Selling doctors on rural communities
Recruiting doctors to small towns is a chronic problem. Most places try to lure a physician by rolling out the red carpet with a big salary, a home on a golf course or other cushy perks.
Not so in Ashland, Kan., population 855, where the head of a tiny hospital is building a reverse recruitment model based on remote access and problems commonly found in third-world countries.
Benjamin Anderson, Ashland Health Center’s CEO, has created what he calls mission-focused medicine, offering up to eight weeks off for missionary work. He’s found that a doctor who is willing to sleep on a cot in the Amazon or treat earthquake victims in Haiti is ready to serve in rural Kansas.
Candidates get a reversal of the red carpet from Anderson. His first question is: “Do you know where we are?”
“We’re two hours from a Starbucks,” Anderson said. “We’re an hour from a Walmart. We’re five hours from a major American city. Are you aware that this isn’t all cake and ice cream? If you’re coming here, you’re coming to serve.”
Anderson has landed his first recruit in Dr. Dan Shuman, who moved here with his family from the Austin, Texas, area in July. Shuman, 41, is a former military doctor who spent a year in Iraq and has worked as a missionary in Mexico and Haiti.
Shuman said the offer of time off to continue his missionary work was what led him, his wife and their five children to Ashland. But the town’s challenges were equally attractive, he said, and Anderson’s blunt pitch didn’t deter him.
“When your primary focus is sort of a mission-based focus – when you get into things in order to try to relieve suffering or work toward eliminating disparities – then you want to know about those things,” Shuman said. “It’s appealing to see opportunities.”
Community leaders in rural areas have long struggled with getting good physicians to populate their small, and often struggling, health care facilities. Of the 2,050 rural counties in the U.S., 77 percent are considered to have primary care shortages, according to a 2005 study by the University of Washington’s Rural Health Research Center. Some 165 rural counties in that study didn’t have a single primary care physician.
Ashland is one of the last western outposts on Kansas’ open range, a dusty dot nestled up against the Red Hills, where buffalo can still be found roaming the rusty, rolling plains just north of the Oklahoma border. The area was Indian country until it became cowboy country and some families trace their ranches and farms back to the Homestead Act of the 1860s.
Dig a little deeper
Main Street has one grocery store, two banks and is capped at the end by a huge grain elevator. There’s a good restaurant in the old Hardesty House Hotel, but the local saloon closed a couple months ago. The one place to get gas is the farmer’s co-op, where credit card approval is done with dial-up.
Maybe Anderson, 32, is skilled at the anti-sell because he went for it himself. He had been working as a physician recruiter in Dallas but wanted to have the job he was so often filling at rural hospitals – the CEO. Anderson remembers the Ashland hospital board chairman being exceedingly blunt during his own interview here.
“Ben, our facilities are 55-years-old, our finances are challenged, our morale is low, turnover is up, we’ve been without an administrator for six months,” Anderson said the chairman told him. “We’ve been without a doctor for seven or eight months. We really need this facility in this community and if we don’t have this facility, we’ll lose our school. And if we don’t have our hospital and our school, this will become a ghost town very quickly.”
That clicked with Anderson and his wife, a social worker, and they felt called to move to Ashland, he said. They arrived in January 2009.
“I’ve always had to have a job that matters. I have to have a position that I know it’s not just a paycheck,” Anderson said. “I have to have a calling or a vocation that I know makes a difference.”
While working as a missionary in Zimbabwe, Anderson said he was struck by the similarities to rural Kansas. Communities in both areas have difficulty getting access to health care, feel isolated and struggle with other economic issues, he said. In addition to its remoteness, Ashland has an aging population and a growing Hispanic workforce from the local meatpacking plants.
“When you recruit a mission-focused provider, they want to see the ghettos. They want to know that there’s no Spanish-speaking provider in more than a one hour drive. They want to see houses that are falling down, widows that are uncared for,” Anderson said. “They want to know that there’s need and that by them coming there they would fill a disparity that would otherwise not be filled.”
Georgeann Lang, who belongs to a fifth-generation Clark County family, returned to Ashland with her husband, Bill, about two years ago after living in Indianapolis for 31 years. They took access to health care for granted in the city, she said, as most people do who are unaware of the remoteness of rural areas.
“If there is no doctor in this town, the nearest one is 30 miles. If you’re in a critical situation, what does that 30 miles mean?” Lang asked. “It may mean life or death.”
Click View Slideshow at the top of the page to see the health center in action
Recruiting medical students to small town America is difficult for several reasons, said Brock Slabach of the National Rural Health Association, based in Kansas City. Young graduates rarely want to work there after training in urban areas, he said. They also have huge college loan debts to repay, which calls for the larger salaries paid by the city-based hospital systems.
The trend toward specialization has also hurt rural areas, which need physicians trained to respond to a host of problems, Slabach said. Residency training slots in family medicine programs often go unfilled which has led to a shortage.
Slabach, a former hospital administrator in rural Mississippi, said Anderson’s approach appeals to those doctors who have a passion for community service.
“Often in rural communities, the vision isn’t very large in terms of what they’re there for,” Slabach said. “So, if you can expand the vision from an organizational perspective, to have a much broader base in terms of the meaning that’s provided to the work that you do, that’s incredibly powerful.”
In creating his program, Anderson sought advice from the Via Christi Family Medicine Residency Program in Wichita, which is part of a non-profit Catholic health care system. Leaders there urged him to recruit two doctors – good physicians want to work with another colleague, he was told – to offer a decent quality of life, to pay a salary in line with the national average and to encourage the doctors to do eight weeks of missionary work.
So far, Anderson has landed Shuman, a new director of nursing from Baltimore who began work this month and another doctor who has been to Ashland for interviews. He’s looking to hire a dentist to do part-time duty at the senior center, which is part of the health center, and other mission-minded employees who, he said, want to speak the local dialect, wherever they work.
“For the missionaries that end up in Zimbabwe, they’ve got to learn to speak Shona,” Anderson said. “And for the people that are living in Ashland, Kansas, we need to figure out the local way to say ‘I love you.’ Maybe that’s assisting with housing issues. Maybe that’s providing quality patient care. Maybe that’s helping on the chamber of commerce. Whatever it is, is service. Service is that common language.”