Physician Recruiting Makeover 2016

transcript

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

Percent 66 and older

Source: AMA Master File

100,490 (13.1%)

298,310 (38.9%)

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

Source: U.S. Census Bureau

By 2030, the entire country

will be as old, on average,

as Florida is now.

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

Resident Physician Shortage Reduction

Security Act of 2015

“A bill to amend title XVIII of the Social Security

Act to provide for the distribution of additional

residency positions, and for other purposes”

A Voice for Physicians

The Physicians Foundation

www.physiciansfoundation.org

Changing Work Patterns

Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014

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

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

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

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?

Source: The Lewin Group

Primary Care Physicians Needed

30 million newly insured patients

2 additional patients visits per year

60 million patient visits

divided by

15,000 additional

primary care doctors

Supply

0.9 Million

Demand1.05 Million

The Coming Gap Between Physician Supply & Demand (2020)

Source: Center for the Future of the Healthcare Workforce (2013)

The Coming Shortage

Supply

21,800 too few physicians today

65,500 too few physicians by 2020

90,400 too few physicians by 2025

Current Physician Shortage Projections

Source: AAMC, March 2015

Shortage in

primary care will

reach 31,100 by

2025 while

demand for

specialists will

exceed supply

by 63,700 by

Washington

What Do You Plan to Do in the Next One to Three Years?

Continue As I Am 56.4%

Cut Back on Hours 18.2%

Retire 9.4%

Switch to Concierge 6.2%

Work Locum Tenens 9.1%

Cut Back on Patients Seen 7.8%

Seek a Non-Clinical Job Within Healthcare 10.4%

Seek Employment with a Hospital 7.3%

Work Part-Time 6.4%

Close My Practice to New Patients 2.4%

Other 5.3%

Now, the Good News

Physicians are seeking

alternatives…

Is your grass greener?

On the Move

Annual Physician Relocation/Turnover

Rates by Specialty

Source: SK&A Healthcare Provider Move Rates, October 2015

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%

Becoming a Doctor Magnet:Why the Grass is Greener

Quality of Life Quality of

Practice

Geographic

Location

Financial

Opportunity

Quality of Life

Quality of Practice

Geographic Location

Financial Opportunity

Practice Positioning

Objective review of the

opportunity:

• How do you stand out?

• How are you different?

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

Physicians are the Key to

Care and Revenue

Becoming a Doctor Magnet:The Right Mindset

Physician Generated Revenue

According to the Lewin Group,

the economic value of a

physician is $2.2 million

All Physicians $1,560,688

Primary Care $1,402,268

Specialists $1,607,750

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.

QualityCost

EffectivenessAlignment

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

• 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:Stay Interviews

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

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

1945 and before

Baby Boomers

1946 – 1964

1965 – 1981

1982 - 2000

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

Becoming a Doctor Magnet:Incentives/Contracts

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)

30 Lashes

(APMs)

Becoming a Doctor Magnet:The Board Must Buy-In

Education is Key

LEAVE NO STONE UNTURNED

Physician conventions

Networking with staff/community/residencies

The Internet (your site, employment sites, the Chamber site)

Direct mail (for “passive” candidates)

Journal ads (focus on residents)

High-need doctors (residents,

military, J-1s)

Becoming a Doctor Magnet:

Sourcing Candidates

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:Is Your Website Working for You…

MEASURABLE ACTIVITY

MEASURABLE RESULTS

This is the “science” of physician recruiting

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

Sourcing Candidates

A Candidate is on the

Now, What Do You Say?

The “Screen” is the

“Art” of Physician

Recruiting

Screening

“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.”

HOW DO YOU GO FROM

STRANGER TO CONFIDANT?

Screening

14 Days

THE ARC OF PERSUASION

Screening

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

Now, the Stage is Set

You’ve Got a Lot of Sweat Equity

in this Search, But…

EXPECTATIONS ARE CLEAR on both sides

The Interview

WHAT IS THE

INTERVIEW FOR?

Confirmation not

Exploration

THE “70/30” RULE

ONE INTERVIEW ONLY,

PHYSICIAN AND

SPOUSE

The Interview

THE PYRAMID OF INTEREST

The Decision

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?

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:

Kurt.Mosley@amnhealthcare.com

How to Make Your Hospital a

Doctor Magnet:

Recruitment, Retention, and Onboarding in 2016

Physician Recruiting Makeover 2016

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