Key Takeaways
In this article, you’ll learn…
- The scope of the leadership crisis in rural healthcare
- What is causing the challenges with rural healthcare leadership recruitment and retention
- How rural hospitals can re-frame their challenges with leadership recruitment
- How rural hospitals can successfully recruit the right leader when a leadership vacancy occurs
- Why partnering with Kirby Bates Associates is a strategic advantage for rural hospitals
The Leadership Crisis in Rural Healthcare
Cutting-edge advances in medical research, surgeries, and overall patient care are pushing the boundaries of what is possible and creating improved outcomes for patients. As outcomes improve, the patient experience becomes a stronger focus for providers and executives across the healthcare industry. And, while the patient experience is notably improving in some areas, many executives struggle to stay ahead of the curve due to a lack of resources. The difficulty in recruiting and maintaining a strong healthcare workforce touches all levels of patient care and reaches every corner of the country.
The increasing pressure on healthcare professionals contributes to the national shortage of qualified healthcare workers and impacts every level of employees within a hospital. At the leadership level, high turnover rates, rural hospital CEO turnover, a shortage of experienced executives, and a high rate of executive burnout combine to shrink the pool of high-quality leadership candidates from year to year. Longer hiring timelines and a more competitive talent market mean the cost of executive recruitment and retention is rising, and the outcome of rural healthcare executive searches matters more than ever.
For rural hospitals, leadership vacancies can significantly impact patient care by affecting access to care, coordination of services, the services offered, and the quality of care received. About 35% of hospitals in the US are classified as rural hospitals. Nearly half of rural healthcare facilities have 25 beds or fewer, and the average occupancy rate is 37%—a much lower rate than urban hospitals, which have an average occupancy rate of 62%. With a host of challenges already in place, rural hospitals can experience an even larger impact during a leadership vacancy, potentially leading to consequences for patients. Patient consequences can include:
- Reduced access to specialists
- Longer wait times
- Increased likelihood of errors
- Delays in implementing best practices
- Patient safety risks
Why Executive Vacancies Hit Rural Hospitals Hardest
While urban hospitals may also see high turnover rates and experience intense competition for qualified candidates, during a rural healthcare executive search, rural hospitals feel the impact at every level of the organization. The National Rural Health Association reported a CEO turnover rate of 20% in rural hospitals in 2020. In general, hospital Chief Executive Officer turnover rates average about 18% per year, according to the NRHA.
The absence of strong or consistent leadership can impede a rural organization from addressing other rural hospital workforce challenges. According to a report by the U.S. Joint Economic Committee in 2024, 91% of all rural counties in the US face a shortage of primary care physicians. Many rural residents go without easy access to nurses, dentists, or other licensed clinicians. Specialty care is also difficult to find in rural settings. The American Hospital Association reports that rural hospitals are closing departments such as surgery and obstetrics at increasingly high rates due to a lack of staffing. In a rural hospital survey published in HFMA Magazine in February 2025, 62% of respondents shared that their staffing needs increased in recent years, but only about 30% were able to hire additional staff. Despite these needs, rural hospital leadership recruitment presents distinct challenges in rural settings. Some common reasons rural hospitals struggle with recruitment include:
- Lower salaries
- Geographic isolation
- Heavy workloads
- Limited career advancement
- Lack of resources
Recruitment challenges in rural health impact both the hospital and the community. More than 46 million Americans live in rural communities and rely on rural healthcare delivery. So, while rural hospitals look for solutions to their recruitment and retention challenges, the entire organization’s health and performance is impacted by leadership vacancies. When services are suspended due to staffing shortages or community needs are not met due to a lack of leadership strategy, patients have to look for other care solutions. On average, rural Americans already travel more than 30 minutes for a one-way trip to receive health care.
Understanding the Unique Needs of Rural Healthcare
During a leadership vacancy at a rural hospital, the hiring team not only needs to find a qualified healthcare leader, but they must find a leader with the right experience and skills to succeed in a rural health environment. In rural areas, the strength of healthcare organizations often relies on the presence of capable, qualified leaders who can navigate the singular opportunities and challenges of serving rural communities.
To complete a successful rural healthcare executive search, it is crucial to understand the needs of the hospital and the community. While there are unique aspects to every leadership search, there are some commonalities across rural leadership searches.
Before a search committee begins looking for candidates, here are five things to consider:
Understanding the needs of the community. Rural health executives impact their community in a variety of ways. Spending a great deal of their time with community leaders, residents, local organizations, and various stakeholders, rural health leaders must have the skill to navigate conflicting viewpoints, different agendas, and the serious health needs of an underserved community.
Recognizing a unique skillset. Only 10% of physicians in the US practice in rural areas, despite 20% of the population living in rural areas. Because of this, rural leaders must be ‘physician whisperers’ and be able to successfully manage physician recruitment in rural hospitals. This is just one skill that rural health executives need for success. Search committees should focus on candidates with expertise in these areas:
- Physician and staff recruitment and retention
- Community partnership
- Strategic planning
- Relationship building
- Wearing multiple hats
- Financial planning
- Service line development
- Mentoring and coaching
Simplifying the complexity of the role. It is helpful for potential candidates, the search committee, and existing executive team members if the job description for a vacancy is clearly defined. Additionally, through the crafting of a detailed job description, the current leadership team goes through a process of defining responsibilities, shaping how the role will fit into the team, and considering future implications for this position. This legwork aids in focusing the candidate pool to high quality, highly qualified candidates and helps the hiring team to get the most from the role going forward.
Looking to the future. The strategic plan and long-term goals of the organization should be considered when defining the role for potential candidates and when identifying organizational needs. To find a leader who meets the needs of tomorrow, a search committee must recognize those needs and incorporate them into the leader they hire today.
Five Essentials for a Successful Rural Healthcare Executive Search
Rural hospital workforce challenges are multifaceted and complex. Rural organizations need the correct information and tools to overcome these challenges and successfully hire an outstanding leader. When beginning a search, the hiring committee should make sure to have these five things in place:
Expertise. The hiring committee should include members with expertise on the open position, the organization in general, the organization’s vision for the future, the community, and the executive recruitment market in the area.
National Reach. While it may seem like a way to reduce expenses to conduct only a local search, limiting the size of the executive search is risky. Reducing the reach or scope of the search can eliminate excellent candidates before the search even starts. A rural healthcare executive search with national reach is much more likely to produce top-tier candidates who have the specialized skillset and experience to meet the unique needs of a rural healthcare organization.
Support. Assuring community support is crucial for the success of a rural healthcare executive search. The search committee should involve the community, accept feedback, and partner closely with community leaders to assure that the chosen candidate is a fit for both the community and the healthcare organization.
Vision for the Future. A leadership vacancy is both a challenge and an opportunity. In order to capitalize on the opportunity, the hiring committee must have a clear vision for the future and the skills to identify a leader who will grow with that vision.
Strong Foundation. While filling one leadership vacancy is difficult, facing multiple vacancies can weaken an organization already short on resources. Future rural healthcare executive searches and all recruitment efforts will be significantly enhanced by focusing on workforce development, education, and mentoring.
Why Partnering with Kirby Bates Associates Delivers Results
During a national search for a rural healthcare executive, it is critical to have the right resources. At Kirby Bates Associates, we know how to lead a successful national search perfectly tailored to a rural hospital’s needs. Our search strategy will be designed with your community, hospital, future goals, and patients in mind. Our established executive network means you will have access to active and passive candidates nationwide who can bring new ideas to support your hospital’s culture.
In addition to guidance, support, and expertise, KBA can provide seasoned interim healthcare leadership to provide stability and assess the role’s needs. To learn more about how KBA can support your next rural healthcare executive search, contact us today or call 1-888-522-5069.
FAQ
- What are the biggest challenges in recruiting rural healthcare executives?
The biggest challenges in rural healthcare executive search are the limited talent pool, managing a search with successful scope on a limited budget, and the unique skillset needed in candidates to be successful long-term.
- How can rural hospitals attract top healthcare leadership talent?
Rural hospitals must be strategic in their approach to leadership vacancies. The right planning, approach, and partnerships can help assure success.
- How does Kirby Bates Associates help rural hospitals conduct successful executive searches?
Kirby Bates Associates is uniquely positioned to support rural healthcare organizations during a rural healthcare executive search. With experience, expertise, and a national network of qualified candidates, Kirby Bates Associates is the perfect strategic parter for rural hospitals.