The United States Bureau of Labor Statistics (BLS) reports that by 2026, openings for nurse practitioners (NPs) and Physician Assistants (PAs) will experience a ten-year growth rate of more than 36%. Many of those new grad NPs and PAs will choose to practice in big cities. As these highly talented clinicians are sought and placed in larger communities, the maldistribution of clinicians to rural communities continues. Three factors drive the need for rural hospital recruiters to grow their advanced practice provider workforce: 1) rates of physician recruitment to rural remain low and is far outpaced by demand, 2) across the country, advanced practice providers are pursuing and obtaining expanded scopes of practice with more autonomy, and 3) advanced practice providers provide quality of care comparable to their physician counterparts for lower compensation.

The question of whether NPs can fill traditional physician roles has largely been settled. Studies of acute care settings show that the appropriateness of NP-delivered care and the perceived quality of that care is comparable to that of physician-delivered care. PAs, whose work is built on a physician/PA supervision model, are also demanding and obtaining expanded scopes of practice across the country. With these expanded scopes comes the opportunity for employment of highly effective clinicians in difficult to fill rural hospital positions. The key to recruitment and retention of rural hospital NPs and PAs is to know why, how, when, and where to source rural focused candidates.

1. Understand What Expanded Scope Means in Your State. Every state has different scopes of practice for NPs and PAs; it’s important to view these scopes as living documents and stay updated on changes. Ensure clarity around Prescriptive Authority for NPs and PAs. This is especially important if you are seeking to fill a role traditionally filled by a physician, so check and plan accordingly. Important also to scope are the requirements around physician supervision ratios, as well as what supervision entails. New grad rural NPs and PAs need and expect physician supervision that’s accessible and technology based. SMS and other technology-based communication methods should be offered and encouraged when within state supervisory guidelines and with broadband availability.
2. Define Rural. Too often students or new grads have a pretty vague idea of what rural means in the context of their job opportunity search. During an interview, ask what rural means to your candidates. Look for answers that point to personal experiences and are more heartfelt. One clinician I interviewed for a qualitative study advised that his interest in rural health developed when he was in a children’s hospital for an extended illness. Such learning is generally discovered when asking more probing questions. Be sure to describe in all social media and promotional material how your hospital and opportunity differs from those in larger cities. Highlight those elements that pose exciting challenges – leadership building, working at the top of your practice scope. Don’t downplay the challenges, but instead focus on ways in which hospital staff helps support the new grad clinician.
3. Look for Rural Roots. Those who grew up in rural communities are more likely to have affinity for and seek opportunities in those communities. Some of this can be gleaned from a CV and a social media search, but a clinician’s history may not be revealed until interviews take place. With our mobile society, many people who aren’t rural have visited relatives who are and have been exposed to rural life. One advanced practice provider student I worked with was fascinated by Appalachian folk medicine and cures because of her own family roots in that culture in the NC mountains. She was clearly going to return to a rural practice setting when she finished training, and she did. In addition to a rural home or rural perspective/background, look for a background in an underserved community. Those from rural and underserved backgrounds share some common roots that include lack of healthcare access, and socio-economic challenges.
4. Find Candidates Trained in Rural. Some rural-trained clinicians choose to practice in non-rural settings, but most will seek to practice in rural communities upon training completion. Those recruiters in the rural primary care physician world are familiar with the Rural Residency Training model; rural advanced practice provider training programs are a newer model that offers immersion in rural settings and clinical skill development. Some programs that aren’t rural host rotations that expose advanced practice provider students to rural life and clinical experiences, all of which help them rule-in or rule-out rural practice. Check with your local Area Health Education Consortium (AHEC) to determine which academic programs sponsor rural or underserved care rotations in your state and be sure to reach out to those students or new grads.
5. Connect with Students and Faculty. Advanced Practice Program Faculty and staff are seeking non-clinical tools – real world skills – for their students. Offer to do a presentation on seeking your first job out of graduate school. This is a great way to connect with and get to know advanced practice provider students and faculty. In work with several SC advanced practice programs, I learned quickly that faculty members will often share with you (quietly) who they view as the stars of their programs. Assuming a baseline of solid clinical skills, the skillsets most valued in a new grad advanced practice provider include a “self-starter” personality; a genuine, caring demeanor; excellent time-management skills; and team-orientation. Most faculty and academic programs will also be happy to share your job postings with their upcoming grads and students.
6. Seek the second careerist. As is common in many fields, those embarking on second (or even third careers) typically have lived experience that can translate into leadership skills. These leaders make excellent rural clinicians and may serve as catalysts for change and growth in rural communities. The reason behind second career seeking may be tied to an “A-Ha moment” that involves looking for more meaning in one’s life. Making a transition to healthcare, and more specifically rural healthcare, is made for those seeking more meaningful connections with others.
7. Consider the Power Couple. People are delaying marriage and couple-hood later and later; it makes sense that the healthcare world would reflects this as well. Many Advanced Practice Provider/MD couples meet while in the healthcare space, either through interdisciplinary student rotations, or similar connections. If in your sourcing and screening you discover a couple that’s rural-oriented, seek creative ways to help employ both or connect one with appropriate employment outside of your hospital to recruit the other. Recruiting and retaining this power couple may bring additional challenges, but the value they bring is worth your time and energy.
8. Search Local. You’d be surprised how many rural clinicians find out about jobs at their church or through other rural communication methods (read “grapevine”.) Go local when looking for your rural talent; you may find there are clinical staff in your hospital training to become advanced practice providers. What better fit than someone trained in your culture who lives or works in the community already? Living in rural means you also know your community members and their families. Maybe your rural pharmacist’s daughter is working on a degree as a Physician Assistant – she may be a perfect candidate for your rural opportunity.
9. Cast A Wide Net. Work with the American Nurses Association (ANA), the American Association of Nurse Practitioners (AANP), and the American Academy of Physician Assistants (AAPA). These organizations have state and regional members with whom you can work to recruit your rural NP and PA workforce. These heavy hitters also host annual conferences where APRNs and PAs get the bulk of their continuing education. Exhibiting is a volume opportunity to talk to students and new grads and hone-in on those with rural affinity. As it goes with rural, connection with people is key, and knowing with whom to connect is critical to building a strong and stable advanced practice workforce for your hospital and community.

Nurse Practitioner and Physician Assistant Recruitment Resources

Nurse Practitioner / Physician Assistant Scope of Practice Issues

• Nurse Practitioner Prescriptive Authority: https://nursinglicensemap.com/advanced-practice-nursing/nurse-practitioner/nurse-practitioner-prescriptive-authority/
• Physician Assistant Prescriptive Authority: https://www.aapa.org/download/43592/
• State by State NP/PA Scope of Practice Policy Issues: http://scopeofpracticepolicy.org/

Find NP/PA Candidates Trained in Rural

• Find Rural NP/PA Training Programs in Your State: https://www.nationalahec.org/index.php/about-us/ahec-directory

Exhibiting Opportunities to Meet Potential NP/PA Job Candidates

• Find Your State Nurses Association: https://www.nursingworld.org/membership/find-my-state/
• Find Your State Physician Assistant Association: https://www.aapa.org/about/constituent-organizations/state-and-federal-service-chapters/
• American Association of Nurse Practitioners Events: https://www.aanp.org/events
• American Association of Physician Assistants Events: https://www.aapa.org/events/

Effective Advertising Option for Rural NP/PA Jobs

• Nurse Practitioner Job Board: https://www.hospitalrecruiting.com/jobs/Nurse-Practitioner-Jobs/
• Physician Assistant Job Board: https://www.hospitalrecruiting.com/jobs/Physician-Assistant-Jobs/
• Pricing Information (job posting includes candidate database access): https://www.hospitalrecruiting.com/pricing-information/