Recruitment challenges, solutions, and outlooks for the rural doc shortage

Rural communities 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 rural hospitals face when trying to recruit physicians.

While roughly 20 percent of Americans live in rural areas, only about 9 percent 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.

Roadblocks to essential services in rural communities

Physician recruitment and retention in rural communities is compounded by professional isolation, limited access to continuing education, and lower compensation compared to urban counterparts².

"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,” says Richard Makowiec, Synergy Health chief medical officer. “Solving this challenge requires more than incentives; it demands a reimagining of how we support, train, and retain providers where they’re needed most."

Rural hospitals often operate on razor-thin margins, making it financially unsustainable to support full-time specialists, surgical staff, and facilities 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 rural recruitment challenges:

• Geographic isolation: Rural areas are often far from city centers and areas with access to shopping preferences, professional services, housing options, airports, and schools for a provider’s children.
• Limited financial incentives: Lower reimbursement rates and financial constraints make it difficult to attract and retain health care providers.
• Infrastructure deficiencies: Inadequate facilities and a lack of advanced medical equipment may not be 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 health care professionals.
   

Evolving solutions to combat physician staffing challenges

• 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: The Interstate Medical Licensure Compact is significantly enhancing health care 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 health care systems are increasingly relying on advanced practice providers 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 manage complex cases.
• J-1 and H-1 visa programs: These programs play a vital role in helping rural communities stay staffed with qualified physicians. Through the J-1 visa waiver program, international medical graduates 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.
• 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, academic-community partnerships create rural training tracks for medical students and residents.

"The key to overcoming physician recruitment problems in rural America lies in building a system that values flexibility, community, and long-term commitment,” Makeowiec says. “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."

Emerging physician staffing models

Beyond traditional medical education, many hospitals are 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.

Making sustainable, long-term strategies the new norm

As rural health care systems continue to navigate persistent physician staffing shortages and increasing patient needs, short-term fixes are no longer sufficient. Sustainable, long-term strategies must be prioritized to ensure rural hospitals and clinics not only survive but thrive.

Proactive strategies designed to create new opportunities for both incoming and existing physicians help ensure the resilience and success of rural health care institutions. Facilities must approach their staffing issues with a multipronged strategy that includes solutions such as:

• Increased authority for APPs: Modernizing scope-of-practice regulations for physician assistants facilitates their ability to serve effectively in rural health care teams. By empowering advanced practitioners, rural systems can become more resilient, responsive, and capable of meeting the diverse needs of their communities.
• Policy advocacy: Advocating for policies that support rural health care funding, workforce development, and education can lead to systemic improvements.
• Retention initiatives: Developing programs focused on professional development, work-life balance, and career advancement can help retain health care providers.
• Fractional staffing models: These flexible models are especially valuable for rural hospitals due to geographic isolation, limited budgets, and fluctuating patient volumes. Benefits can be great, including:
  • Cost control: Provides access to specialty care without the full expense of hiring permanent, full-time physicians
  • 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, optimizing resources without overstaffing
  • Stronger recruitment appeal: Attracts physicians who prefer variety, geographic flexibility, or semi-retirement options.
    
    
• Incentive-based recruitment: 
  • Loan repayment programs: Partnering with the National Health Service Corps or state-funded programs to offer medical education loan forgiveness.
  • Sign-on bonuses and relocation assistance: Providing competitive financial incentives to reduce barriers to relocation
  • Housing support: Offering subsidized housing, temporary lodging, or housing stipends.
    
    

• Career development opportunities: 
  • Leadership tracks: Create pathways for physicians to assume leadership or administrative roles within the hospital.
  • Continuing medical education: Offer paid CME time and access to courses or conference travel.
  • Academic partnerships: Align with medical schools to offer teaching, mentoring, or research roles.

Addressing rural recruitment challenges is not just a health care priority — it is a moral and economic imperative. The well-being of millions of Americans depends on meaningful action that goes beyond temporary stopgaps.

Through a combination of innovative staffing models, targeted federal and state programs, educational reform, and strategic community involvement, rural hospitals have a fighting chance to reverse the current trajectory. 

NRHA adapted the above piece from Synergy Health Partners, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.

About the author: Daniel Siegel, MBA, CEO at Synergy Health Partners, has dedicated more than 15 years to scaling innovative physician staffing and management programs that align incentives to support physicians and hospitals while expanding patient access to quality surgical care.

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