At a recent recruitment fair, a program administrator commented that he was worried about his rural numbers for the future. Over 50% of his residents had chosen rural and most of those were still in practice at their original rural location. He noted that he has recruited more out of state residents lately, but mostly he was concerned about the level of organization of the recruitment efforts in rural communities. He noted that towns in other states consistently had better information, public relations, and organization.

Most of us at the meeting were happy to hear him say that. Looking at the national figures, most medical schools and residency programs would be happy to have only small declines in the numbers choosing rural. Often rural faculty or program directors have residents show interest in a rural site, only to see them recruited elsewhere with a more organized approach. We have some handouts for those interested in more outreach to rural communities, but let me relate the story of one rural community. The story begins about two years ago. The town had just lost one of the two younger physicians and was concerned about losing the other one. Two older physicians announced pending retirements. Hopes raised as a resident with a local commitment neared graduation, but final negotiations broke down and the resident's obligation was bought out by another rural hospital.

The incident highlighted problems with communication between the hospital and others in the area. Other problems included a potential buyout of key physicians in town by an urban network. Short of physicians, the existing doctors cut down access and stopped going to satellite clinics. The future did not look so bright.

Instead of blaming poor reimbursement, politicians, or personalities, the community addressed specific problems. Personnel changes occurred. The hospital bought out and consolidated the practices of the retiring and younger doctors. The threat of loss of market to an outside force was minimized. Now more unified in effort, the community attacked recruitment. Mailings and attendance at Recruitment Fairs and family practice residency events landed some prospects. Attention to detail actually got them the original resident back as well as another physician. They have also signed with another physician who will begin in 1998! They even offered to negotiate with a female medical student with a rural obligation who just happened to be in town for a project.

The community did not make the mistake of sitting on its laurels. It continued to attend fairs and meet with residents. This is but one example, but it is worth sharing. Rural communities must organize and follow through. Rural faculty can help them in this effort. Why should we train residents rural only to lose them at graduation? A recent study at the North Colorado FP residency showed that some 40% of graduates wanted to go rural but did not. Could it be that they faced the same barriers and did not find a community willing to put forth some extra effort?

There is a role for rural faculty in this area. We can act as go betweens to insure good communication and regular contact. Too often rural communities fail to keep contact with residents. One situation exploded last year involving a resident with a commitment to a community. Over the two years since he first signed, the community lost their key physician (to become a faculty member in another state). This physician owned the clinic and was the glue that held the system together. The resident was concerned about the lack of organization and when he received little response to his requests for some evidence that the hospital would consolidate the practices or commit to develop them, he looked elsewhere and ended up going to a rural town in another state near his wife's family.    Increasing Recruitment Contact with Residents

Another community responded differently when one resident asked for similar reassurances about practice structure and call no more than every 4th night and weekend. A less diligent hospital administrator might have been incensed and presented the resident's request to the board in a different fashion. This one warned the resident that his request was a bit different for the board and the other physicians, but he presented this to the board in a positive way. He also presented concerns fairly from the board to the physician. This resident was happy to sign. His initial relationship with the community leaders has been positive. The expectations of both "sides" are more realistic. Fulfilled expectations and few surprises may be a key to retaining physicians. Faculty only had a minor role in this, but if the information flowed poorly, a faculty member could meet with the administrator or some board members.