For physician practices, the process of filling a vacant position may take more than a year and require some creative incentives, especially for the smaller cities and towns most in need of primary care doctors.

Tony Stadjuhar, president of recruiter Jackson Physician Search, said practices know demand for doctors far outstrips supply as older physicians retire. Adding to the stress on the industry is some of the physicians retiring are what he calls the “Marcus Welby” types who were willing to work much longer hours than their younger replacements.

“Those doctors … were trained to where they virtually got no sleep. They saw a lot of patients every single day,” he said at the Medical Group Management Association (MGMA) conference in Anaheim, California. “These physicians falling off are going to probably take at least a doc and a half, at least, to be able to fill their shoes once they do retire.”

Stadjuhar emphasized practices have to plan far in advance to recruit a physician and potentially think several years ahead in terms of what doctors may be retiring and what the practice’s staffing needs will be by then. Many incentive options may ease the process for practices thinking so far in advance, from student loan repayment and tuition reimbursement to a training stipend for recent graduates which fill a need in a specific specialty to “homegrown” programs for rural communities where a practice recruits a local before they even enter medical school and assists them with those costs “from the very beginning.”

Andy Davis, MBA, CEO of the 550-bed Erie County Medical Center in Buffalo, New York, said his facility has offered $2,000 monthly stipends and up to $40,000 in student loan forgiveness, in partnership with local medical schools, to attract physicians, provided they stay at the center for at least one year.

“If you’re in a market where you have federally-qualified health centers, they’re great resources and partners to have because loan forgiveness in those organizations is sanctioned by the government and can be an easy way, especially for primary care physicians, to extinguish their debt,” Davis said.

The monetary incentives do matter, Davis and Stadjuhar said, as millennials coming of medical school typically seek a clear understanding of what they’ll be paid in salary and bonuses. There are also factors which may be important to them than money—work-life balance, paid time off and having a sense of integrity and pride with the organization they’ve chosen. As Davis put it, “It’s not about money, it’s about fit.”

These efforts could easily get lost in the deluge of job opportunities for new physicians, Stadjuhar said. He cited a physician survey from Doximity where most physicians said less than 10 percent of communications they receive from recruiters are relevant. Others are using the wrong medium to get through to available doctors, he said, “wasting money” on snail mail when most of the potential recruits would prefer to be contacted by e-mail in formats easily readable on a smartphone.

The whole process may take a year from start to finish. Despite all the calculated efforts on identifying staffing needs, offering the right incentives and targeting recruits in the most effective way, landing the right physician may require some personal touch to seal the deal—and some extra effort to make the new hire is settling in after they start working.

“When I talk to physicians after a decision and ask, ‘What made you pick this one over somebody else?’” Stadjuhar said. “Invariably, it’s that somebody along the way during the interview, either mentally or physically, put their arm around them and said, ‘You know what? You’re going to be fine. You come here, we’ll take care of you.’ Most of the time, these people are going places they really don’t know.”