Kearny County Hospital's Physician Recruitment Model
- Need: Physicians to serve in an increasingly diverse population in rural Kansas.
- Intervention: Kearny County Hospital changed their recruitment model to include paid time off for doctors and midlevel providers to serve as international service workers, as well as medical school loan forgiveness.
- Results: Kearny County Hospital has re-opened their services to out-of-county patients and are receiving an increase in applications from medical providers.
Due to a shortage of medical providers, Kearny County Hospital in Lakin, Kansas, had resorted to turning away at least 50 patients a week from 2014-2015. Its clinic doors were closed to out-of-county patients in order to keep up with their own residents of Kearny County, a sparsely populated and medically underserved area in southwest Kansas. To address this issue, Kearny County Hospital bolstered their recruitment plan.
Hospital administration proactively began recruiting graduates from Via Christi's International Family Medicine Fellowship of Wichita, Kansas. The competitive one-year fellowship curriculum equips physicians to serve underserved populations with limited resources. The training these physicians receive fits the needs of Kearny County Hospital and, in turn, the hospital's large immigrant patient population is a draw for these physicians.
Kearny County Hospital's recruitment plan includes medical school loan forgiveness, but the main incentive is paid time off for doctors to serve internationally as international service workers. So far, doctors have taken their vacation time to work in places like Ecuador, Egypt, Somaliland, Niger, Morocco, Zimbabwe, Mexico, Jordan, India, Rwanda, Liberia, Kenya, Ghana, and Haiti.
Hospital administration actively recruits three types of providers to fill the service needs:
- Goers – Commit to staying for several years, but plan on becoming full-time international service workers oversees.
- Senders – Plan on staying long-term while taking their vacation time to serve internationally.
Because southwest Kansas has become home to 30 different nationalities, Kearny County Hospital believes that having international experience better equips doctors to work in rural areas of Kansas, and vice versa. The hospital's administration has found that doctors desiring to serve people in marginalized countries are more willing to serve poor patients in more isolated areas in the U.S. where health disparities are similar to what they encounter internationally.
This video further describes Kearny County Hospital's mission:
Incentives established by Kearny County Hospital and their network partners to recruit mission-minded providers:
- Medical school loan forgiveness
- Up to 10 weeks of paid vacation time
- Full employment at an established medical facility
- Mission-focused mindset and policies
- Supportive board and administration
- Full-spectrum family practice medicine
- At least 1 mission-focused physician mentor
- Reasonably maintained facilities
- The national average salary, at minimum
- Limited on-call schedule and 4-day week clinic schedule to protect family life
In 2015, Kearny County Hospital created a network to support both doctors and other rural medical facilities. The 25 medical providers from the 180-mile distance from Del Norte, Colorado to Ashland, Kansas work together to recruit doctors. This model allows for adequate coverage when physicians take extended time off to serve abroad.
Kearny County Hospital also recruits medical providers to partners with their Pioneer Baby project. Aimed to improve health outcomes for mothers and infants, visiting specialists come alongside of Kearny County providers to offer prenatal care to high-risk pregnant women. By addressing complications early in the pregnancy, the program has helped to reduce birth complications and the need for neonatal intensive care while improving overall health outcomes for both mothers and infants. This video shares more:
Twice a year, Kearny County Hospital hosts a Focus Weekend for prospective medical providers, doctors in training, and rural hospital administrators. Many of them have a desire or experience providing care to undeserved populations in the U.S. or internationally. Attendees are introduced to the area's health needs and the unique models, created by Kearny County Hospital and those in their network, that meet those needs. January 2019's Focus Weekend was attended by more than 50 practicing physicians and residents in training.
Positive outcomes from Kearny County's recruitment and networking model include:
- Added 3 medical providers in 2018 and 3 in 2019,
totaling 15 currently employed by Kearny County Hospital:
- 7 Family Medicine Physicians
- 4 Family Medicine PAs
- 1 Family Medicine APRN
- 1 ENT Physician
- 1 ENT PA
- 1 ENT APRN
- The increase in providers has allowed the hospital to re-open their services to out-of-county patients. The clinic has added over 5,000 new patients since 2015.
- The hospital is receiving more medical provider applications than they are able to hire.
- The hospital has eliminated its use of locum tenens doctors to cover its emergency room.
- Clinic visits have increased by 59%, ER visits by 20%, and surgeries by 103%.
- Gross revenue has increased by 35%.
- Profit margin improved from -7.61% to 3.10% between FY 2014 and FY 2018, largely through cost containment, introduction of profitable service lines, and expansion of market share.
- On average, one baby is delivered per day at Kearny County Hospital, totaling 327 babies in 2018. The number of babies delivered in southwest Kansas has more than doubled in the past 12 years.
- Obstetrics volume has increased by 67%.
The hospital board and administration have found that the benefits offered to the providers instills in them a sense of loyalty to the hospital and to the community. After returning from serving abroad, doctors bring a renewed sense of compassion and grace to their practices. In turn, the town has shown rousing support of their international mission work.
Additional publications that highlight Kearny County Hospital:
- Full-scope Family Medicine Flourishes in Southwestern Kansas, AAFP, 2019
- Creative Recruiting Helps Rural Hospitals Overcome Doctor Shortages, National Public Radio, 2019
- How a Tiny Kansas Town Rebooted Its Struggling Hospital into a Health Care Jewel, Politico, 2018
- The Balancing Act of Clinician Supply and Demand, HealthLeaders Media Magazine, 2017
- Refugee populations drawing doctors to rural Kansas, Associated Press, 2017
- Dinner exchange aims to bridge cultural gaps, The Garden City Telegram, 2017
- Rural Kansas Hospital Thrives By Keeping Patients Out Of The Hospital, KCUR, 2016
- Southwest Kansas Hospital Looks To Thrive By Focusing On Patients' Needs, KMUW of Wichita, 2016
Like many other rural hospitals, Kearny County Hospital faces financial challenges due to declining reimbursement from payers and its significant number of uninsured patients (Kansas is one of many rural states that have not expanded Medicaid). But provider compensation and benefits have proven to be sustainable as the recruiting, networking, and hard work from their providers is paying off.
Prior to Benjamin Anderson being recruited to fill the hospital's CEO position, the board, administration, and medical staff had a similar mission as they do now, but it was not as well-known. Since Mr. Anderson stepped in, their aggressive recruitment plan and networking model has increased their effectiveness and made an avenue for their mission to operate at a higher caliber.
Read more about Anderson's methods in the RHIhub Rural Monitor article Young Rural Healthcare Leaders Share Experiences and Insights.
Before you begin recruiting:
- Define your mission and develop a mission-focused culture within your organization.
- Assess the special qualities of your town: what are the unique factors that could make it a desirable place for primary care doctors to practice? Evaluate your assets and capitalize on them.
- Community hospitality is important for retaining new physicians and their families. If far from home, your recruits will be asking "Who will be my family here?" Brainstorm ideas to engage community members, schools, businesses, and your hospital board in welcoming new recruits throughout their first year.
- Offer training for your board members. So they can better understand the hospital's mission-mindset, send administration and board members to travel abroad with the doctors on their mission trips.
Key characteristics primary care physicians are looking for in a rural hospital:
- Working with a team - Good physicians don't often practice alone, and the custom of having a solo family practice doctor per rural area is fading. Recruit more than one doctor at a time.
- Equitable call structure - Give the same call structure to all physicians, no matter their seniority. To prevent physician burnout and to increase staff retention, limit clinic to 3 days a week. Limit emergency room calls to no more than 1 night a week and 1 weekend out of every 5.
- Fair compensation – Be willing to pay your doctors the national average salary (at the minimum) in addition to extended time off.
- Mission-driven culture - Millennial physicians, especially, want to know how they fit in to an organization's work in eradicating the suffering of your vulnerable population. They will also be looking for the freedom and support to implement new ideas.
- Standardized roles - Be clear with expectations for call and procedures.
- Time off - Be generous with your paid vacation policy. In the long-run, this will make more financial sense than staffing an emergency room with locum tenens doctors.
Loans, loan repayment, and loan forgiveness for health careers
Recruitment and retention of health professionals
February 8, 2016
Date updated or reviewed
October 18, 2019
Suggested citation: Rural Health Information Hub, 2019. Kearny County Hospital's Physician Recruitment Model [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/890 [Accessed 22 October 2020]
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.