Rural CEOs: The Unknown Shortage

This article first appeared in the December 2017 issue of HealthLeaders magazine.

Talk of shortages usually centers around the clinician workforce, but Benjamin Anderson, MBA, MHCDS, CEO at Kearny County Hospital in Lakin, Kansas, says rural healthcare organizations are facing another less talked about shortage: hospital administrators.

"We're investing billions of dollars as a country into the training, recruitment, and retention of really good, full-spectrum family physicians," he says. "We're investing very little comparatively into the training, recruitment, and retention of really compassionate and competent rural hospital CEOs or healthcare delivery leaders."

According to a report released in February 2017 by the American College of Healthcare Executives, hospital CEO turnover was at 18% nationwide in 2016.

In the survey, Hospital CEO Turnover in Kansas by the Kansas Hospital Education and Research Foundation, 57% of 78 current Kansas CEOs reported they had been in their positions for three years or less.

This churn of administrative talent should be of concern to those in the healthcare industry.

"They help determine the culture. The culture determines whether people stay," Anderson says.

With the retirement of baby boomers on the horizon—49% of the current CEOs in the KHERF survey are 60 years old and older—it's time to be strategic about developing a new crop of leaders who are prepared to tackle the challenges facing rural healthcare.

"Most efforts in our country to train hospital leadership or healthcare delivery leadership are designed for urban centers," Anderson says. "And we have a class of baby boomers that are retiring right now, and we do not have an adequate farm team to replace them."

Over 70% of the organizations surveyed by KHERF said they did not conduct formal succession planning. Organizations with greater than $29 million in revenues reported conducting more formal succession planning than organizations with less revenue. Less than 6% of organizations with revenues less than $6.3 million reported conducting succession planning.

"We're not often enough selecting bright students that are good in business, and wooing them to hospital administration or healthcare delivery transformation," he says.

And even in the cases where there is a focus on healthcare administration, the emphasis is geared toward the needs of urban centers. "You look at the rural states where CEOs are turning over, and very often people come there, they want to build their career, and they leave," Anderson says.

To increase the interest in and retention of rural healthcare administration, Anderson suggests establishing a model to develop rural hospital CEOs similar to the Scholars in Rural Health Program at the University ofKansas' School of Medicine.

"They're strategic in selecting bright, young students in rural areas that are great in the sciences, getting them into good premed programs, selecting them out of those programs, and recruiting them into medical school," he says. "They're so strategic about that, and we're not doing that for leadership."

Anderson says one group that has the potential to be a good source of future rural CEOs is the millennial generation.

"I think they are more mission-driven or they have a social conscience or a sensitivity with social justice that comes with the access of information that's available now. [There is more awareness] of global suffering now because of the Internet, because of information channels, so they are very socially conscious," he says.

A new study published in October 2017 in Health Affairs seems to support Anderson's assessment that work with meaning motivates millennials.

Researchers at Montana State University found that millennials (born between 1982 and 2000) are becoming RNs at almost double the rate that baby boomers once did.

Additionally, they are 60% more likely than those in generation X (born between 1965 and 1981) to become nurses.

"We're not often enough selecting bright students that are good in business, and wooing them to hospital administration or healthcare delivery transformation." 

"[Millennials] are driven by mission and purpose, and they want to be part of something that's greater than themselves, so it takes a culture that can attract them there. I would say, among many millennials, that culture is more attractive than the bright lights [of the city]," Anderson says.

Anderson acknowledges that many rural communities are dealing with challenges such as struggling schools, poverty, or poor health outcomes. While it may seem counterintuitive, being open about these issues may be key to attracting this group.

"To attract many millennials who are mission-minded, really the cream of the crop among the millennial generation, the ones who are servant-hearted, you have to identify and promote the need," he says. "We have immigrants driving for 2 hours to get to a Spanish-speaking obstetrician. We have women with female genital mutilation that are coming in to deliver a baby. That's real stuff. We're doing this in the rural community. If you want to do that, we're as competitive as anywhere in the United States.

"And as it's turning out, there are millennials that want to do exactly that. They're willing to live, as we've learned, far, far away from conveniences of an urban center, if where they live includes being part of a cohesive team and developing deep meaningful, family relationships with other people," he says.