Redefining Recruitment to Retention

The Changing Landscape of Rural Recruitment

By Liz Mahan, CPRP
AAPPR Physician Recruitment Advisor


Like the communities they serve, rural health systems are unique and, unsurprisingly, have unique challenges.  In September, AAPPR hosted a series of member roundtable discussions on the topic of rural recruitment.  A common theme to all the discussions was how much has changed in the last six months.

The landscape of health care nationwide has been changed, possibly forever, by the COVID 19 pandemic, and rural areas are no different.  From telemedicine to candidate pipelines, recruitment professionals have seen a shift and felt the impacts of a changing world.

If you asked recruitment professionals in rural areas a year ago about the most significant challenges they faced, the first would likely have been location, the second sourcing, and the third perhaps competition from larger, urban health systems.  A year ago, most would have agreed that these challenges were, in many cases, difficult to overcome.  Now, however, it seems that the pandemic has shifted the landscape in ways that previously seemed unimaginable.

Over the last six months, what was once the biggest challenge for recruitment professionals, a rural location, has become one of their most significant assets.  AAPPR members who recruit in rural areas almost universally reported that they have seen an increase in providers seeking opportunities outside of major metropolitan areas.  Individual reasons for relocation vary from wanting to reside in less densely populated areas to hoping to be closer to family. Still, the commonality is a search that looks more closely at rural areas.  The result is recruitment professionals in rural areas seeing more robust, deeper pipelines.

Traditionally, sourcing has also been challenging for recruiters.  Many rural recruiters relied heavily on career fairs, residency and fellowship program visits, and clinical conferences to meet candidates, network and, build relationships with them.  Brad Lindblad, Director of Provider Development, Professional Development at Mary Lanning Healthcare, in Nebraska, has been working in a rural setting since 1997. He believes that “in rural recruitment, it always comes back to creative sourcing and building relationship.  In some cases, that means starting to recruit someone 4-5 years before they are actively looking for a job and building a long-term relationship.” For the first time this year, Lindblad signed a provider virtually.  He feels that “a good recruiter sees a challenge and turns it into an opportunity.  Providers who may not have been interested in a rural area a year or two ago are now interested and will have a conversation with us.”

Other rural recruitment professionals agree as the pandemic continues to change how teams approach searches, many are finding new and creative ways to source, recruit, and hire candidates. In some cases, recruitment professionals have noted that virtual interviews and site visits have allowed them to show off practices and communities to candidates who might not have previously thought about a more rural area without having a significant impact on timelines or budgets.  Furthermore, as both health systems and candidates become increasingly comfortable in a virtual world, many AAPPR members noted that their timelines to interview and hire candidates have tightened.  With so many employees continuing to work from home, recruitment professionals report that their teams have invested the time to streamline their processes and adapt them to remote work.  Additionally, as virtual interviews and site visits become the norm, many providers who otherwise would have to take several days to travel to a rural location can get a feel for the hospital, clinic, colleagues, and community in a few hours without ever leaving home.

Rural health care has also seen considerable benefit from the increased use of telemedicine.  Rachel Ruddock is the Workforce Development Manager at the Michigan Center for Rural Health and serves as a board member for the National Rural Recruitment and Retention Network (3RNet).  She has also noted the number of providers interested in telemedicine opportunities, which for rural communities, could bring needed services into underserved areas.  Ruddock believes that “telemedicine will transform how medical care is delivered to rural communities.  Pre-Covid many rural clinics and hospitals already utilized telepsychiatry, teleneurology, and other telehealth services due to providers shortages and lack of access to these specialties. This usage has exploded in the last several months as a result of Covid-19.  Overall, the feedback from patients and providers who are using telemedicine during this pandemic has been positive. Patients are grateful to no longer need to travel far distances to access care, and providers appreciate being able to see patients in a manner that keeps them healthy and safe. Telemedicine is here to stay even after Covid-19 ends.”

There are, however, two sides to every story.  There are certainly health systems struggling with the impacts of COVID 19, and rural communities are no exception.  They, too, have had their share of hospitals and clinics furlough employees or freeze hiring initiatives.  Ruddock notes that “six months ago, almost any rural healthcare employer would have told me they needed more primary care providers. Now, as a result of COVID 19, I’m seeing rural primary care providers being let go due to a lack of volume and financial constraints. This isn’t happening everywhere, but I’ve seen this occur more in the past six months than the last five years.” Many continue to wonder if the financial implications of COVID-19 will lead to an increase in mergers between health system and how the plans of large corporations like Walmart and CVS to enter the health care field will impact the already tight competition for providers, especially in rural areas.

Like their counterparts in metropolitan areas, rural recruiters are watching trends and working hard to leverage what they can to continue to bring top talent to their communities.  In rural areas, recruitment professionals understand that they have a window to work with providers seeking new opportunities in smaller communities.

They continue to work hard to build long-term relationships with candidates while being mindful that health systems’ long-term viability may depend significantly on how the pandemic continues to unfold in the coming months.

Absent a crystal ball; the future is uncertain whether you live in a city of millions or a town of just a few hundred.  But one thing is sure; rural recruitment professionals are continuing to adapt to an ever-challenging and changing landscape.  With COVID-19 still a very real presence across the United States, collectively, they are finding creative solutions to both old and new challenges and are embracing the success of every new provider they bring to their communities.