More recruiters making first move toward medical school residents

Why and how to target residents earlier in the recruiting process

If you’re having trouble finding physicians, consider a technique that’s becoming increasingly common in the recruiting field — targeting medical students before they’ve completed their education.

It may once have been considered robbing the cradle, but unusual times sometimes call for unusual measures. Besides, it’s not that unusual anymore.

According to a 1996 study by Cejka & Company, a St. Louis-based research and recruiting firm, and Modern Healthcare magazine, 42.4% of 269 hospitals surveyed are using early targeting as a way to bring more practitioners on board. That was 7.5% higher than the previous year, and it accounted for the single largest gain among the techniques measured in the survey.

"These are mostly rural and underserved hospitals," explains Geoff Staub, director of marketing at Cejka. "They are in a more difficult position."

The difficulty of finding people to work at small hospitals has plagued Atoka Memorial Hospital in Atoka, OK, for years, says Bruce Bennett, chief executive officer. "We are two hours from Dallas, from Tulsa, and from Oklahoma City," he says. "If you are an hour or 90 minutes away, you can usually attract people, but we are just too far."

Until two years ago, Bennett would wait until medical students completed their education before contacting them. But positions were not being filled. He decided to try a different tactic, and the last two doctors hired were brought into the loop a year prior to finishing their residencies. "When you don’t have a lot to attract people to your area, you have to find people who need funds to finish school," he says.

Know your candidate

But there are dangers in such programs. "People can change their minds," Bennett says. Checking references carefully can usually help weed out people who are not serious about moving to a small rural community. It’s even better if you know the candidates.

Attracting medical students from the proverbial backyard is the core of the program set up by Graham Hospital in Canton, IL, which serves 35,000 people in a rural area near Peoria. Ray Slaubaugh, MBA, president of the hospital, says the program’s success is helped by the fact that each of the students is known via word of mouth and has roots in the area that usually go back more than one generation.

"We find people who will come back to the area, who are not afraid to live in the same town as their parents," he says. "We start following them informally while they are undergraduates and then make formal contact when they are accepted into medical school."

For a loan covering four years of medical school, the graduates are expected to put in at least four years of service at the hospital in a needed specialty. "It isn’t just family practice," Slaubaugh says. "We have general surgery, obstetrics, urology. But if you are interested in neurosurgery or cardiac surgery, then we don’t have the population for that to work."

There are still worries — will the student change his or her mind as the various rotations are completed? Will there be a marriage or a relationship that takes the candidate away? Slaubaugh says the best way to deal with those issues is to talk about them upfront.

"We talk about the consequences. If they decide to come back, the four years of interest on the loan is forgiven, and it is possible that part of the principle will be forgiven." If they change their mind, however, the principle and interest are due and payable within 30 days. "We aren’t a bank. If you don’t commit to us, we will ask for our money back."

In the 12 years the program has been running, Slaubaugh has never had a debt not paid within that 30 days. About half of the candidates recruited in this way do actually come to the community to work. Part of the success is from the roots the future doctors have in the community, but part is from the way the students are included in the hospital from the beginning of the recruiting process.

Slaubaugh invites them to all hospital events and during vacations encourages them to shadow doctors at the hospitals. If they are married, there are similar activities planned for the spouses.

The biggest danger — one which Graham Hospital has not yet faced — is that a student would drop out of medical school and end up in a position with less income potential. "If they just decide to go to another hospital, their earning potential is at least as high. We know they will pay back the loan. But if they don’t stay in medicine, then we have something to worry about."

Safeguarding your program

There are some simple ways to ensure that you are protected financially from students changing their minds, says Bennett. "You just have to make it a condition that if they change their minds, they pay you back. If you are fairly sure they will join you, then your papers just ask for principle and interest. If you are less sure, you tell them there will also be a penalty. That usually scares off the people who are just looking for a free ride."

Making sure the physicians perform at a certain level is another worry. Slaubaugh recommends that hospitals put in a clause that says if the physician is terminated for cause, then the loan is immediately due and payable.

"Otherwise, there could be some argument that they want to stay and finish paying off the loan," he says. "All we have now is that they be on active staff and meet staff standards. It is vague enough that any decision would currently be decided in a court of law."

Yet, having a loan program is not enough to bring someone to your community, warns Bennett. "You have to have a salary and benefit package that is also competitive. But if you don’t have the location, then offering a loan to complete medical school is a good way to get them in the door."