How to Make Your Hospital a Doctor Magnet: Recruitment, Retention, and Onboarding in 2016 Physician Recruiting in 2016
There’s good news…
…and bad news. First, The Bad News
The Physician Shortage is Likely to Get Worse Before It Gets Better Who is on the Team Today?
The Physician Workforce Total In Practice 767,100 Number in primary care (FP, IM, PED) 246,239 (32.1%) Number in specialties 520,861 (67.9%) Total residents and fellows 123,190 Total final year residents 30,212 Percent male 530,833 (69.2%) Percent female 236,267 (30.8%) Percent international medical graduates 250,075 (32.6%) Percent 56 and older 298,310 (38.9%) Percent 66 and older 100,490 (13.1%)
Source: AMA Master File Rising Demand
50 million more people from 2000 to 2020
We will be adding the population of England Rising Demand
150,000,000 Additional Physician Visits Per Year By 2020 Based On Population Growth Alone (3.0 visit per/pop X 50 million population growth) Florida is Our Future
By 2030, the entire country will be as old, on average, as Florida is now.
Source: U.S. Census Bureau Physician Supply Capped
• Balanced Budget Act of 1997 capped number of residencies supported by Medicare
• Curtailed physician supply due to estimates of 100,000 too many physicians by 2000 Supply Static
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A Voice for Physicians www.physiciansfoundation.org Changing Work Patterns
Physician Practice Patterns • Physicians are seeing 3.0% fewer patients per day than in 2012 • They are working 6.0% fewer hours from 2008 • They spend 20% of their time on non-clinical paperwork
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014 Result: A “Silent Exodus”
• A 6% reduction in work hours (from 2008) = a loss of 44,250 FTEs • 3.0% fewer patients seen per = over 30 million fewer patient encounters • 20% of time spent on paperwork = a loss of over 139,000 FTE’s
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014 What Does the Future Hold?
• Employed physicians see 7.8% fewer patients per day than owners • Female physicians see 11.7% fewer patients per day than males • Physicians older than 45 see 3.5% fewer patients per day than those under 40
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014 What Has Changed? What Has Changed?
Since 2012, the healthcare system in the United States has seen more changes than in any comparable two-year period in recent memory • Enrollment of 12.7 million people in insurance plans through the Affordable Care Act (ACA)
• The enrollment of an additional five million Americans in Medicaid
• The number of retail clinics doubled and the number of patient visits is estimated at 10.8 million per year
• An unprecedented number of hospital and medical group consolidations
• A growing physician shortage, dramatically highlighted this year by long lines at Veterans Administration facilities How Many More PCs?
Primary Care Physicians Needed 30 million newly insured patients X 2 additional patients visits per year = 60 million patient visits divided by 4,000 = 15,000 additional primary care doctors
Source: The Lewin Group The Coming Shortage
The Coming Gap Between Physician Demand Supply & Demand 1.05 Million (2020)
Supply 0.9 Million
Source: Center for the Future of the Healthcare Workforce (2013) Current Physician Shortage Projections Shortage in 21,800 too few primary care will physicians today reach 31,100 by 2025 while 65,500 too few physicians by 2020 demand for specialists will 90,400 too few exceed supply physicians by 2025 by 63,700 by Source: AAMC, March 2015 2025 What Do You Plan to Do in the Next One to Three Years?
All Washington Continue As I Am 56.4% 52.3% Cut Back on Hours 18.2% 22.6% Retire 9.4% 11.6% Switch to Concierge 6.2% 4.8% Work Locum Tenens 9.1% 8.3% Cut Back on Patients Seen 7.8% 9.8% Seek a Non-Clinical Job Within Healthcare 10.4% 8.6% Seek Employment with a Hospital 7.3% 6.3% Work Part-Time 6.4% 7.5% Close My Practice to New Patients 2.4% 2.3% Other 5.3% 6.0%
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014 Now, the Good News
Physicians are seeking alternatives…
Is your grass greener? On the Move
Annual Physician Relocation/Turnover Rates by Specialty
2012 2015 Orthopedic Surgery 10.2% 10.6% Psychiatry 14.2% 14.6% Family Medicine 12.6% 13.5% Internal Medicine 11.3% 9.3% General Surgery 11.4% 11.2% OB/GYN 11.4% 10.7% Average 12.1% 12.0%
Source: SK&A Healthcare Provider Move Rates, October 2015 Becoming a Doctor Magnet: Why the Grass is Greener
Quality of Quality of Practice Positioning Life Practice Quality of Life Quality of Objective review of the Practice opportunity: • How do you stand out? • How are you different? GeographicGeographic FinancialFinancial LocationLocation OpportunityOpportunity Becoming a Doctor Magnet: A Sound Model is a Good Beginning
A Sense of Urgency
Hospitals, medical groups, CHCs all are looking for the same doctor you are Becoming a Doctor Magnet: A Sense of Urgency is a Good Beginning
Multiple Service Sites…
• Academic Centers • Hospitals and health systems • Large group practices • ACOs • Free standing emergency departments • Urgent care centers • Retail clinics (NP/PA’s Walgreens) • Employers • Insurance Companies
…All Seeking Physicians Becoming a Doctor Magnet: The Right Mindset
Physicians are the Key to Care and Revenue Physician Generated Revenue
All Physicians $1,560,688 Primary Care $1,402,268 Specialists $1,607,750 According to the Lewin Group, the economic value of a physician is $2.2 million
Source: Merritt Hawkins 2016 Physician Inpatient/Outpatient Revenue Survey Cost/Benefits
Specialty Revenue Salary Cardiology (Non-Inv) $1,260,971 $461,000 Cardiology (Invasive) $2,448,136 $570,000 Family Practice $1,493,518 $225,000 Gastroenterology $1,422,677 $482,000 General Surgery $2,169,673 $378,000
Source: Merritt Hawkins 2016 Physician Inpatient/Outpatient Revenue Survey Moral: Value Your Physicians
Despite the growing number of providers, physicians are at the center of the system and control 87 percent of all spending on personal health.
Cost Quality Alignment Effectiveness
Are largely in their hands Recruitment and Retention
Two Sides of the Same Coin Recruitment
HOW DO YOU ATTRACT PHYSICIANS?
Make the practice environment as efficient, open, remunerative and appealing as possible. Retention
HOW DO YOU RETAIN PHYSICIANS?
Make the practice environment as efficient, open, remunerative and appealing as possible. Becoming a Doctor Magnet: Retention
Physicians are not pulled from their practices…
…they are pushed. Becoming a Doctor Magnet: Check Twice, Onboard Once
• Effective onboarding practices start well before the doctor gets to town • Onboarding checklists increase productivity, make the new physician happier, and provide cost savings • Incorporate family onboarding into the checklist system Becoming a Doctor Magnet: Stay Interviews
• Informal one-on-one meetings conducted 30, 60, 90 and 180 days after the physician starts the new position • Not performance evaluations, but rather a casual and friendly exchange to learn how the physician is adapting to new community • Should also address how the doctor feels they “fit in” with others in the practice both clinically and philosophically Becoming a Doctor Magnet: Have a Vision!
Where will your facility be in 2 years? 3 years? 5 years? • An ACO? • Bundled Payments? ($27,870) • Employed Model? • Traditional Acute Care? • Outpatient? • Needs Assessment? The Key to Being a Doctor Magnet
First and foremost consider the “primacy of the workshop”. Give physicians a haven.
Physician communication (formal & informal) Physician employment Pay for ED call Hospitalist program Gain Sharing/Joint Ventures Appropriate nurse staffing Timely test turnaround Access to patient data Consistent OR availability Enhanced ER triage Convenient parking Marketing/Contracting By Embracing a New Staffing Paradigm
THE “CONE OF COMPLEXITY” The Age of Teamwork
Medical specialists Primary care physicians Pharmacists (PharmD) Advanced practice Nurses/PAs Nurse specialists Therapists LPNs Nurses aides Case managers Are PAs and NPs the Answer?
83,000 Physicians Assistants 2/3 in specialties 1/3 in primary care Median salary: $91,000
155,000 Nurse practitioners 75% in primary care 25% in specialties Mean salary: $93,310
A 20% deficit by 2025
Source: American Academy of Physician Assistants, American Academy of Nurse Practitioners, “Physician shortage isn’t the only looming one,” Advance for Nurse Practitioners & Physician Assistants, July 28, 2011 Four Generations of Doctors
Traditionalist Baby Gen X Gen Y 1945 and Boomers 1965 – 1981 1982 - 2000 before 1946 – 1964 Becoming a Doctor Magnet: Incentives/Contracts STANDARD RECRUITING CONTRACTS TODAY TYPICALLY WILL COVER... Salary and production bonus Income guarantee Educational loan forgiveness Continuing Medical Education Duties/Patient Encounters Hours/Schedule Vacation Benefits Termination From Fee-for-Service to Fee-for-Value
What are the metrics involved in changing compensation formulas? What is the “Goldilocks Zone”?
The right formula for balancing volume and value MACRA Gives Physician Who Wish to Bill for Medicare Services Two Choices
Walk the Plank (MIPS) or 30 Lashes (APMs) Becoming a Doctor Magnet: The Board Must Buy-In
Education is Key Becoming a Doctor Magnet: Sourcing Candidates
LEAVE NO STONE UNTURNED
Networking with staff/community/residencies
The Internet (your site, employment sites, the Chamber site)
Direct mail (for “passive” candidates)
Journal ads (focus on residents)
Physician conventions
High-need doctors (residents, military, J-1s) Becoming a Doctor Magnet: Is Your Website Working for You…
OR AGAINST YOU?
• Section specific to physician recruitment
• Physician video testimonials!
• Virtual tour (facility & real estate)
• Consistent with Chamber of Commerce Becoming a Doctor Magnet: Sourcing Candidates
MEASURABLE ACTIVITY = MEASURABLE RESULTS
This is the “science” of physician recruiting Becoming a Doctor Magnet: Sourcing Candidates
SOMEONE HAS TO GET ON THE PHONE Usually after hours or on weekends
Suggested Telephone Metrics for In- House Recruiters
100 dials per week 10 physician contacts per week 3 Healthcare Center opportunity presentations 1-2 candidate referrals from physicians contacted 1 potential candidate sourced per week Becoming a Doctor Magnet: Screening
A Candidate is on the Phone Now, What Do You Say? The “Screen” is the “Art” of Physician Recruiting Becoming a Doctor Magnet: Screening
HOW DO YOU GO FROM STRANGER TO CONFIDANT? “Leave your practice, Doctor, take your kids out of school, sell your home, and quit the country club, because have I got the deal for you. Trust me.” Becoming a Doctor Magnet: Screening
THE ARC OF PERSUASION
14 Days Becoming a Doctor Magnet: The Interview
Now, the Stage is Set You’ve Got a Lot of Sweat Equity in this Search, But…
You know your candidate (written profile, professional and personal) The candidate knows you (setting, hours, finances, mission, etc.) Your offer is ready Your team is ready The interview itinerary is ready
EXPECTATIONS ARE CLEAR on both sides Becoming a Doctor Magnet: The Interview
WHAT IS THE INTERVIEW FOR?
Confirmation not Exploration THE “70/30” RULE
ONE INTERVIEW ONLY, PHYSICIAN AND SPOUSE The Decision
THE PYRAMID OF INTEREST Success!
Now, it is time to incorporate the new physician into the Retention Program while the Recruitment Cycle begins again. What Does the Future Hold? Continue the Conversation
A Raised Hand – Blog by Kurt Mosley
Follow on Twitter: @Kurt_Mosley Continue the Conversation
Rural Physician Recruiting Challenges and Solutions Physician and Hospital Reimbursement: From “Lodge Medicine” to MIPS Telehealth: The Integration of Telecommunication into Patient/Provider Encounters Population Health Management and Physician Staffing Convenient Care: Growth and Staffing Trends in Urgent Care and Retail Medicine Psychiatry: “The Silent Shortage” The Aging Physician Workforce: A Demographic Dilemma Nurse Practitioners and Physician Assistants: Supply, Distribution, and Scope of Practice Considerations The Physician Shortage: Data Points and State Rankings Physician Supply Considerations: The Emerging Shortage of Medical Specialists The Economic Impact of Physicians Ten Keys to Physician Retention Continue the Conversation If you have any questions, please contact Kurt Mosley at: [email protected]
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