Healthcare Hiring…Off the Beaten Path

Insights and Strategies for Recruiting Executives in Small and Rural Hospitals

Marie Vienneau chuckles as she describes the setting of Maine’s Millinocket Regional Hospital, the 25-bed Critical Access facility over which she presides as CEO: “We’re a small town in a cold climate, 40 miles from the nearest Walmart. The North MaineWoods begins just north of us… we’re literally at the end of the road.”

For Vienneau, and thousands of other small and rural hospital CEOs, directors and board members like her across the country, isolation determines the way in which both hospital staff recruitment and retention are accomplished. And yet with 20% of the US population living in areas defined as rural by the 2000 US Census (now totaling over 60 million Americans), the need for effective staffing in out-of-the-way locations is as great as ever.

When it comes to recruitment in small and rural hospitals, and despite popular perceptions, the good news is that it’s not all bad news (not by a long shot). Many of the most successful small and rural hospitals, in fact, use their unique surroundings and remote locations to their advantage in bringing aboard qualified medical staff at all levels. One key, it seems, is in knowing how to leverage a small or rural hospital’s unique assets.

Play to your strengths, but don’t oversell

Stressing the benefits of life in a beautiful, natural setting, far from the congestion, crime and high cost of living more typical of urban areas, was a recommendation made by nearly all of the people interviewed for this article. Tana Casper, for example, Chief Nursing Officer of Grand Itasca Clinic & Hospital in Grand Rapids, Minnesota remarked, “Because of our location and the characteristics of the region, our appeal is the outdoors and an outdoor lifestyle. It’s an important part of any recruitment,” she says, “and we include a heavy emphasis on the region and what it has to offer in our recruiting materials, our Web site, and our discussions with potential hires.”

For those who appreciate rural life, the opportunity to enjoy fishing, camping, hiking and other outdoor activities year round, and just minutes from where they live and work, is a treat and a benefit to relocation. That said, successful candidate placement comes not from convincing people to relocate to small and rural areas, but rather from finding people who will be a good fit because of the interests they already have.

As Joseph Woodin, President and CEO of Gifford Medical Center in Randolph, Vermont, explains, “If somebody doesn’t want to be here, you can’t pay them enough to be here. An extra $50,000 to be in a place you don’t want to live doesn’t work.”

Instead, says Woodin, the key is to have frank conversations with candidates about what life is like, and to not overstate the benefits of small town living. Woodin’s discussions with candidates include providing information regarding distances to nearby cities, quality of schools, recreational activities, and of course, weather – all in an effort to put all the cards on the table. Woodin has these discussions early in the interview process and continues probing to find out why a candidate might want to live in rural Vermont. Drilling down with candidates regarding their interest in the region allows him to differentiate between the person who will fit in well and thrive in a rural setting, and the person who is simply attracted to a fictional fantasy of small-town America.

Hire the person first, the skill set second

In many ways, of course, staff at small and rural hospitals face the same challenges as their counterparts at larger institutions. They perform surgery, take care of broken bones, deliver babies, etc. A critical difference between the two, however, is that the breadth of responsibility in a small or rural setting is typically much wider than its counterpart in an urban setting.

Says Woodin, “When you work in a rural location, you need to be much more of a jack-of-all-trades. There are not as many specialized functions, and an orthopedic surgeon, for example, may need to cover lots of modalities.” Woodin emphasizes the importance of screening for a willingness to perform a wide range of tasks and work as part of a close-knit team. “There’s no right or wrong,” he says, “but again, we want to make sure that people realize how we operate, and that we bring in people who will appreciate that.”

Vienneau of Millinocket Regional agrees, and suggests that in a small hospital, hiring for personal fit may be as important as professional skills. Skills can be taught, she explains, whereas the “chemistry” needed to integrate well with the existing staff is often more a matter of personal makeup and character. “We have primarily one culture and one personality and one community, and for you to be happy here you need to like it. In a large hospital, if you want a different culture, you switch departments.”

Hire families, not just individuals

When a new hire relocates, it’s often with a family in tow. Even if this person thrives in her new position, if her spouse and children are miserable, the match probably won’t last.

To manage this, many small and rural hospitals deliberately and extensively involve the spouse in the match-making process from the start. This can involve arranging meetings with real estate agents to help the family find the right house; with school officials to make sure the children are comfortable; and with others who will have an impact on the life of the family. In addition, if the spouse works outside of the home, many hospitals will take an active role in helping him or her find suitable employment.

Once on board, Grand Itasca’s Casper recommends taking it a step further by using a “welcome wagon” approach to make sure everyone gets happily settled in; a lesson she learned the hard way while with a previous hospital. “We lost a physician because his spouse was very unhappy” she says. “We just didn’t do as good a job as we could have in helping them make the transition as a family.

Start early and work your relationships

Relationships are the backbone of any small community, and for many hospitals, this personal approach extends to the recruitment process. Working through her extensive local network, for example, lifelong local resident Vienneau will often attempt to recruit back into the area people who’ve moved away, sometimes even paying for their education as part of the arrangement.

Woodin does the same, in addition to taking a long range view by keeping tabs on which members of the community are attending medical school. “We start relationships and stay with them for years,” he says.

In addition, both Vinneau and Woodin work to continually stay visible, make connections in the community, and communicate with their respective staff members regarding available positions and hospital needs. Taken together, it all adds up to a strong, word-of-mouth recruiting effort, one which pays off handsomely over time.

Keep ‘em if you’ve got ‘em

All the hospitals we spoke with boasted of “better than average retention,” an outcome that’s not surprising given the tight-knit communities so typical of small and rural locations. The hospitals that are most successful in maintaining the staffing levels they need, play this to their advantage.

Says Linda Minsinger, Chief Nursing Officer of Gifford Medical Center, “We know each other well and spend a lot of time together. The CEO makes rounds and we never want staff to feel that we’re not listening or that we’re mandating things they don’t want. We’re simple people – not a lot of politics, not a lot of ego, and all on the same team.”
This is not to say that small and rural hospitals don’t bring in outside expertise when they need it – particularly for specialized skills and experiences that may not be found internally. Still, the benefits to the hospital staff and the patients they serve of seeing the same people year after year are great, and the most successful of these institutions work hard to keep turnover low.

Get help when you need it

In general, the use of external recruiters – for either permanent placements or interims – is seen as an important part of the mix. In a small institution, the loss of a key player can have a devastating impact, since there are typically fewer people available to backfill (particularly for positions that require specialized or mission critical skills). As Woodin makes clear, “You could lose a key specialist and that could cost you millions of dollars in revenue until that position is filled.”

In particular, the use of interims is on the rise, as small and rural hospitals have slowly come to appreciate the benefits this tactic provides. One such benefit is that of “taking the pressure off,” while the search for an appropriate permanent candidate can be conducted. Without such a person in place, the temptation is great to simply fill the hole, a situation which can ultimately prove frustrating for all involved.

Interims also seem particularly well-suited to jumping into the cohesive team environment of most small institutions. As Casper observes, “They tend to be people who are go-getters. They hit the ground running and are usually very outgoing in nature.”

Furthermore, Casper recommends that when using interims, it’s important to set clear expectations with staff. “When I introduce them, I frame it as ‘we are not on hold; we’re moving ahead.’ I want it to be clear they are in charge – not just here to sign time cards and hand out checks.”

In Summary

Hiring in small and rural hospitals is clearly not for the faint of heart. Still, neither is it the impossible task it’s so often described to be. Honest communication, a commitment to the whole person and family, and patience go a long way towards staffing success.

As Tana Casper observes, “Transparency is ultimately the best thing you can do. Be clear about the job, the situation, the region, the town…all of those things from lifestyle to professional. Otherwise you’re just wasting everyone’s time and money.

Many of the most successful small and rural hospitals, in fact, use their unique surroundings and remote locations to their advantage in bringing aboard qualified medical staff at all levels.

About Jeff Souza, BSN

Jeff Souza brings to Leaders For Today a 28-year track record of leadership with successful start-ups. His experience covers both healthcare and life sciences, across roles that include medical, clinical, nursing, laboratory science, human resources/staffing and consulting.

Jeff has a Bachelor of Science in Nursing, as well as training in executive management and quality service. In addition, he is a Panel Member at the Massachusetts General Hospital Institute and Public Relations Chair for the New England Chapter of the Association for Clinical Research Professionals.

About Leaders For Today

Leaders For Today is a leader in healthcare interim & permanent executive management. The Company works with top hospitals and healthcare institutions across the country to find, place, and support healthcare executives and directors. These organizations hire interim & permanent executives from Leaders For Today to provide leadership during times of transition, help improve current operations, deliver superior expertise, and mentor junior staff.