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 ResidentResident Physician Physician Shortage Shortage Reduction Reduction ResidentResidentSecurity Physician Physician Act Shortage ofShortage 2015 Reduction Reduction ResidentSecurity Physician Act ofShortage 2013 Reduction SecuritySecurity Act Act of of 2011 2009 “A bill to amend titleSecurity XVIII of Act the ofSocial 2007 Security “A bill to amend title XVIII of the Social Security Act“A tobill provide to amend for thetitle distributionXVIII of the of Social additional Security Act“A tobill provide to amend for thetitle distributionXVIII of the of Social additional Security residencyAct“A tobill provide to positions, amend for thetitle and distributionXVIII for other of the purposes” of Social additional Security residencyAct to provide positions, for the and distribution for other purposes” of additional residencyAct to provide positions, for the and distribution for other purposes” of additional residency positions, and for other purposes” residency positions, and for other purposes” The Physicians Foundation 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