Hiring a good doctor can be hard enough. But it's doubly difficult if you're hospital is in the middle of nowhere and the closest department store is 100 miles away.

That reality has been front and center for Kiley Floyd, the chief of Osborne County Memorial, a tiny critical access hospital in Osborne, Kan. Convincing a physician to come aboard is challenging when he or she has never heard of the community, there's no place for family members to work and it takes at least an hour to reach a larger facility.

"There is no direct route to any of them. You have to cross a lake no mater how you go," Floyd says. "One of the things candidates ask me is ‘How far is Walmart? ' It's a hundred miles. So it's very difficult. If you can get a doctor who wants to do rural medicine, that's great. But you've got to convince their spouse that this is the place for them."

Osborne County Memorial tried using one of the larger-sized recruiters to fill some positions. But the price tag was hefty — in the neighborhood of $50,000 a placement, Floyd says — and the hires only stayed for a couple of years at most. But the hospital, along with 15 other rurals, has a membership with a nonprofit network in Kansas that's looking to cure the hiring headache.

Earlier this year, the Sunflower Health Network, in Salina, Kan., hired a full-time recruiter to be of service to its members. Participating hospitals pay a monthly fee of $125 to seek a midlevel practitioner, and $250 for doctors, along with a $10,000 to $15,000 placement fee if a match is found.

Sunflower's members had already been collaborating since the mid-90s — on everything from joint purchasing, to group health insurance — and it made sense to try recruiting, says Heather Fuller, executive director of the network.

"It's so expensive, just like anything else, for the critical access hospitals that don't have a lot of money," Fuller says. "They were being charged huge amounts from outside agencies and recruitment firms to get these doctors. And so, they thought, why can't we work together on this, like we have some of our other ventures and programs in the past?"

The recruiter, Jill Mick, is a native Kansasan, she has ties to the community and nearby universities, and she is stationed in the Jayhawk state, rather than a skyscraper in New York. Since February, Mick has already made six placements at member hospitals, she told me by phone recently. Over at Osborne, with the help of the program, the hospital has hired two doctors and a physician assistant who both seem to be good fits, says Floyd. Even though Sunflower's members are competing for the same docs, they've remained professional about it, and participants know that winning the candidate is about making the best sales pitch.

Jason Johnson, a recruiter with the larger-sized $18 million recruiting firm Kaye/Bassman, cautions rural hospitals not to be wooed by big-city recruiters in "shiny suits." Do your homework, see whom they've made the last five placements for recently, and don't pay someone who wants to be paid on retainer for months without producing any results.

"Always give yourself an out in a contract," he says. "Don't pay a big retainer fee. If they're worth their salt and are good at what they do, they should be able to do it on a contingent basis."

And on the flipside, don't blame a big recruiter if your management doesn't take the right steps to retain clinicians, he says. Work to keep them happy and acclimate them to the new setting.

What's your experience been like with recruiting docs to your rural hospital? Do you usually get the Walmart question? Have you gotten burned by a slick recruiting firm? Tell us your stories, and watch for my story on the Sunflower Health Network in the December issue of Hospitals & Health Networks.