• 4 Medical Doctors (3 FPs, 1 Internist)
• 1 Physician Assistant

(Existing professionals are present or former Federal Loan Repayment Program participants.)

• 1-2 Family Practitioner(s)
• 2 Nurse Practitioners
• 1 Physician Assistant
• 1 LPN and I CAN
• 1 Medical Technician/Receptionist.

• Contacted county executives for support.
• Contacted two local hospitals.
• Informed doctors of intention to provide non-profit medical care for the underserved.
• Worked with area hospitals to find buildings and equipment.

• Inviting local doctors to participate minimized resistance. Doctors offered to have patients admitted to the hospital through them.
• Negotiated with the county officials and hospitals. The hospital in Dayton turned the clinic operations over to Ocoee Regional Health Corp. Also, the county offered part of a building in exchange for assuming a portion of building's renovation and maintenance costs.

• Linkages with training institutions - a former employee teaches at East Tennessee State University, another has a link with a Physician Assistant school in Nashville.
• They have had success with retired health care professionals. Recruitment Fairs used materials from Tourism Boards and Chamber of Commerce.

• 6 Medical Doctors (2 FPs, 2 Internists, 1 OB-GYN, 1 Ped.
  
• 2 Podiatrists (part-time)
  
• 3 Dentists (2.1 FTEs)
  
• 2 Nurse Practitioners
  
• 1 Physician Assistant
  
• 1 Licensed Social Worker

(A Physician Assistant is Federal Loan Repayment Program [FLRP] participant. One M.D. and one Nurse Practitioner were formerly FLRP participants.)

• Hospital created a board to develop a clinic.
• Board was changed to a Community Board.
• Determined the community's needs.
• Developed a business plan.
• Promoted their goal of creating comprehensive community health.
• Created linkages with established health care community.

• Communicated effectively from the onset the intention to serve persons who were currently not being served. Inviting all local doctors to work at the clinic helped diffuse resistance and possibly increase participation.
• Aggressive marketing used to overcome welfare clinic stigma.
• Operated each site like a business. Reduced reliance on grant money significantly.
• Utilized technical assistance from the U.S. Public Health Service and the State.
• Educated the community about the range of health care professionals available to provide primary care.

Target Areas:

• Recruit medical students originally from the area.
• Recruit foreign nationals with American medical degrees.

Initial Screening/Interviews:

• Include leaders in the community, banking, and real estate on recruitment committees.
• Examine your needs and screen candidates accordingly.
• Interview by telephone only 3-5 candidates, including spouse.
• Prepare for interview and determine potential needs, considering religion or background.
• Cover everything: call coverage, salary/bonus, health care philosophy (e.g., willingness to provide contraception).
• Offer a constant, yet simple, incentive plan with a ceiling to all candidates.

Onsite Interviews/Selection:

• Invite spouse and family to first onsite interview, arrange for child care.
• The focus should be on the family's interests.
• Do not hide community, show it off.

• Call coverage flexibility; allow them to arrange their own calls.
• Allow peer professional development.
• Performance review at least twice per year.
• Tie family into community (e.g., PTA, Little League).

• Administrator involved in an on-going recruitment process.
• Involved clinic physicians in the recruitment process.
• Greater use of nurse practitioners.

• 13 M.D.s (6 Internists, 3 FPs, 3 GPs, 1 Pediatrician)
  
• 3 Dentists
  
• 4 Nurse Practitioners (3 Family, 1 Adult)
  
• 1 Dental Hygienist

• Formed the St. Charles Health Council, Inc. (SCHC)
• SCHC formed a cooperative agreement with Western Lee County Health Clinic, Inc. for the provision of shared services.
• SCHC convinced 3 community groups in two counties to consolidate as one CHC and affiliate with SCHC.
• Worked with county and hospital officials to establish OB-GYN services.
• Created linkages with mental health services.
• Created linkages with public health department.

• Convinced three existing community groups with similar objectives to consolidate.
• Use of the local hospital's Medical Arts building.
• Employment of physicians already practicing in the region.
• Operated each site like a business.

• Advisory Boards for each clinic and the overall Governing Board have elected community representatives. A proportional percentage of each Advisory Board's members is made up of sliding-fee clients served by that clinic.
• Each clinic has a yearly public meeting. Anyone who attends may vote for Board members.

Target Areas:

• Concentrated on professionals who knew they want to live in the area.
• Advertised in numerous journals.
• Ad hoc recruitment committees made up of board members who represent the community.

Initial Screening/Interviews:

• Use in-depth telephone interviews to screen candidates.
• Ask the candidate to work one half-day with the Medical Director or appropriate provider. If they decline, withdraw them from consideration.
• Concentrate only on candidates you know want to work in your type of community.
• Talk with spouses over the telephone.

Onsite Interviews/Selection:

• Invite spouse and family to first onsite interview.
• Keep a tight agenda.
• Determine what the candidate and the family want to see during the visit (medical facilities, schools, housing, shopping).

• Flexibility with office hours and work schedules.
• Allow peer professional development.

• A staff person devoted to recruitment and retention conducts in-depth research of candidate background, which has proved to be cost-effective and advantageous for retention.
• Practitioners have more input in management decisions and greater practice autonomy.
• Greater use of non-physician professionals.
• Balanced approach to practitioner staffing, i.e. equal emphasis on seasoned professionals.

• 14 M.D.s (4 Internists, 4 FPs, 6 Pediatricians)
  
• 1 Podiatrist
  
• 1 Pediatric Nurse Practitioner
  
• 1 Physician Assistant (currently recruiting another)

(Some physicians are Federal Loan Repayment Program participants.)

• Determined the community's needs.
• Created linkages with established health care community.

• Operate site like a business.
• Establish a Community Board.

Target Areas:

• Recruit physicians who dislike the business responsibilities of a practice.
• Concentrate on seasoned physicians who know what they want.
• Advertise in a number of publications to target a wide range of possible recruits, e.g., military publications.

Initial Screening/Interviews:

• School superintendents, realtors, and bankers should assume important roles on the recruitment committee.
• One staff person devotes 99% of the work day to recruitment.
• Screen candidates through lengthy telephone conversations.
• Conduct in-depth research on the background of candidates and family.
• Examine the employment potential of the spouse.
• Enlist support of the community to create a promotional video.

Onsite Interviews/Selection:

• Schedule a 2-day visit to include mostly social activities.
• Insist that the family attend the first onsite visit.
• Do not hide what you think may be the drawbacks of the community.
• Individuals from the community display what the area has to offer. Appropriate board members meet with the candidates.
• Do not make an offer based on only one site-visit.
• On the second visit have the practitioner work at the appropriate clinic.
• Offer 2-year contracts with salary based on experience.

• Retention at rural sites is extremely poor for providers who have never lived in rural areas.
• Individual clinic directors have a high level of autonomy.
• Have annual evaluations on time.
• Accept input from professional staff especially on the design of new facilities.
• Encourage all professionals to attend board meetings. Institute Total Quality Management (TQM).
• Take the consensus management approach. Clinic director at each site meets monthly with management team, which includes Clinical Services Director, Health Education Director, Administrator (CFO), and Human Resources Director.
• Give a "personal touch" to the professionals on your staff, giving special recognition whenever appropriate.

• 2 M.D.s (Family Practitioners)
  
• 2 D.O.s (Family Practitioners)
  
• 1 Physician Assistant

(New physicians (D.O.) at Limon and Hugo sites are Federal Loan Repayment Program participants.)

• Existing solo practitioner with the addition of NHSC doctor established a group practice.
• In-depth needs assessment.
• Created an integrated network with local hospital, nursing homes, private dental practice and local mental health and social services.
• Addition of Hugo site, PMC incorporated a physician (the town recruited) into their group practice.
• Establish monthly clinics to be conducted by visiting specialists.
• Joint effort with local hospital to solicit proposals from tertiary care centers for advice and assistance in the following areas:
  • recruitment/retention;
  • continuing education;
  • outpatient surgery;
  • collaborative purchasing;
  • specialty clinics;
  • family practice residency programs;
  • financial management; and
  • telecommunications.

• Single point of service - PMC leases space within their building to a dental practice, the local mental health agency, and a public health nursing service.
• Sound financial operation.
• Direction from the community, which must have good leadership.
• Coordinated efforts with the local hospital.
• Converted to a Rural Health Clinic (cost-based reimbursement).
• Board provides vision but stays out of day-to-day management. Solicit the advice of external experts such as NHSC representatives.
• Take initiative and risks, understand that it is okay to make mistakes.
• Currently going through Healthy Communities initiatives, funded by Colorado Trust.

• Community meetings held to determine what the people want.
• 7-member Community Board represents agriculture, education, insurance, and banking, ranging in age from 27 to 70.
• Establish advisory groups to focus on future demands, such as the inmate population.

• Board's strategy is to provide professionals with a decent facility, quality management and relatively good compensation.
• Recruitment Committee headed by one Board member.
• Upon de-designation as a HPSA designation, PMC created its own Loan Repayment Program.
• Rural preceptorship for D.O. (Denver).
• All providers are part of their recruitment committee, since they are naturally the best recruiters.
• Prepare thoroughly for onsite visits.
• Examine the employment potential of the spouse.
• Enlist support of the hospital in recruitment efforts.
• Establish productivity expectations (350 visits/month).
• Make all of your health care professionals employees of the clinic, pay their health and malpractice insurance and offer a 403(B) pension plan (available to non-profits).

• Autonomy in the practice of medicine; allow new practitioners to do things differently.
• Health care professionals not only attend board meetings, they direct the process.
• Encourage input from professional staff on the design of new facilities.
• Very supportive doctor committee oversees practice operations. All billing expenses, insurance, and money hassles handled completely by office staff.
• Continuing Medical Education (CME), mileage, and society dues paid by PMC..