Framing the issue

  • Rural and inner-city health care organizations often have a hard time hiring physicians.
  • Some doctors have a strong desire to serve needy populations.
  • Many of these doctors are young and idealistic.
  • Many, but certainly not all, are guided by their religious faith.
  • Although several weeks of paid time off may sound daunting to small hospitals, it can be boon to recruitment and retention efforts.

As a rural hospital CEO struggling to recruit physicians to Ashland, Kan., population 855, Benjamin Anderson believed that "desperation often breeds innovation." When he arrived in 2009, Ashland Health Center's 24-bed hospital had a solo physician assistant who had been "hanging on by his nails" for two years, working with only remote physician supervision and weekend emergency department coverage pieced together with traveling providers. Worst of all, the facility had just two weeks of capital on hand. "We were in peril," Anderson says. "We needed good physicians — not just those who didn't fit anywhere else."

Anderson learned that Via Christi Health in Wichita was a leader in training family physicians for rural practice, so he sought out Todd Stephens, M.D., director of Via Christi's International Family Medicine Fellowship. Stephens' first words of advice: "You will get two physicians or you will get none." Doubling up on docs is critical so that one provider doesn't have to bear the full burden of providing care 24/7, including ED call coverage.

Although a competitive salary was an obvious must in any contract the hospital offered, Stephens suggested that a more unconventional lure might be equally attractive to certain candidates: eight weeks of paid time off to travel anywhere in the world. Those doctors, often motivated by their religious faith, could spend that time tending to needy populations in places where medical care is primitive, if not nonexistent. Each physician would pay for his or her own trip, but while one was overseas, the other would take care of the medical needs back home.

Following Stephens' advice triggered what Anderson calls "a transformational process in our organization." Ashland now has a solid medical staff, including two physician assistants, a nurse practitioner and a full-time physician, as well as another doctor whose practice is shared across state lines.

Anderson left last June to become chief executive at Kearny County Hospital, another critical access hospital two hours away in Lakin, Kan. By then, Ashland Health Center had 50 days of operating capital on hand and its clinic had seen 30 percent more patients than in the previous year.

"There is this perception that this program can't pay for itself, but it can," he says. "It's sustainable. That time off pays off."

Although most international service programs are faith-based, Anderson notes that Ashland is a secular, tax-supported hospital district, and does not require staff to choose a faith-based program.

At Kearny, Anderson is building on a similar culture and recruiting program that the retiring CEO had started three years prior. The paid time off, or PTO, option had been offered exclusively to physicians, but he plans to offer all employees four to eight weeks of PTO, depending on their years of service, to use as they wish.

The international service concept has attracted the attention of Kansas colleges. Last summer, students from Newman University in Wichita, Washburn University in Topeka and Southwestern College in Winfeld came to Kearny County Hospital to participate in and learn more about cross-cultural programs. Anderson thinks the college connections will give the hospital yet another recruiting advantage.

John Birky, M.D., has been a family physician at the hospital for two years andwas attracted by the opportunity to continue his mission trips to Africa. "When I asked for four weeks at a time at other places I applied, they were concerned about the overhead costs [during my absence]," Birky says. "But Kearny is great. Benjamin wants to recruit the mission-minded."

Birky was hired in tandem with a medical school colleague, making the PTO option feasible for both. He believes the PTO model will attract physicians who share his interest in international service. "The needs [abroad] are as wide open as you can imagine," he says. "If you can do it, it is needed."

Rick Donlon, M.D., could say much the same about the inner-city neighborhoods his federally qualified health center serves. He's CEO of Christ Community Health Services in Memphis, Tenn. To attract the kind of professionals the organization needs to provide care in one of its seven medically underserved neighborhoods, it offers medical staff two weeks' paid time off beyond their standard four vacation weeks to do mission work in one of four international locations where CCHS has long-term relationships. If physicians choose another service location, they must pay their own expenses and do not receive the additional two weeks' time.

"It's the ethos of our organization to provide care to the poor, especially marginalized people," Donlon says. "There are still younger providers who want to remain true to a cause. Organizations can show legitimacy [toward that goal] by letting them give care overseas."

When Donlon co-founded the program 18 years ago, CCHS sent one physician overseas and soon had 23 who wanted to go. The FQHC now has 40 physicians and Donlon says they turn away interested providers every year.

"We don't spend money on headhunters or locum tenens — this is the most effective way to recruit and retain excellent physicians," he says.

Donlon finds a correlation between the care CCHS's physicians provide in Memphis and abroad. "Those who will deal with danger and work with limited resources — those are the same skill sets you need to work in difficult communities overseas. They are better clinicians for it and they stay longer."

Benjamin Anderson believes the millennial generation of clinicians is more mission-driven than its baby boomer predecessors. "So many people complain that millennials are lazy and self-centered, but it's not true," he says. "They know more about human suffering than we did 50 years ago, and that's the whole point of this model. If they see the need to help the underserved abroad, they will see it in the United States as well."

If an organization is having trouble recruiting doctors but still uncertain about the value of offering time for service abroad, he says, "Look at your locum tenens rates. That's a short-term solution; it's cheaper to have employees. If you can offer physicians a steady life, they will want it. It becomes an offer to each other, rather than a 'taking-from-each-other' employment situation."

Laurie Larson is a freelance writer in Chicago.

The allure of global health

Paid time off for overseas stints isn't the only option for attracting physicians interested in serving communities in need. For instance, Sonya Shin, M.D., leads a project to reduce the burden of chronic diseases in the Navajo Nation. Though based in Gallup, N.M., she says her work falls under the realm of global health, which has a particular appeal for some docs.

"Global health is not just international health. [It means] addressing and overcoming challenges that contribute to health disparities," says Shin, an associate physician in the Division of Global Health Equity at Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School, both in Boston.

The Community Outreach and Patient Empowerment Program is a collaboration between the Navajo Nation Community Health Representative Program; the Gallup, Shiprock, Fort Defiance and Chinle Service Units of the Indian Health Service; and BWH's Division of Global Health Equity. Outreach "requires mobilizing the community workforce to make hospital and clinic care carry through to home care," Shin says. Some 85 community health representatives go into neighborhoods to ensure that residents get the ongoing care and health education they need to better manage chronic conditions and avoid hospitalization.

"It's not easy work, but we've played a role in recruiting physicians here through our programs," Shin says. An example is a residency in global health equity and internal medicine offered through Brigham and Women's, which allows residents to work with COPE. A number of providers just finishing residency have obtained joint appointments at BWH for their COPE involvement.

"I would like to think that we have contributed to the successful recruitment of at least a half-dozen outstanding young physicians interested in global health careers over the past four years," Shin says. "I think we are just starting to see a shift in the culture. I think our physicians feel galvanized, because they are part of a global health community." — Laurie Larson