Physicians Want Team Culture, Autonomy to Work at Rural Hospitals

August 01, 2019 - Physicians want more than competitive compensation to work at a rural hospital. They are also looking for the autonomy and the right cultural fit, according to a new survey conducted by Jackson Physician Search.

The physician recruitment firm surveyed 105 rural health system administrators and 150 physicians, of which 78 percent currently practice in a community of fewer than 25,000 individuals. The survey showed that administrators overemphasize the role compensation plays in physician decision making.

Hospital administrators cited compensation as the number one reason a physician chooses to practice in a rural hospital. But compensation came second for physicians, following community culture. Physicians also cited proximity to family, friends, and colleagues as the top reason for practicing in a rural community.

The other top reasons cited by hospital administrators – preference/needs of spouse/partner and offer of loan repayment – did not even make the top three reasons why physicians said they would choose a rural hospital job.

“Compensation will always be a driving factor in recruitment and retention, but this survey confirms how a variety of less easily quantified factors play as important a role in rural physicians' practice location decisions,” Tony Stajduhar, president of Jackson Physician Search, stated in a press release. “It's vital for hospital administrators to understand that physicians place heavy emphasis on other aspects such as community and workplace culture when considering accepting a position in a smaller, rural or community health setting or staying in that position—especially as the national physician shortage increases.”

The Association of American Medical Colleges (AAMC) recently projected a physician shortage of up to 121,900 doctors by 2032. While the shortage can be felt across the nation, rural areas are getting hit hard by the lack of physicians practicing.

A 2018 report from UnitedHealth Group found that rural residents are about five times more likely to live in a county with less than one primary care physician per 2,000 people compared to urban and suburban residents.

Additionally, a recent poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H Chan School of Public Health found that one in four individuals residing in rural areas reported not getting the healthcare they needed.

Attracting and retaining physicians is a top challenge of rural healthcare. Just one percent of residents in their final year said they preferred to work in a community of 10,000 individuals or less. Another three percent said they would practice in a community with fewer than 25,000 residents, a Merritt Hawkins survey found.

Rural hospital and system administrators need to ensure their organization is not only offering the right compensation package but also the right culture and work schedule, the Jackson Physician Search survey showed.

Physicians are attracted to a competitive compensation package. Almost one-third of respondents (31 percent) said compensation was the single most influential incentive that was offered by a practice or hospital. Hospital administrators agreed, with 35 percent citing compensation as the top incentive.

But physicians selected other incentives that were not on the priority list for administration. Thirty percent of respondents said autonomy and culture were major incentives, and 14 percent said leadership opportunities.

"Overall, our survey has shown that while compensation and other financial incentives matter, other factors swing the decision to accept an offer to practice in a rural community," said Stajduhar. "Rural health system administrators have to develop a culture that is attractive to physicians and more importantly demonstrate their unique―and opportunity-filled―environment throughout the recruitment process. The cliché 'it takes a village' most assuredly applies to rural medicine and shouldn't be discounted as a selling point."

To improve recruitment, Stajduhar advised rural hospitals to assure physicians of autonomy and demonstrate a team-based culture. The hospital’s culture should also be family-friendly, he said, highlighting community benefits and connecting candidates with community leaders.

While hospital administrators have a different view on what it takes to successfully recruit a physician, they should be heavily involved with the recruitment process, Stajduhar added.

“One of the lost arts of physician recruitment is the involvement of Hospital CEOs and Administrators. Physicians rank the impact of culture on their job consideration as number 3, according to the survey. Culture is typically established from the top, so there is no better representation of culture than from the Hospital administrator taking the time to share his or her vision and philosophy to the candidate,” he said.