Rural Recruiting in 2021: How COVID-19 Changed Rural Recruiting

By: John Mehall, MD

In part one of our series, “Rural Recruiting in 2021”, we discussed the current landscape of rural medicine, covering rural physician employment trends and the financial impact of COVID-19 on rural hospital operations. In part two of our series, we cover which physicians are more inclined to enter rural medicine, and how the pandemic has led to some unexpected rural recruiting tailwinds.

Who Becomes a Rural Physician?  
Two of the strongest predictors that a physician will choose rural practice are specialty and background: Family physicians are more likely than those with less general training to go into rural practice, and physicians with rural backgrounds are more likely to locate in rural areas than those with urban backgrounds. 

Other factors associated with an increased likelihood that a physician will choose rural practice include:

  • Training at a medical school with a mission to train rural physicians. Such schools are more likely to graduate students who go into rural practice than schools that do not have a rural mission. (There is, however, evidence that physicians who go into rural practice after having been trained at a school that does not have a rural mission tend to stay in rural practice longer.)
  • Osteopathic training. Osteopathic medical schools have a long tradition in rural communities, and physicians who are trained in osteopathic medicine are more likely to select family practice as a specialty than those trained in allopathic medicine (46% vs. 11%) and to practice in rural areas (18.1% vs 11.5%).
  • Training that includes rural components. Rural rotations and other rural curricular elements in medical school and residency training are critical to keeping students who have an interest in rural practice from looking elsewhere.

While those factors are strong predictors of a physician engaging in a rural-based profession, by no means does coming from those training backgrounds equate to a “sure thing.” There are a variety of factors that prevent many physicians from entering rural medicine, although most of them can be addressed properly if a hospital is willing to put in the necessary effort to do so.

What Holds Physicians Back from Rural Practices?  
The overwhelming majority of physicians still prefer to live in urban areas. In fact, only 1% of doctors in their final year of medical school say they want to live in communities under 10,000; only 2% want to live in towns of 25,000 or fewer.

Here are some of the common reasons physicians stay away from rural opportunities:

Family Obligation
Physicians want to live and work in an area that is comfortable for their entire family. However, in smaller towns, there are naturally fewer work options, and many physicians are married to professionals who are not able to align their careers to the location of the potential role.

The lifestyle for the physician and their family is also a large consideration and maybe a reason for turning down a rural offer. Personal desires outside of work like the proximity to restaurants, shops, gym facilities, and other essentials that come with an urban lifestyle may be non-negotiable for certain families.

Location Ties
It’s not uncommon for physicians to want to end up near where they were born, or where they currently have family. Since rural areas are not densely populated, it’s less common for physicians to have ties to such areas.

Residency Programs
Most medical residency programs are in urban areas and medical providers get accustomed to enjoying the benefits of urban life. So at the end of the program, moving from fast-paced city life to a rural community can seem like a drastic change.

Professional Development
Urban areas tend to have larger hospitals with more patients, researchers, and funding. Some physicians might look at this abundance as a chance to grow in their profession with more state-of-the-art tech, career support, and mentorship in their day-to-day work.

Lack of Support
Since rural clinics lack the specialists that large hospitals often have, physicians are often asked to treat a diverse set of illnesses among their patients, without extensive training in many of those areas.

Though rural recruitment is certainly without its dearth of challenges, recent macro-level developments have given rural recruiters a much-needed jolt of momentum in 2021 and the years to follow. In the next section, we example some of the industry-wide implications that unexpectedly arose from the coronavirus pandemic, and why they could drive a major shift in how physicians think about practicing rural medicine. 

COVID-19 Recruiting Tailwinds
While COVID-19 has certainly put financial strain on rural hospitals, in many ways the pandemic has also leveled the playing field for rural recruiters. The onset of the pandemic fundamentally altered the urban living experience, serving as the catalyst for many working professionals, physicians included, to rethink their priorities and become more open to embracing a more rural lifestyle. In fact, a recent Gallup poll found that nearly half of all U.S. adults said they prefer to live in a small town or rural area in 2020, up from 39% in 2018. 

These recent trends bode well for the sector. According to the Association for Advancing Physician and Provider Recruitment (AAPPR), there have traditionally been three main factors that hinder a rural hospital’s ability to recruit, which may no longer be as difficult to overcome.

“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.”

Rural hospitals can provide better work/life balance, offering a lower volume of patients, while the cost of living in those markets is significantly lower than that in metropolitan areas. As “remote work” becomes more prevalent and culturally acceptable, “location” will slowly become less of a deal breaker moving forward. 

Another trend that has emerged from the pandemic is the switch to virtual interviewing, which not only reduces the time-to-fill but also results in significant cost savings, eliminating the need to cover travel and room & board for the interview candidate. With the interview costs ranging up to $30,000 per interviewee, the financial upside of the new digital approach to interviewing is quite substantial. Furthermore, it’s also much easier to secure an interview with a candidate; since there’s no investment on their part to fly out for an interview earlier in the process, employers can get the candidate on a hook much sooner than it was once possible.

Finally, the rapid adoption of telemedicine that arose due to COVID-19 has allowed rural hospitals to increase their access to specialists from larger hospitals, helping physicians working in these smaller markets better manage complex and acute patients. Since there are fewer physicians per capita in these regions, they’re often required to take on unfamiliar cases often not aligned with their training. For many physicians, especially primary care physicians who were once hesitant to take a rural opportunity because they felt they couldn’t adequately provide proper care, telemedicine has significantly helped ease their worries.

Rural Recruiting in 2021
Interested in learning more? Download our comprehensive eBook, “Rural Recruiting in 2021”, to learn more about how you can effectively source, recruit, and retain physicians for your hiring strategy.

Geyman JP, Hart LG, Norris TE, Coombs JB, Lishner DM: Educating Generalist Physicians for Rural Practice: How are we doing? Journal Rural Health 2000; 16: 56-78.
2 Rabinowitz HK, Diamond JJ, Hojat M, et al: Demographic, educational, and economic factors related to recruitment and retention of physicians in rural Pennsylvania. J Rural Health 1999;15(2):212-218.
3 Pathman DE: Medical education and physician’s career choices: are we taking credit beyond our due? Acad Med 1996;71(9):963-968.
5 Recruiting Rural Clinicians: The Doximity E-Book