I spent nearly 10 years working at Enterprise Rent-A-Car before my career eventually brought me to rural healthcare. At first glance, rental cars and rural medicine don’t have much in common, but there’s a lesson from the rental car business that has stuck with me: sometimes the lowest-cost way to acquire something isn’t necessarily the best way to ensure you have what you need when you need it. For rural hospital leaders evaluating whether to employ a physician directly or partner with an organization like RPG, I think that concept is particularly relevant. Ultimately, rural hospitals aren’t hiring physicians simply to fill a schedule. They’re trying to maintain access to care close to home and keep local patients local. The question isn’t simply which model costs less. It’s which model creates the most sustainable way to deliver care to the community over time.
Why Rent a Car When You Could Own One?
Think about a business that regularly needs vehicles. The company could purchase its own fleet. If it knows exactly how many vehicles it needs, keeps them highly utilized, and plans to hold them for a long time, ownership may be less expensive. A rental company doesn’t change that math. It must buy the same vehicles, maintain them, employ people to manage the fleet, and ultimately earn a return. So why would a rational business pay a premium to rent? Because the rental company provides more than access to the vehicle. It provides the infrastructure surrounding it. Maintenance, mechanical issues, body damage, fleet management, and vehicle downtime aren’t unique problems every time they occur. Across a large fleet, they’re normal parts of operating the business. The rental company has people, systems, and processes in place to manage them, with those resources spread across a much larger operation.
More importantly, it has scale. Imagine your company owns five vehicles, and one becomes unavailable. Twenty percent of your fleet is suddenly out of service. For a large rental company, one unavailable vehicle still matters, but it occurs within a much larger system built to respond. Scale doesn’t eliminate challenges. It creates greater capacity to anticipate, absorb, and manage them.
That’s where I see a parallel to rural medicine.
“Couldn’t We Just Hire the Physician Ourselves?”
When a rural hospital evaluates a physician services partnership, that’s exactly the question its leadership team should ask. If we’re simply comparing the cost of direct physician employment to the contracted cost of a comprehensive physician services solution, direct employment may very well be less expensive.
But for a CEO or CFO, the analysis shouldn’t end there. The next question is: What does the hospital need to build, maintain, and manage around that physician to create a sustainable clinical program?
Physicians don’t practice in isolation. Successful programs require an ecosystem around them: recruiting, credentialing, scheduling, coverage planning, administrative support, operational leadership, performance management, communication, and retention. Just as importantly, physicians need an environment that allows them to focus as much of their attention as possible on caring for patients. All those elements are part of the decision, regardless of who employs the physician.
In Rural Healthcare, Scale Matters
This is where the equation can look very different for a rural hospital than for a larger organization. Consider a rural hospital that employs a single orthopedic surgeon. That physician may be incredibly committed to the hospital and community. But physicians are people. They take well-earned vacations. Families relocate. People retire. Illness happens. Careers and circumstances change.
If that physician unexpectedly relocates, retires, or takes an extended leave, the hospital may suddenly face months of recruiting efforts, temporary coverage costs, scheduling challenges, and reduced local access to care. A larger platform doesn’t prevent those challenges from occurring. It provides recruiting resources, coverage capabilities, and operational support that are already designed to respond to them.
The question isn’t whether challenges will occur. The question is how much infrastructure already exists to address them when they do.
You’re Not Just Paying for the Physician
This is where my experience in the rental car industry continues to influence how I think about our work today. When you rent a car, you’re paying for more than the use of the vehicle. You’re accessing an infrastructure that already exists around it. Similarly, when a hospital partners with a physician services organization, it isn’t simply paying for a physician’s time; it’s accessing the organization surrounding the physician.
At RPG, recruiting isn’t a capability we suddenly need to create when a hospital needs another physician. Scheduling isn’t something added to an administrator’s already full workload. Operational support isn’t built from scratch around a single program. Those capabilities already exist and support a much larger group of physicians, providers, and hospital partners. For a rural hospital that may need only one or two physicians in a particular specialty, replicating those organizational capabilities internally can be difficult.
That Infrastructure Should Work for the Physician, Too
There’s another side of this equation that’s equally important. At RPG, we effectively serve two customers: our hospital partners and our physicians and providers. A sustainable solution must work for both. Our hospital partners need reliable, sustainable physician coverage that works operationally and financially. Our physicians need an environment where they are supported, respected, and positioned to provide excellent patient care. The infrastructure surrounding a clinical program shouldn’t exist solely to create predictability for the hospital. It should support the physician, too.
A sustainable program shouldn’t depend on one physician continually carrying the weight of an entire service line. Thoughtful scheduling, recruiting support, coverage resources, communication, and operational support can create an environment where physicians have the backing they need to focus on their patients.
The hospital, physician, and partner ultimately share the same goal: creating sustainable access to care for the communities they serve.
The Cost of a Physician Isn’t the Same as the Cost of a Solution
There’s a difference between asking:
“What does this cost?”
and asking:
“What does it take to make sure the solution is there when we need it?”
For a hospital, direct employment may offer a lower expected cost. The more important question is what happens when the unexpected occurs.
For a physician, which model creates an environment where they have the support needed to take great care of patients?
The best solutions align both.
I never expected that nearly a decade at Enterprise Rent-A-Car would influence how I think about rural healthcare. But years later, I keep coming back to the same basic principle: Scale doesn’t eliminate challenges. It gives an organization greater capacity to manage them. In rural medicine, that capacity shouldn’t exist solely for the benefit of the hospital. It should benefit the physician as well. The hospital needs a clinical solution it can depend on. The physician needs a program designed to support them. And the community needs both if we’re going to keep local patients local.
Blog Author: Christopher Dick
To learn more about RPG’s service lines, explore partnership opportunities, and discover how Rural Physicians Group® is helping strengthen rural healthcare, visit www.RuralPhysiciansGroup.com.
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