Rural Hospitalist Staffing Models: What’s Working Now

Most hospitalist staffing models cover at least one need for rural hospitals, but few can cover all your community’s needs. And the list of needs is long when it comes to staffing in rural areas – from recruitment and education to management and retention.

That’s what makes rural hospitalist staffing such a challenge. It’s not enough to fill open roles. When clinical and cultural alignment are on the line, you need the best solution (and physicians) available.

But is that even possible? What does success look like in rural health staffing?

Success in rural health staffing is attracting “right-fit” rural hospitalists for your community. It’s making sure your staffing processes are financially sound, align with your goals, and position you for long-term stability.  

Rural hospitalist staffing is difficult, but winning strategies do exist. Let’s review some of those winning strategies.

Rural Hospitalist Staffing Solutions

Before we dive into the top strategies for staffing rural hospitalists, it will be helpful to understand the general landscape. There are a few solutions being used today – some more than others and each with pros and cons:

Employed by the Hospital

When you think about hiring a hospitalist, you may picture this physician being a full-time employee of the hospital. That seems ideal, but it’s rarely a viable option. It’s incredibly difficult to find the right physicians for your community and then convince them to relocate their families to a rural area.

This reality is a big reason why the following rural hospitalist staffing solutions exist.

General Hospitalist Staffing

Some large hospitalist staffing groups work in rural communities too. Providers in this model don’t specialize in rural medicine though, which can cause serious alignment issues down the road. With large groups that don’t understand the unique challenges of rural hospitals, you’re less likely to keep patients local, have continuity of care, and admit higher acuity patients.

General staffing groups also commonly use a tactic you’re familiar with called locum tenens. For this reason, they tend to be more expensive overall and don’t ensure continuity of care for patients. These effects are all connected to your rural hospital’s overall stability.

Hospital-Based Family Practice and Primary Care

The other model for staffing rural hospitalists is through hospital-based family practice systems, or primary care clinics that expand their services. While these physicians may already be aware of your community and culture, they don’t check all the boxes a rural hospital needs to remain stable and aligned. Even these rural hospitalists may not fully understand (or embrace) the unique challenges of a rural hospitalist. 

In rural medicine, the best hospitalists want to practice at the top of their license and lead in the most challenging situations. Like other models that lack full-coverage, hospital-based family practice providers are going to be more likely to transfer patients – presenting the same issues as the previous model.

Full-Coverage 24/7 Rural Hospitalist

Rural Physicians Group created their full-coverage 24/7 rural hospitalist model with the shortcomings of the previously mentioned staffing models in mind. As hospitalists who specialize in rural medicine, full-coverage 24/7 hospitalists at Rural Physicians Group provide stability and total alignment, giving administrators peace of mind. In this model, your hospital is matched with experienced physicians who are passionate about rural health. And they are permanent solutions to your rural hospitalist needs – not a bandage or stopgap.

What's Working Now 


1. Deploying Turnkey Recruiting Solutions

Full-coverage 24/7 models permanently remove the burden of recruiting rural hospitalists. With a senior leader’s workload, how do you find time to attract, assess, close, and onboard the right physicians?

The most effective strategy now takes care of these tasks for you. From the beginning, your hospital plugs into the rural hospitalist group’s team of physicians. They’ll meet with you to determine the medical care your community needs. And if a rural hospitalist leaves, the group you’re partnering with finds their replacement.

2. Establishing Predictable and Long-Term Scheduling Patterns

Rural hospitalists in the full-coverage 24/7 model are available at your hospital 24 hours a day for shifts that usually span 5-10 days. Combined with fewer transfers, this means more patients can rely on one physician throughout their care at your rural hospital.

Stronger continuity of care reduces mistakes, improves quality, and enhances the patient experience at your hospital. Another aspect of this model administrators are seeing is value in is physician access for patients. These rural hospitalist teams give patients and their families around-the-clock access to a hospitalist via cell phone. If they have a question, they can always reach the care team.

3. Outsourcing Physician Administration Tasks

Every employee of your hospital requires work on the administration side, but physicians often require even more if they are employed by you. Administrators are finding it easier and more effective to outsource physician administration tasks by partnering with a full-coverage 24/7 rural hospitalist group.

These rural hospitalist groups take care of all administrative responsibilities associated with hiring and managing physicians. And the occasional headache of people management is outsourced too. In this model, you don’t have to worry about transitioning physicians who may not align with your community’s goals. The full-coverage 24/7 rural hospitalist group will lead those communications and find their replacement.

4. Choosing Rural Hospitalists Who Teach

Administrators are discovering the value of hiring physicians who are comfortable in the rural setting and feel called to serve there. In the full-coverage 24/7 model, these hospitalists approach their work with a teacher’s mindset and are proactive about helping your staff elevate its skills.

The most effective rural hospitalists become a voice of leadership on your medical teams. They take ownership at every level and don’t just act as a short-term extension of your team like some staffing models. Hospital leaders know by choosing rural hospitalists who teach, they are establishing a strong foundation.

5. Partnering for Physician Retention

Full-coverage 24/7 rural hospitalist models are designed for retention. That’s because their employment setup is unmatched on the physician side. These rural hospitalists have great benefits and work environments. In fact, these physicians are known to get attached to the community and stay at the same rural hospital for years. And if they do decide to leave, we’re back to the strategy of deploying a turnkey recruiting solution.

These strategies are all connected, and administrators especially understand how physician retention impacts the entire patient experience. It’s important for everyone in the community to see the same faces of medical leadership for as long as possible. This consistency helps ensure your rural hospital is operating well clinically, culturally, and financially.

What’s Required in the Future

One of the toughest parts of planning as a leader is managing your current needs while also considering the future. Healthcare is changing, and rural hospitals may feel these changes more than anyone.

It’s never been more important to staff rural hospitals with experienced physicians who provide stability and education. Rural hospitalists now and in the future must understand the unique challenge of practicing in a rural community, and they must be prepared to face anything that comes through the door.

Historically, your rural hospital has always been able to transfer patients from the emergency department or inpatient setting when their medical needs have exceeded your team’s capabilities. If a patient was unstable and you needed a specialist, your medical teams had that option with some certainty.

This option is becoming increasingly more difficult to fulfill. The pandemic in particular has left major urban hospitals either without beds or without the ability to staff those specialized needs. As a result, rural hospitals are scrambling to find the care these patients need – whether it’s boarding them at their own emergency department or finding a regional hospital with the right resources to stabilize.

Whether it’s the pandemic or something else causing stress on a hospital system, the takeaway here is that administrators need to have physicians on staff who are comfortable being uncomfortable. Rural hospitalists of the future must be capable of (and willing to) serve your community on its toughest days. As acuity increases – without the immediate option to transfer – they must be teachers who help raise your staff’s skills.

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