Recruitment Challenges, Solutions, and Outlooks
Rural communities across the United States are increasingly burdened by a persistent and growing shortage of both general physicians and specialized surgeons—a crisis that threatens the health and economic stability of nearly 60 million Americans. One of the most critical causes of this shortage is the challenge hospitals face when trying to recruit physicians to make careers in small town America.
While roughly 20% of Americans live in rural areas, only about 9% of the nation’s physicians practice in those regions1. This disparity is even more pronounced for specialists, including general and orthopedic surgery where access is often unavailable without traveling hours to urban centers.
But how do hospitals in rural locations stem the tide and overcome the current challenges associated with recruiting physicians for services that are so desperately needed in rural locations?
Roadblocks to Essential Services in Rural Communities
Several structural and systemic factors intensify this healthcare gap. Physician recruitment and retention in rural communities is challenged by professional isolation, limited access to continuing education, and lower compensation compared to urban counterparts2.
But there’s more. Per Dr. Richard Makowiec, our Chief Medical Officer, “Recruiting physicians to rural America isn’t just about filling jobs—it’s about restoring access, dignity, and trust in communities that have long been overlooked. Solving this challenge requires more than incentives; it demands a reimagining of how we support, train, and retain providers where they’re needed most.”
To further complicate the problem, rural hospitals often operate on razor-thin margins, making it financially unsustainable to support full-time specialists, surgical staff, and the necessary facilities required for complex procedures.
In many cases, rural hospitals are forced to rely on costly locum tenens and other temporary labor, which disrupts continuity of care and can delay both elective and emergency surgeries3. As a result, rural patients frequently forgo routine screenings, face prolonged surgical wait times, and endure poorer outcomes from delayed or inaccessible treatment.
Several factors contribute to the challenges of recruiting physicians to live and work in rural areas:
- Geographic Isolation: Rural areas by their definition are often far from city centers and areas with access to personal shopping preferences, professional services, housing options, and even smaller considerations like access to airports and the right schools for a provider’s children.
- Limited Financial Incentives: Lower reimbursement rates and financial constraints make it difficult to attract and retain healthcare providers.
- Infrastructure Deficiencies: Inadequate facilities and a lack of advanced medical equipment may not be exciting or enticing to new professionals who want to work with the most advanced technologies.
- Educational Barriers: Fewer opportunities for medical education and training in rural settings limit the pipeline of new healthcare professionals.
Evolving Solutions to Combat Physician Staffing Challenges in Rural America
- Telemedicine: Through virtual visits, rural patients can consult with specialists, receive diagnoses, and manage chronic conditions without the burden of traveling long distances. This technology not only improves access to care but also reduces costs, minimizes delays, and helps rural hospitals extend their services and retain patients within their communities.
- The Physician Licensure Compact (IMLC): The Interstate Medical Licensure Compact is significantly enhancing healthcare access in rural communities by streamlining the process for physicians to obtain licenses across multiple states. This expedited licensure pathway enables more physicians to practice in underserved areas, either in person or through telemedicine.
- Advanced Practice Providers: To mitigate physician shortages, rural healthcare systems are increasingly relying on Advanced Practice Providers (APPs), such as Nurse Practitioners and Physician Assistants to deliver primary, emergency, and specialized care. These providers are often supported by telehealth technologies, allowing them to consult with physicians remotely to effectively manage complex cases.
- J-1 and H-1 Visa Programs: These visa programs play a vital role in helping rural communities stay staffed with qualified physicians amid persistent provider shortages. Through the J-1 visa waiver program, international medical graduates (IMGs) can remain in the U.S. after residency if they commit to practicing in underserved areas for at least three years. Similarly, H-1B visas allow hospitals to hire skilled foreign physicians directly to fill critical gaps in care. These visa pathways provide a reliable pipeline of talent, bringing much-needed stability to rural hospitals and ensuring continued access to primary and specialty care for millions of underserved patients.
- Residency and Training Programs: Programs like the WWAMI Regional Medical Education Program provide community-based medical education, encouraging graduates to practice in rural regions4. In addition, there are also academic-community partnerships that work together to create rural training tracks for medical students and residents.
Per Dr. Makowiec, “The key to overcoming physician recruitment problems in rural America lies in building a system that values flexibility, community, and long-term commitment. Hospitals must invest in training pathways, modern care models, and supportive environments that not only make rural practice possible but also help combat physician burnout and make the work deeply rewarding.”
New Physician Staffing Models are Emerging
Beyond traditional medical education, many hospitals are now adopting flexible, team-based physician staffing models such as the Surgicalist Model and fractional physician staffing. These models offer cost-effective, consistent coverage for specialties like orthopedics, trauma, and general surgery that create unique career paths for physicians that align with their personal and professional goals.
In addition, fractional physician staffing offers a range of advantages for hospitals in rural or resource-constrained settings. This model allows physicians to work on a scheduled, part-time, or rotational basis—offering more flexibility than traditional full-time employment or costly locum tenens contracts.
Fractional Surgeon Staffing in Motion: Mahon Deaconess Hospital
A Case Study in Success
Mahon Deaconess Hospital in Glasgow, Montana (population: 3,500) provides a critical lifeline for up to 10,000 patients in the surrounding areas. Their challenge was a growing physician burnout problem in their local surgeons as they were the sole providers for the extended community. Previous openings for local staff had gone vacant for long periods of time, resulting in revenue loss and fewer services for an already medically underserved region.
When an orthopedic surgeon position opened, the hospital leaders knew that replacing the only doctor who was providing general orthopedics, total joints, and on-call services would be a tall order, so they turned to Synergy and our Surgicalist Model.
The Results
Synergy provides three Surgicalists who each travel to Glasgow for a rotation of 10 to 12 days per month, during which they provide 24/7 call coverage, perform surgical cases, and see clinic patients. This staffing model still helps patients develop a relationship with a doctor locally instead of needing to drive 300+ miles for specialty care.
This is significantly more than the facility was able to offer before, as the three rotating surgeons provide coverage that is the equivalent of 1.4 full-time staff surgeons–quite an accomplishment for a hospital that was struggling to recruit a single provider for this position.
Since Mahon Deaconess Hospital partnered with Synergy, it has achieved Advanced Total Hip and Knee Replacement Certification from the Joint Commission. And it is the only facility in Montana to attain this recognition. Furthermore, it has been named one of the Top 100 Critical Access Hospitals in the Nation.
Per Dr. Makowiec, “The Surgicalist model has been so successful for Deaconess that the hospital is now working on expanding its General Surgery specialties with our team.”
Benefits of the Fractional and Surgicalist Models
- Cost Control: Provides access to surgical care without the full expense of hiring permanent, full-time surgeons.
- Improved Continuity of Care: Offers consistent, scheduled coverage—superior to the fragmented nature of locum tenens staffing.
- Access to Specialists: Enables rural hospitals to provide services like orthopedics, general surgery, and trauma care on a predictable basis.
- Reduced Burnout: Allows physicians to work flexible, balanced schedules, increasing job satisfaction and retention.
- Operational Flexibility: Staffing levels can be scaled with seasonal or procedural demands, thus optimizing resources without overstaffing.
Final Words
Addressing the problems of physician recruitment for rural healthcare hospitals is not just a healthcare priority—it is a moral and economic imperative for the nation. The well-being of millions of Americans depends on meaningful action that goes beyond temporary stopgaps.
Per Dr. Makowiec, “These efforts require collaboration across healthcare systems, government bodies, new staffing solutions, and the input of community stakeholders, all united by a shared vision to close access gaps and ensure equitable health outcomes.”
For rural America to remain vibrant and resilient, its hospitals and clinics must not only be staffed with the best and brightest surgeons, but also empowered with the tools, funding, and ancillary talent to deliver high-quality care—no matter how remote the ZIP code.
Learn More
Synergy Health Partners is proud to offer solutions for rural hospitals that need access to cost-effective solutions that help them grow the bottom line while providing the surgical services that are so vital to these remote communities.
To learn more about the Surgicalist Model and Fractional Staffing solutions at Synergy Health Partners, please contact us here.
Sources
1U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). “Healthcare Workforce Shortage Areas.” https://data.hrsa.gov/topics/health-workforce/shortage-areas.
3RHI Hub, Rural Health Information Hub. “Recruitment and Retention for Rural Health Providers.” https://www.ruralhealthinfo.org/topics/rural-health-recruitment-retention.
3Association of American Medical Colleges (AAMC). “The Complexities of Physician Supply and Demand: Projections from 2021 to 2036.”, https://www.aamc.org/media/75231/download?attachment.
4Wikipedia, “WWAMI Regional Medical Education Program”, https://en.wikipedia.org/wiki/WWAMI_Regional_Medical_Education_Program.
