For Mercy Medical Center in New Hampton, Iowa, the phrase "If you build it, they will come" is more than just a slogan. Mercy successfully used it as part of a 2008 campaign to recruit six family physicians to this northeastern Iowa town of 3,750 residents. The lessons Mercy learned from its recruiting experience provide important insights for other health care organizations in need of doctors.
Even though Mercy faced a physician shortage, it was moving ahead with construction of an 11,000-square-foot, $3.5 million clinic to be located next to the hospital. The now-completed clinic has space for six physicians with three patient rooms for each, two minor procedure rooms, a laboratory, diabetic education offices and meeting space. In 2008, Mercy had only two doctors serving in its existing clinic and both announced plans to retire.
The clinic was an important symbol for Mercy and the community. "The facility was constructed in large measure as a recruitment initiative," says Bruce Roesler, president of Mercy Medical Center–New Hampton and vice president of Mercy Medical Center–North Iowa in Mason City. "To be competitive in today's market, we needed a great facility that would help attract physicians."
The stars seemed to align for Mercy when a letter arrived in spring 2008 from six doctors (two married couples and two single men) asking if the hospital would consider hiring all six of them. The colleagues were completing their family medicine residency at Via Christi Health System in Wichita, Kan., and searching for a rural setting that not only was willing to take them as a group, but also would agree to a number of other requests.
The married female doctors, for example, wanted to practice part-time and all six of the physicians wanted to do mission work abroad on a rotating basis for three months each year. The married couples wanted to go on their mission together. They also needed help in paying off medical school debt and hoped to practice in a fairly modern clinic where they could do a full spectrum of family medicine, including operative obstetrics.
The Wichita Six are of the so-called millennial generation, share family and religious values, and want foremost to make a difference. They mailed more than 500 letters to small hospitals in 10 different states, trying to find a hospital willing to meet their requirements. After an extensive search, about six hospitals wound up on their radar screen, but it was Mercy that garnered most of their interest.
Flexibility is Key
The hospital was flexible and responsive from the start, says John Epperly, M.D., one of the six doctors. "Mercy said, 'Here is an open canvas and you paint it.' That was very appealing."
Being flexible is one of the most important lessons learned from this effort, Roesler says. Tommy Bohannon, vice president of recruiting for the Irving, Texas, physician search and consulting firm Merritt Hawkins, says hospital executives must be open-minded and agile when it comes to meeting the demands of young physicians. "For example, quality of life is primary today," Bohannon says. "Younger female doctors don't always want to practice full time, so it may take two physicians to fill one full-time role."
He advises rural hospitals to create a physician practice environment that is as appealing as possible. "Often, this means the hospital must employ the physician; offer financial incentives that are competitive on a national level, not regionally; and help with medical school debt," he says.
Small hospitals typically have a hard time recruiting even one physician, much less six at once. Bohannon says the New Hampton situation is unique as far as his experience is concerned. "Typically, doctors are looking to fulfill personal goals when seeking a practice, not collective ones," he says.
The six doctors were not typical in that sense. "We shared a common dream to practice together and spend some of our time doing international mission work," says Epperly, who planned to return to Zimbabwe in January with his wife, Shea Epperly, M.D., and their two young children. Richard Moberly, M.D., another one of the doctors, describes the group as a service-oriented bunch. He believes hospitals may see more doctors requesting international leave so they can serve the medically underserved.
Think Outside the Box
To demonstrate its strong interest in hiring the doctors, Mercy sent representatives to Wichita to meet with the six and explain the benefits of living and working in New Hampton. As part of this effort, they used the "build-it" slogan to highlight the new clinic. "We gave them a basketful of local area products, as well as The Field of Dreams DVD, to introduce them to our community," says Jennifer Monteith, Mercy's development and public relations director.
Mercy also demonstrated its willingness to adapt the staffing model the physicians envisioned and to show the doctors its deep commitment to providing quality health care to the community over the long haul. While some hospitals might balk at the idea of losing doctors to mission work every year, Roesler says Mercy is a faith-based organization and understands and appreciates the doctors' passion to serve abroad.
To accommodate their missions, the hospital set up four three-month rotations. Moberly, who is single, returned from Zimbabwe in October, and Jack L. Kline, M.D., also single, completed his three-month mission at the end of December.
"We realized that trying to meet the needs of physicians is very important," says Paul Manternach, M.D., senior vice president of physician integration for Mercy Health Network. "If a hospital is unable to provide physicians with what they're looking for, you will be out recruiting again in two years," he says. Nevertheless, the model must be financially sustainable. While Mercy's situation is unique, it could be adapted by other health care organizations, Manternach says.
It often makes sense to hire more than one physician at a time, says Roger Tracy, assistant dean/director of the Office of Statewide Clinical Education Programs for the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa. "It is easier and more effective for everyone if a health care organization can hire in multiples," he says, noting that it also helps with retention.
Bringing in one physician at a time definitely has its downsides. For example, since there aren't enough doctors in the call schedule, the new physician has to work more nights, weekends and holidays. Before Mercy began its recruiting effort, Tracy met with the hospital's board of trustees and administrative staff to point out the benefits of hiring in multiples.
It is also important not to neglect the employment needs of the doctors' spouses and their outside interests. "The defining lesson for rural communities trying to recruit physicians is that hospitals have to offer lifestyle advantages," Tracy says. Today's young doctors are looking at how they can mold their professions to their lives, as opposed to being molded by the profession.
The community also played a big part in recruiting the doctors. In addition to visiting Wichita, hospital executives and community leaders planned a weekend of special events when the doctors visited New Hampton. Roesler says they received "an Iowa welcome," including dinner with residents, and took part in community activities like ice skating and hockey. "We incorporated business in the visit, but we wanted to be sure the doctors had a good time while they were in New Hampton," he says.
The doctors say the campaign was effective. "They impressed upon us the warm nature of New Hampton as a community," says Paul McQuillen, D.O., who, with his wife, April McQuillen, D.O., round out the Wichita Six. "We found it is a wonderful town where neighbors lend a hand to each other and people come together to accomplish common goals."
In addition, the town's local industrial development corporation raised money to provide an ancillary physician-signing bonus outside the hospital employment agreement. Those funds eventually translated into an offer to help the new physicians buy homes in the community. "This was one more factor that helped communicate to the doctors how engaged the community was in the recruitment process,"Roesler says.
Mercy also demonstrated to the doctors the long-term view it was taking. "It put in the effort and financing up front to help ensure that we will be in the community for a lifetime," McQuillen says.
Their employment agreement includes a loan-forgiveness provision. Mercy was willing to help with their debt because it understands that family doctors earn less than specialists, McQuillen says. "The financial reality of today's medical training is a factor hospitals need to consider."
Professional recruiters say it is best to focus on a physician's qualifications, not the board's wish list, which might be limited to younger, U.S.-trained physicians.
"The best candidates are those who are qualified, have a good bedside manner, work hard, and want to live in your community or city," Bohannon says.
Joan Szabo is a freelance writer in Great Falls, Va.