Practicing medicine on the frontier in Kansas doesn't have a whole lot in common with big city medicine — so why would small town hospitals use big city physician recruiters?
Kiley Floyd said it's clear to her now that they shouldn't, but the chief executive of Osborne County Memorial Hospital learned the hard way.
"Small rural hospitals are not the same as large tertiary hospitals. Requirements of docs are different, the relationship with staff is different, the patients are different. When you're using a large recruiting firm, I learned the hard way that they don't get that. They're in it to make money," Floyd said. "We needed a good match."
The last time she used a national recruiting firm, it took two years to fill a family practice physician vacancy — and that's all the longer the doctor stayed at her north-central Kansas critical access hospital.
"The doc was not a match at all. He looked good on paper, he was a great interview, but he was not a match. He lasted a couple years," Floyd said. "He was a city guy. He'd never lived in a rural community. He thought he wanted to, but when it came down to it, he did not."
Overall her experience recruiting has been time-consuming and expensive.
"We've hired recruiters, we've done contingency firms, we tried it on our own. We've kind of run the gamut," she said. "My experience was terrible previous to Sunflower."
<a name="continued"></a>Things are different now.
To fill the last two openings at her hospital, Floyd has enlisted the physician recruiter from the Sunflower Health Network.
The network — one of a dozen in Kansas — consists of 15 critical access hospitals that share services, pool resources and refer patients to a common hub, Salina Regional Health Center. Salina Regional first began contracting out its internal recruiter to network members in 2009.
Floyd decided to give the new recruiting service a shot, and said that in about three months she had filled the position at a third of the cost of the previous, failed effort.
Photo courtesy of Kiley Floyd
"And it was a good match," Floyd said of the recruit, Dr. Dorothy Breault.
In February, the recruiter began working full time for the Sunflower network. In the last three years, eight openings at member hospitals have been filled and three more are in contract negotiations to start in 2013, said the network's executive director, Heather Fuller.
"This is a service our members wanted," Fuller said. "It's just so expensive for hospitals, especially critical access hospitals, to do on their own. It made sense to look at it from a group standpoint. It's something they all need at one point or another."
A fraction of the cost
Member hospitals pay an annual fee to be part of the Sunflower network, which provides other perks such as group purchasing for supplies, group contracting for equipment inspections and group insurance policies, among other things.
Fees for recruiting only apply as services are used. They are $250 per month for physicians and $125 per month for mid-level providers, plus a placement fee that is less than half what most national recruiters charge, Fuller said — putting the fee at about $10,000 to $15,000.
Currently there are eight openings at seven different hospitals. Though many are for similar positions, Fuller said using the same recruiter can work well even in a competitive network environment.
"Definitely there's competition there. But we're open about that. If there's more than one hospital recruiting the same person, we let those hospitals know, so they know exactly what they're up against and can bring their best game," she said.
"I think it works well in our network because our hospitals work so well together and have been together so long doing projects similar to this. The trust is there between hospitals and between administrators, so that's what makes it successful."
Local network-based recruiting is also successful because it starts early, said Dr. Scott Owings, who helps with placement at both the Smoky Hill Family Medicine Residency Program and the University of Kansas School of Medicine, both based in Salina.
"More and more what I see smaller and community hospitals doing is they're getting contracts with these guys while they're in medical school," Owings said. "From a recruitment standpoint, it really is a long-term process."
Owings said when he graduated in 2002, it was common to wait to commit to a job until just before the end of the third and last year of residency.
"That was the norm. In the last three or fours years, the majority of our residents have commitments well into the first half of the residency," Owings said.
He said Sunflower's recruiter Jill Mick keeps a leg up on national recruiters by forming relationships with medical students early and helping match their interests with the needs of hospitals in her network.
"One nice thing about Jill and the health network is the students know they can work with them, they know them as opposed to these headhunters, these national recruiters, where maybe their personal interests aren't the foremost priority," Owings said.
Unique in the nation
Utilizing a rural health network's pooled resources for recruitment is a unique concept, but not without some precedent in other rural states, said Mike Shimmens, executive director of the Rural Recruitment and Retention Network (3RNet).
Shimmens said while Sunflower may be the first rural health network to hire a recruiter, various consortiums around the country have begun experimenting with pooling resources for physician recruitment. Some critical access hospitals have done so in Illinois, he said. Primary Care Associations have helped with recruitment for small health centers in Oklahoma, Colorado, Maine and elsewhere. And in southwest Missouri, larger hospitals have lent their internal recruiters to referring hospitals.
"You're seeing more and more of this right now because hiring a search firm can cost you anywhere between $25,000 to $50,000 easily for one physician. That's basically two hospitals going in together to hire a recruiter if they pool that kind of money — and they'd get a more consistent approach to recruiting and be able to work on the retention side," Shimmens said.
"Recruitment firms don't even touch retention. The large national recruiters are interested in making the placement and collecting their fee. It doesn't necessarily have to be a great fit — matter of fact, it's probably more profitable for them if (a physician is) not retained, because they can take them and try to put them somewhere else and generate another fee. Continually using that system can devastate a hospital," he said.
Photo by Ann Brussow
Matching the community
In Abilene, Mark Miller's hospital has a much larger budget than its network peer in Osborne — some $24 million versus $4.5 million.
Even so, the chief executive of Memorial Health System can't afford the fees he’s been quoted — $20,000 to $30,000 — to use a large recruiting firm.
He just used a national firm to recruit a general surgeon and in that arena, he said, large firms might have an edge over local recruitment, given the smaller pool of regional specialist graduates.
But for family practice physicians — which is what he needs now to replace three of his six on staff soon to retire — the Sunflower network's recruiting is ideal.
He said two of the three spots are nearly filled thanks to Sunflower — all that remains is "dotting I's and crossing T's in the contracts."
Miller said "A national firm, first and foremost, is looking to place somebody because that's how they get paid. They pay a lot less attention to the factors which we find important, such as a local individual who we know is going to be happy in a rural community."
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