by Candi Helseth
Like many other rural healthcare administrators nationwide, Nadine Boe and Jim Potvin really work two jobs—in addition to managing the day-to-day operations of their North Dakota clinics, Boe and Potvin spend an inordinate amount of work time engaged in “active recruitment” methods to fill primary care positions.
Active recruitment involves a multi-dimensional process that links providers and rural communities with a concerted effort going toward making a good, lasting match, according to Tom Morris, Associate Administrator at the Federal Office of Rural Health Policy (FORHP). This is in contrast to traditional or passive recruitment, where administrators simply post an ad and wait for someone to apply.
“We’ve never had a doctor apply when we just place an ad,” Potvin said. “We’re not exactly a preferred destination point. We make numerous contacts and interview a lot of potential candidates to get one solid lead. Recruiting and retention is another full-time job on top of the one we already have.”
After researching family medicine students with ties to the Midwest, Potvin mails personal letters inviting them to consider working at Heart of America Medical Center Johnson Clinic (HAJC) in Rugby, ND, which he manages. Then he pursues contacts that show any interest. Success comes in small doses, but when it does, it’s sweet. He recently signed one of those students to practice in Rugby following her graduation in 2014.
Boe’s active recruitment efforts included a trip last year to the East Coast to seek primary care providers affiliated with the National Health Services Corps (NHSC) to work at Northland Community Health Center (NCHC), which she manages. The NHSC network offers scholarship and loan repayment support programs for health professionals that commit to serving in an underserved area for a specified time period. Boe, who worked in coordination with Workforce Specialist Aaron Ortiz at the University of North Dakota’s Center for Rural Health, was able to recruit Physician Assistant Martha Williams. Williams has since moved to Rolla where she works as a provider at the Center. The Center is a Federally Qualified Health Center (FQHC) that provides medical and dental coverage with clinics in Turtle Lake, McClusky, Rolette and Rolla, ND.
“The people here are very friendly and welcoming,” said Williams, whose roots are in California and West Virginia. “Rolla is a nice community.”
Boe and Potvin say successful recruitment involves more than simply getting a provider to sign on the dotted line. When they interview, they look for qualities that convince them interviewees want to practice in a rural area. The administrators also work closely with their communities to enhance retention.
“Over the years, we’ve learned the hard way that you can’t just plunk a provider into a rural community and expect it to be a good fit if you didn’t do the front-end work to assure that,” Morris said. “Recruitment and retention is really the same process. Recruitment isn’t going to be effective if you’re not simultaneously thinking about how you’re going to retain that individual.”
3RNet, other resources enhance recruitment and retention
One of the largest and most comprehensive recruitment and retention resources, with members in all 50 states, is 3RNet (National Rural Recruitment and Retention Network), a not-for-profit network funded by FORHP and member dues. Members consist of a variety of state-based organizations, such as State Offices of Rural Health (SORHs), Area Health Education Centers (AHECs) and primary care organizations.
According to Executive Director Tim Skinner, 3RNet drives more than 1,000 medical professional placements annually by using active recruitment tools that allow members to have autonomy, yet access valuable resources. Ninety percent of placements every year have been in designated shortage areas.
3RNet member services include a website where members maintain state and regional pages relative to their needs, a database that currently has about 40,000 profiles of providers interested in rural service, educational webinars, consultation with 3RNet staff, strategic planning resources and a “unified voice” to represent rural providers nationally and legislatively. Morris noted that 3RNet has also developed practice site software that is valuable in helping automate the recruitment process, allowing small staffs to work more efficiently.
Stacey Day, director of provider recruitment at South Carolina Office of Rural Health (SCORH) credits 3RNet for about one-third of the physician and non-physician placements SCORH makes each year. Using 3RNet saves time, she said, because she’s not weeding out candidates who are only interested in metropolitan areas or private practices.
“There is such a vast body of knowledge available to us, both through the staff and through all these other members,” Day said. “We speak with 3RNet members across the country. There is always someone who has encountered a similar challenge and is willing to share how they dealt with it. And 3RNet itself is a virtual resource with staff that have many years of experience behind them.”
SCORH connected with Dr. Sean Boynes through 3RNet. Since 2010, Boynes has worked as Director of Dental Medicine at CareSouth Carolina, an FQHC in Hartsville, SC. Boynes left a thriving private practice in Pittsburgh and a position as a Director of Anesthesia Research at the University of Pittsburgh School of Dental Medicine to move to rural South Carolina. While in Pittsburgh, he participated in several clinical trials, served as principal investigator for research projects and authored more than 50 published articles.
“Dr. Boynes had numerous faculty appointments, national speaking engagements and a very busy practice but he also had a specific interest and heart for working with underserved patients,” Day said. “We are fortunate to have gotten such an accomplished dentist. He also has extensive experience and training in pain and anxiety management.”
In addition to his busy dental practice, Boynes has initiated the “Miles of Smiles” program, a mobile unit that travels to schools in several rural communities to provide dental care for students with no dental home.
Rural North Dakota providers like Potvin and Boe have access to 3RNet through North Dakota’s member, the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. While each state gets one official organizational member, Skinner said many states have partnerships within their memberships. Oklahoma is the only state with two members—the Cherokee Nation, a sovereign entity, is the second member.
“3RNet is a wonderful laboratory for recruitment and retention to underserved areas,” Morris said. “It helps communities and states accomplish goals more effectively by learning from each other and sharing strategies instead of competing against each other and canceling each other out. The 3RNet active recruitment model can go a long way toward helping us address challenges, such as promoting practices, interviewing candidates, securing clinicians in areas that need them and retaining them long-term.”
Boe and Potvin also use online services that Potvin jokingly refers to as “a dating service for providers and physicians.” These include resources such as eDoctor Jobs, Practice Match, and the National Association of Community Health Centers.
Rural supporters work to implement change
Resources like 3RNet and SORHs are working to change the image many providers apparently have about working in rural America, by marketing rural living as a favorable lifestyle. Shorter commutes, more recreational time, a better work-life balance, safer family environments and community relationships are selling points. 3RNet often posts status updates on its Facebook page touting the value and beauty of rural areas. (A recent post exclaimed: “There is so much to do, see, and explore in rural Illinois—when you live here, you’ll never be bored.”) In addition, some rural communities are structuring their own loan repayment incentives when a prospective candidate doesn’t qualify for federal loan reduction programs.
3RNet is collaborating with HRSA, FORHP and state organizations to try to draw more medical school residents and graduates to rural practices. They are also partnering to influence legislators—and consequently legislation—that directs medical schools to admit more students with interests in primary care medicine and a willingness to work in rural areas where need is greatest. Because legislators determine funding for medical schools, these schools should be held responsible for how they use that funding, Skinner contended, adding that rural needs must be better represented now and in the future.
Like rural administrators nationwide, Potvin and Boe welcome any change that will ease the recruitment burden in rural areas. Potvin is currently seeking seven providers for three clinics with services spread across nine counties. Boe is looking for a doctor, dentist and three midlevel providers to work in a service area that encompasses nearly 4,000 miles. The state’s reputation for harsh winters and long distances between facilities scares away many potential candidates. However, Potvin noted, that doesn’t change the fact that the 25,500 patients HAJC served last year need health care services just as acutely as people living in urban areas.
The rewards for practitioners who come to rural areas can be great. In South Carolina, Dr. Boynes has discovered the benefits of community.
“One of the biggest rewards of working in a rural region is forging relationships within the community,” Boynes said. “We are very fortunate to serve communities with great leadership. It is fantastic to see a community come together around a common goal. For example, just last week we set up our portable dental clinic in a church, thanks to all aspects of the community working together to find a venue for care. Many of the areas we serve are in dire need of oral health care, and the local leadership recognizes the importance of having access to care in their communities.”
Other Active Recruitment Programs
Other active recruitment programs include Rural Training Tracks (RTT), AHECs and the Community Apgar Questionnaire (CAQ) (which have all been highlighted in previous issues of the Rural Monitor, though the CAQ article is no longer available online).
- RTTs place medical residents in rural environments the last two years of their residencies with the intent of increasing rural placements.
- AHEC programs expose elementary and high school students to rural health professions, serve as liaisons for medical students’ clinical training opportunities, and improve retention by offering support services for providers in rural areas.
- CAQ is an innovative, evidence-based questionnaire designed to strengthen rural recruitment strategies.
For more information on the health care workforce and recruiting, and projected workforce effects of health reform, see:
Rural Health Information Hub resources
- Health Care Workforce Topic Guide
- Health Reform Topic Guide (No longer available)
- Models and Innovations by Topic: Healthcare workforce
Back to: Spring 2012 Issue