Our Take

Boosting rural/remote staff recruitment and retention

15 Minute Read

Misconceptions abound about what a career at a rural/remote organization looks like—especially what life in a rural/remote community looks like as well. Whether you’re recruiting clinical or non-clinical staff, rural/remote employers need to demonstrate the long-term appeal of a career in a rural/remote setting and address these misconceptions head-on. By revitalizing recruitment and retention efforts to focus not only on the workplace, but on the local community as well, rural/remote employers can sustainably grow their staff numbers.


How we define a rural/remote organization

Many experts in health care recruitment group rural and remote organizations together as a way of distinguishing areas that are hard to recruit for. This encompasses cities and towns that, while not technically rural, are geographically distant from other metropolitan areas. While the definition of rural and remote varies by country, a common theme is that these organizations find it difficult to recruit candidates because of their geographic position.


The conventional wisdom

Trying to hire an employee for life, when 3-5 years is already a ‘win’

Rural and remote organizations know that, by and large, the model of hiring and retaining an employee for life has disappeared. They accept that it is increasingly difficult to recruit and retain someone for even three to five years, let alone for life. But most organizations don’t explicitly align their recruitment and retention strategies with this new reality.

Recruiting for ‘clinical fit’ and ignoring ‘community fit’

In fact, most rural/remote organizations parallel their urban counterparts in recruiting candidates based on clinical fit (how closely does a candidate meet the specific clinical needs/experiences of the position). But, while a candidate may be a good fit for the position, they often are not a good fit for a rural or remote area. Failure to assess whether a candidate is a good fit for the community inevitably leads to poor retention rates.

Engagement efforts limited to the workplace

Most organizations, rural and urban, view engagement outside of the workplace as the employee’s responsibility. However, if an employee is disengaged from their community of residence, this will have a direct impact on the likelihood of retaining them. Put simply, even if an employee is satisfied with their job, they are unlikely to stay if they lack a sense of connection to the community.

Money doesn’t buy retention

Rural/remote organizations often rely heavily on financial incentives such as signing bonuses to recruit employees. However, such incentives are increasingly commonplace, fail to differentiate employers, and often lead to a financial arms race: an arms race rural/remote organizations are ill-equipped to enter. Plus, evidence suggests financial incentives play a limited role, if any, in staff retention.


Our take

To both hire more employees and retain them, rural/remote organizations need to do two key things:

  1. Meet employees where they are by mapping recruitment and engagement efforts to a three- to five-year timeline of employee retention.

  2. Ensure that recruitment and retention efforts extend beyond the workplace to address each employee’s personal engagement with the local community.

Most rural/remote organizations would already view three- to five-year retention of health care employees as a win. By acknowledging that most new employees only plan to stay for a few years—and by front-loading career development and engagement efforts—employers are more likely to entice longer-term employment beyond the three- to five-year mark.

The average turnover decision among rural practitioners is made 12-18 months into tenure. This serves as an opportunity for rural organizations, because urban counterparts often experience turnover within a few months.

Retention is inextricably tied to a feeling of engagement both at work and in the community. And this is especially the case in rural/remote areas. As a result, it is the employer’s responsibility to drive engagement from the community perspective as well as from the workplace.

Both recruitment and retention efforts need to address the importance of the local community. Specifically recruiting and interviewing candidates for rural/remote fit is a vital first step. Then, organizations need to continue to engage employees in relation to their lives outside work to ensure that their rural/remote experience is a fulfilling one.


Four steps to boost rural/remote recruitment and retention

To hire and keep staff in hard-to-recruit-for areas, employers need to take a candidate-centric focus for both recruitment and retention efforts. There are four steps to enable this approach:

  • Step

    Reframe the ‘limitations’ of working in your area

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    Refocus recruitment to determine rural/remote ‘fit’

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    Front-load career development

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    Involve the community in recruitment and retention

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Parting thoughts

The health care landscape is rapidly changing, especially in rural/remote areas. To remain attractive to candidates, these rural/remote organizations need to not only reconsider the ways they recruit and retain staff, but also reconsider who can deliver that care (and how it’s delivered).

As telehealth becomes common for rural care, so will telecommuting

Rural/remote organizations have been at the forefront of the adoption of telehealth and virtual care. With the Covid-19 pandemic, these platforms have become common methods of care delivery. The question now is how to use telehealth as a recruitment and retention driver. Around the world, older and retired clinicians have shifted to telehealth roles: a model for retaining staff who are nearing retirement. Additionally, as the number of telehealth roles expand, so too will the opportunities for telecommuting, suggesting that recruitment pipelines will grow as well.

Will the ‘country doctor’ be replaced by the ‘country NP’?

The number of advanced practice providers has increased greatly in recent years. And as those numbers have grown, so has the role those clinicians play in care delivery. This change has been especially prominent in rural areas, with the share of nurse practitioners (NPs) in particular growing significantly. Rural/remote organizations need to consider how their overall workforce profile can change to incorporate new roles, as well as work with officials to expand scope of practice.

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