Recruitment and Retention Educational Resources

The shortage of healthcare workers in rural communities is the greatest rural health issue facing America today. While about 20 percent of the American population – approximately 61 million people – live in rural areas, only about nine percent of all physicians1 and 12 percent of all pharmacists2 practice in rural communities. Rural areas average about 30 dentists per 100,000 residents, while urban areas average approximately twice that number.3 Shortages of nurses (both registered nurses and licensed practical nurses) and allied health professionals also abound.

This shortage is only expected to worsen as the demand for healthcare workers nationwide grows faster than the supply over the next several years. Consider the following:

  • Overall, the Bureau of Health Professions projects that there will be a 33 to 44 percent increase in demand for physicians and a 41 percent increase in demand for RNs between 2000 and 2020.4  Unfortunately, supply is not expected to keep up with demand; projections indicate there will be a shortage of approximately 200,000 physicians and 800,000 RNs in the United States by 2020.
  • The Bureau of Labor Statistics projects that between 2000 and 2010, an additional 1.2 million (50 percent increase) nursing aides, home health aides, and persons in similar occupations will be needed to (a) cover the projected growth in long-term care positions and (b) replace departing workers.  However, the pool from which such workers have traditionally been drawn – mainly women between the ages of 25 and 50 without post-secondary education – continues to shrink.
  • The cost of medical education has reached unprecedented levels.  According to the Association of American Medical Colleges (AAMC), the average medical school debt of students from the class of 2007 was $139,517; approximately 75.5 percent of those students graduated with a debt load of at least $100,000. Given these reports, it should be no surprise that most choose to enter a subspecialty with a salary of $300,000 as opposed to primary care with a salary of $120,000.
  • The average cost to replace a critical care RN is $64,000 and the cost to replace an RN on a medical surgical unit averages $42,000, including recruitment, orientation, and non-productive time.
  • According to the Bureau of Health Professions, there is an acute shortage of pharmacists in the U.S. In February 1998, there were 2,670 unfilled full and part-time positions in the U.S. as compared to 6,920 in February 2000. Adding to this, enrollment rates in U.S. schools of pharmacy declined during this period.

As those living in rural communities already know, a shortage of healthcare workers has a profound impact in a variety of ways: decreased access, which has a profound impact on quality of care; increased stress in the workplace; increased medical errors; increased workforce turnover/decreased retention rates; and increased healthcare costs. The projected national trends will only exacerbate the impact of rural health workforce shortages that currently exist.

State Offices of Rural Health have a rich history of developing partnerships; creating, delivering and managing programs; and providing resources and technical assistance that help meet the healthcare needs of rural Americans. Therefore, these organizations can play an important role in addressing these challenges. However, new rural healthcare policies and programs and additional funding are crucial if states are expected to address rural health issues and concerns as effectively as possible.


Rural Recruitment and Retention Network (3RNet)

Recruitment and Retention Toolkit

NOSORH Resources:

For a full list of all available NOSORH resources, click here.