The Challenges Facing Rural Health Hospitals

Of all the challenges facing rural health hospitals, recruiting physicians remains one of the most difficult. While the growing shortage of doctors affects the entire country, rural hospitals are arguably the worst-positioned to handle it, since they generally have fewer financial resources and their surrounding communities may not always appeal to physicians interested in the lifestyle of a larger city or suburb. Even so, their disadvantages have not stopped rural healthcare organizations and state and federal governments from finding ways to steer doctors to work in underserved areas.

Traditionally, community health centers, critical access hospitals, and clinics in rural neighborhoods have struggled with funding, given their lower-population service area and larger share of poorer and sicker patients. As a result, they can’t afford to offer the salaries necessary to reliably attract doctors who could stand to make more at a larger health system or medical group. While serving the needy naturally appeals to many doctors and is still a major reason why some choose careers in rural areas, today’s medical school graduates have substantially more debt, and may be less likely to take the more idealistic path.

Subsidizing physicians’ school loan payments has long been a strategy to encourage physicians to work in rural areas. Since 1970, the federal government has operated the National Health Service Corps, which offers to pay a portion of physicians’ debt in return for a term of service in any of one of the thousands of Health Professional Shortage Areas (HPSAs), designated places with few physicians per capita and/or substantial health needs. Several states have introduced their own programs as well, and the total number of state and federally funded loan repayment programs reached 98 in 2010, according to a study by the North Carolina Rural Health Research and Policy Center. Though widely considered successes, the programs are not enough to solve the entire problem alone. A Kaiser Family Foundation study found that as of 2014, roughly 60 percent of all HPSAs had enough medical professionals to meet their needs for primary care, and an additional 8,000 physicians would be needed to fill the gaps.

Another successful strategy has been to expand medical education and residencies in rural areas. Research indicates nearly 70 percent of physicians who complete all of their training in a single state end up practicing in that state, and the same holds true for those that train in rural areas. Building new training opportunities can be difficult, however, and it often requires collaboration between hospitals, medical schools, and state governments. Hospitals don’t always have enough residency positions or available funding to accommodate new graduates. There are also federal programs to increase training opportunities. The Improving Rural Health Care Initiative, launched in 2013, created several Rural Training Tracks that offer residencies with two years of service in rural family medicine. Nearly 40 tracks were available across the country as of 2015.

Finally, rural health organizations have emphasized non-financial advantages of employment in order to attract physicians. A 2012 publication of the New England Journal of Medicine recommended that recruiters for rural hospitals advertise the benefits of living in the country, such as less noise and pollution and opportunities for activities like hiking and camping. The prospect of a tightly knit community can also be appealing to some physicians. Also, some hospitals have explored new contracting models that offer flexible hours and times without requiring the physician to permanently relocate.

While there are no easy solutions for rural hospitals’ physician recruitment problems, it’s important to note that in recent years the state and federal governments have consistently prioritized support for medical care in rural areas. In addition to loan repayment and subsidy programs, government-supported initiatives like out-of-state telemedicine licenses and regulations allowing physician assistants and nurses to take a greater role in patient care could greatly benefit rural hospitals, even though these specific measures have yet to be widely implemented, if at all. Physician recruitment will likely be an ongoing issue for rural hospitals for the foreseeable future.

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