Rural communities often face challenges in maintaining an adequate health workforce, making it difficult to
provide needed patient care or to meet staffing requirements for their facilities. These challenges have only
become more evident during the COVID-19 pandemic. Therefore, rural healthcare facilities should be proactive and
strategic about recruiting and retaining personnel.
Recruitment focuses on attracting current health professionals and students to open positions
or to future positions. Retention focuses on keeping healthcare professionals employed in
their healthcare facilities and communities.
Successful recruitment and retention practices can minimize the number and duration of staff vacancies, which
can, in turn, save money, improve quality of care, and ensure that services are provided in the community.
This guide covers recruitment and retention issues including:
Strategies and incentives to help communities attract healthcare providers
Organizations and programs that support the recruitment and retention of healthcare professionals
Statistics on vacancies in rural areas
Information on compensation, benefits, and incentives that rural facilities might offer to potential
For information about financial aid, see the RHIhub topic guide on Scholarships, Loans, and Loan Repayment for Rural Health
Frequently Asked Questions
Where can rural communities get help in recruitment and retention activities?
As one of the largest and most comprehensive recruitment and retention resources,
3RNET (National Rural Recruitment and Retention Network) is a nonprofit network funded by the
of Rural Health Policy and member dues. 3RNET has one dedicated Network Coordinator in each of the 50 states and
Commonwealth of the Northern
Mariana Islands. The Indian Health Service, the Cherokee Nation, and the U.S. Department of Veterans Affairs are
also part of 3RNET. According to Executive Director Mike Shimmens, more than 2,000 medical professional
achieved annually through 3RNET’s recruitment tools, with 90% of these in designated
Some of the services 3RNET offers include:
A website, 3RNET.org, where health professionals seeking jobs in rural
or underserved areas can register for free to browse and search jobs, and healthcare employers can post jobs
through their 3RNET Network Coordinator
A blog about recruitment and retention in
rural and underserved areas
The 3RNET Recruiting for Retention Academy and the 3RNET Annual
Community Based Training – 3RNET offers
training focused on practical strategies for recruiting for retention
Education on recruitment and retention best practices
The main focus of 3RNET’s efforts is to connect people seeking healthcare-related jobs in rural or underserved
communities with healthcare employers known as “safety net providers.” These include:
Critical Access Hospitals
Rural Health Clinics
Federally Qualified Health Centers/Community health centers
Public health agencies
Community mental health centers
Substance use disorder treatment facilities
Report, 2019-2020 includes
statistics and describes major accomplishments by staff and member organizations. 3RNET also publishes the Employer's
Guide to Workforce Programs, providing an overview of J-1 Visa Waivers, loan repayment programs, and
Health Professional Shortage Areas.
To find the 3RNET Network Coordinator for your state, visit 3RNET
Network Coordinator Contacts.
What is recruiting for retention?
Recruitment and retention are closely linked. Recruiting healthcare professionals and acclimating them to a
community and facility can be expensive, and often lengthy, endeavors. It is important to recruit professionals
who are well-suited to both the community and facility in which they will work, and to be proactive in retaining
those professionals. This is called recruiting for retention.
According to 3RNET, recruiting for retention involves having strategies in place, thinking long-term, and making
planning an ongoing process. Strategies should focus on keeping rural healthcare professionals employed in their
healthcare facilities and communities as long as it remains a good fit for both parties, thus minimizing
turnover. Communities that have made planning and preparation important parts of their recruitment and retention
strategies have an advantage in filling vacancies if professionals leave on short notice. These steps are
Recruitment efforts should emphasize making an appropriate match for candidates, their
families, healthcare facilities, and the community. Factors that contribute to a good fit include:
Mission/purpose of the facility aligned to provider's purpose
Region of the country desired
Size of town/community desired
Amenities that match family interests, such as outdoor recreation, arts/culture
School availability and quality, if there are or will be school age children
Apgar Program, developed by collaborative partners in Idaho, is a tool for improving rural communities’
recruitment and retention of family practice physicians, nurses, and hospital administrators in Critical Access
Hospitals, community health centers, and Rural Health Clinics. It identifies and weighs factors important to
each community regarding physician recruitment and retention, and assists with specific strategic planning and
Before recruitment efforts begin, such as placing an ad in a national journal or working with a recruiter,
attention should be given to planning and preparation. This includes:
- Assessing the community’s need for a primary care provider, such as a physician, physician assistant, or
- Securing the support of the community. This may include school principals, bankers, and other community
members who can help promote their organization and the community to potential candidates.
- Forming a recruitment and retention committee
- Budgeting for retention, something that is often not done but is extremely important
- Interviewing the candidate and meeting his or her spouse, if any, to determine how closely they match the
and the culture
- Preparing for the site visit
- Evaluating whether the current environment makes staff feel valued and identifying areas for improvement
The white paper Rural
Physician Recruitment: Results from our Rural Physician and Administration Survey notes that
administrators who recruit physicians with the intention of having them stay in place long term will need to
“do more homework” in terms of understanding the physician's background, and should be creative when
creating an offer. According to a survey referenced in this paper, the two most compelling incentives for
physicians to remain in one position for five or more years are increased compensation for clinical or
leadership duties and reduced hours or a more flexible work schedule.
Why might healthcare professionals be reluctant to practice in a rural setting? What are positive aspects of
Healthcare professionals who are considering a job opportunity in a rural community may have a range of concerns
A heavy workload, with a large number of patients to see and patients who require more care
Difficulty taking time off
Challenges in maintaining professional boundaries
A healthcare professional's family may also bring concerns to the table when considering a rural job offer.
Family concerns may include:
Limited job opportunities for spouses
Travel distances to attend school
Availability of afterschool programs and daycare
Lack of groups and other support for special interests and needs
Rural healthcare facilities and communities can help job seekers consider some of the rewards that balance out
the challenges of a rural position. Positive aspects of rural practice can include:
Rural practitioners can experience a greater sense of mission and accomplishment because they serve in an
area of need.
They may also find they can develop stronger relationships with patients whom they come to know in many
other contexts in the community.
There are also personal rewards for both providers and their families: a lifestyle that has a slower pace,
greater access to the outdoors, and other factors that make rural life an appealing choice.
A greater sense of practice autonomy
Opportunities for leadership or preceptorship
Opportunities for incentive programs such as loan repayment programs
The 2018 Family Medicine article Competence Revisited in
a Rural Context discusses challenges and opportunities in rural practice that may require unique
How can telehealth and other technology be used to make rural practice more attractive to candidates?
Using technology to lessen isolation and provide support to the rural health workforce can make working in a
rural setting more attractive. In Alaska, an eICU
system allows rural providers to collaborate with Anchorage intensive care unit staff, who assist in
monitoring and treating patients. Project ECHO — Extension for
Community Healthcare Outcomes — allows remote primary care providers to work with academic specialists,
who provide support and share knowledge about chronic disease management. The Rural Telementoring Training Center (RTTC) offers free training,
tools, and technical assistance to support implementation and evaluation of telementoring programs for rural and
remote healthcare workers. RTTC's supported telementoring modalities include:
- Project ECHO
- Individual consultation
- Online modules and curricula
- Community health clubs
For more examples, see RHIhub’s Telehealth Use in Rural Healthcare guide.
Younger providers whose training and experience include use of electronic health records and other technologies
may be attracted to positions in locations where those tools are already in place. For more information on
electronic health records, see RHIhub’s Health Information
Technology in Rural Healthcare guide.
What are the impacts of staff vacancies on rural healthcare facilities and the communities they serve?
Quality of care is harder to maintain when the facility is understaffed. Staff may be working with fewer
people to cover the same number of patients and/or working longer hours. In addition, using temporary staff
may impact quality and coordination of care and can be expensive. In some cases, vacancies can even result in
some services being
suspended until the position is filled.
Impacts associated with vacancies may include:
- Limited healthcare services to residents throughout the community as well as the surrounding area
- Increased costs due to overtime pay for other staff
- Increased costs of coverage through locum tenens physicians (short-term physician staffing assignments) or
other traveling personnel
- Costs of recruitment and training of new personnel
What are options for recruiting international healthcare workers to rural communities?
Many communities recruit international medical graduates to fill physician vacancies. The Conrad
State 30 Program allows each state’s health department to request J-1 visa
waivers for up to 30 foreign physicians per year. In
addition to the J-1 visa waiver, non-immigrant H-1B
visas can sometimes be used to fill employment gaps. The U.S. Citizenship and Immigration Services has issued temporary
policy changes that impact foreign medical graduates during the COVID-19 Public Health Emergency.
For more information on H-1B visas and J-1 visa waivers, see RHIhub's Rural
Healthcare Workforce and Rural J-1 Visa Waiver topic guides.
What kinds of benefits and incentives can be included to make compensation packages desirable to potential
Added benefits and incentives can help organizations recruit and retain employees. These may include:
- Insurance benefits
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Professional benefits
- Coverage of malpractice insurance
- Payment for licensure fees
- Payment for association dues
- Payment and time off for continuing education
Limited call requirements
- Other benefits
- Retirement packages
- Paid time off
- Sick leave
- Leave for volunteer work
- Sabbaticals for research, education, or mission work
- Sign-on bonuses
- Retention bonuses
- Bonuses for meeting certain goals
Staff recruitment bonuses (i.e. a current staff member helps find a new staff member)
- Other incentives (especially for rural and underserved areas)
- Low-interest home loans
- Relocation expenses
- Practice set-up costs
- Assistance with finding spousal employment
- Assistance with locating daycare
Underserved locations may qualify for loan repayment, which can be a significant incentive. According to Mike
Shimmens, Executive Director of 3RNET, offering loan repayment or forgiveness is critical in recruiting
primary care physicians to practice in underserved areas. Many of those reviewing online job boards and
websites are especially interested in this benefit.
Shimmens expressed his concern that,
“The number of primary care physicians available to serve in underserved
areas is trending down while the demand is increasing. Finding physicians to practice in these areas of need
is becoming incredibly more important and more difficult to do.”
For further information regarding loan repayment, see the RHIhub topic guide on Scholarships,
Loans, and Loan Repayment for Rural Health Professions.
How can I research what a competitive salary would be for a given health occupation in my region?
Professional, recruitment, consulting, and government organizations often survey healthcare providers or
employers for compensation information. Participating in these surveys is a good way to gain access to their
results. Research or educational organizations may also survey new graduates regarding starting salaries.
Recruitment and professional organizations may charge for wage data and some professional organizations limit
access to compensation information to members only.
Key sources of salary information include the Occupational
Employment Statistics: Wage Data by Occupation from the Bureau of Labor Statistics (BLS), which provides
average salaries by occupation and industry with some breakdowns by state and metropolitan area. See the BLS
Using OES Occupation Profiles in a Job Search for additional information on how to use their wage data.
Here are some additional resources that provide national data. Some include further breakdowns:
Behavioral Health Occupations