It Takes a Village

By Carrie Vaughan for HealthLeaders News , September 26, 2007
Recruiting physicians to rural areas nationwide is challenging at best, and International Falls, MN, was no exception. The Duluth Clinic International Falls had lost several of its family physicians due to retirement and illness; as a result, its OB call went from rotating every six days to every four days, which makes recruitment even more difficult, says Administrator Sheila L. Hart. "Finding family medicine physicians who still practice OB is a challenge in and of itself. Many family medicine residency programs no longer teach OB skills to their residents."

The town’s location on the Canadian border--roughly 100 miles from the nearest community and 150 miles from the nearest tertiary-care center--along with different expectations of younger physicians looking to practice weekdays with no OB or hospital call further complicated recruitment efforts. What’s more, the clinic--like all rural facilities--faced a general shortage of physicians willing to practice in rural areas; even though 21 percent of the U.S. population lives in rural areas, only 10 percent of physicians practice there, according the American Academy of Family Physicians.

After traditional recruitment efforts proved ineffective, the clinic decided to get the community more involved. It held a "community ideation" session with community leaders in August 2006 to highlight the physician shortage and generate creative approaches to recruitment, says Hart. "Our main message to the community was that it was not our clinic and hospital that needed physicians, it was our community that needed physicians." From that meeting, the clinic, which employs four family physicians, an internal medicine physician, a psychiatrist and a general surgeon, developed a marketing campaign focused on the beauty and small-town lifestyle that International Falls offers. For instance, the clinic placed recruitment posters in the local airport with a photo of Rainy Lake and the slogan "What if you did not have to leave?" The clinic also added a bright neon sticker to its practice opportunity announcements that said: "We're looking for a doctor who isn't afraid to use leeches," and it gave away fishing lures at conferences with the Duluth Clinic International Falls imprint, Hart says.

Yet perhaps the clinic's most unconventional idea was its pitch to Garrison Keillor, host of NPR's Prairie Home Companion. In an effort to garner national media attention, the clinic sent a package to Keillor with a CD of a recruitment song composed by a local songwriter, along with a letter from the mayor and a pair of "choppers" (leather mittens). After receiving the package, Keillor, who has spent time on Rainy Lake, decided to write his own song about International Falls' recruitment needs. The song aired in April 2007 and included lyrics such as: "They don't need a psychiatrist; they're basically all right. But one who can remove fishhooks and can treat frostbite."

Hart says the song created more media buzz than direct physician contacts, but it did generate interest in the community. International Falls has seen increased success with its recruitment efforts, adding three new family physicians, a nurse practitioner and a physician assistant. "Our success is not due to any one recruitment element, but rather the result of lots of teamwork and effort," says Hart. "What is key is that recruitment becomes not just the job of the recruiter but a concentrated shared effort by healthcare administration, physicians, staff and the entire community."

Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at




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