstaff,physicianswillquicklyrealizetheirjobbecomesmuchtougher.
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What does this factor mean?The availability and quality of local physician work opportunitiesoutsidetheroutineCHCprovisionofcare.
Why is it important?Many demographics of healthcare professionals have an interestinemploymentopportunitiesoutsidetheCHCrealm.
Candidates interested in rural and underserved areas often haveadesiretogivebackorserve.
Example: Candidate asks about the ability to moonlight during theironsiteinterview.
Potential Facility/Community AdvantagesIfyourfacilityisflexiblewithallowingmoonlighting,thecandidatemayviewthisasanadvantage.
If your community has numerous other healthcare opportunities,acandidatemayviewthisasanadvantage.
Example: A pediatrician candidate would like to work in the local hospital’s Urgent Care on Saturdays treating the pediatric patients.Youfacility’sflexibilitywouldmakethispossibleforthecandidate.
Moonlighting Opportunities
Potential Facility/Community ChallengesIfyourfacilityisunwillingorunabletoofferflexibleschedulingforthecandidatetomoonlight,candidatesmayviewthisasachallenge.
Ifyourcommunitylacksotherhealthcareopportunities,acandidatemayviewthisasachallenge.
Example: A candidate has a desire to earn extra money workinginthelocalERonedayaweek.Yourfacilitydoesn’toffertheflexibilityintheprovider’sscheduletoallowthis.
Ideas for Solutions to ChallengesBeflexiblewiththepossibilityofprovidersworkingelsewhereinthecommunity.
Build partnerships in the healthcare community to foster workingrelationshipswithyourprovidersandtheirs.
Ifyourcommunitydoesn’thaveotherhealthcarefacilities,reachouttotheclosesthealthcaresystem.
Be mindful of the impact any non-compete clauses could have on the provider’s ability to participate in moonlighting possibilities.
SummaryBeingflexibleinyourrelationshipwithyourproviders.Investin the community and provider by allowing the provider to practice their skills in other areas of the community and giving theprovideropportunityforadditionalincome.
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Conclusion
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Sowhatdoruralphysicianswant?Itdepends.
Thekeyquestionis,whatrecruitmentadvantagesdoesyourfacilityhave?
Byknowingyourstrengths,youcantargetspecificgroupsofphysiciansthosestrengthsaredesirableto.
Ifyourstrengthsdon’talignwithyouridealcandidate,changesmustbemade.
Example:Dr.Smithissearchingforajob,anddetermineswhatsheislookingfor.Assheisreviewingpracticeopporunities,she compares each opportunity based on the factors she wantsinherpractice.
Usingthetablebelow,sheisabletofindanopporunitythatofferswhatsheneeds.IfDr.Smithisyouridealcandidate,youmust have and be able to communicate strength in the factors shedesires.
Scope of Practice Salary Outdoors Call Schedule Loan Repayment Services Physical Plant Part-time TelemedicineCHC 1 X X X X X X XCHC 2 X X X X X XCHC 3 X X X X X XCHC 4 X X X X X X X