RetainingProviders in Rural KentuckyKRHA Annual ConferenceAugust 16-17, 2012 - Bowling Green, KYJan Hurst, National Rural Recruitment and Retention Network3rnet.org

• This presentation is sponsored by the Commonwealth of Kentucky Health Care Access Branch/ Primary Care Office (PCO) using federal funds provided by Health Resources and Services Administration/ U.S. Department of Health and Human Services.

objectives

• Profile trends regarding provider mobility • Note barriers to longevity in practice• List effective methods to enhance retention• Identify rural specific solutions• Develop action plan

economic climate

Cause• Unemployment and

restricted capital

• Drop in stock market

• Declining housing values and reduced employment

Effect• Delayed expansion

• Revenue shortfalls

• Retirement postponed

• Relocation unattractive

recovering economy

pent-up demand

improving

conditions

Increased Turnover

since 2008

5 - 6% turnover

pre-recession

598,000 physician jobs in US, 20% experienced turnover in 2004

cost$ of losing physician

• Recruiting replacement expenses• Cost of starting new practice• Loss of down-stream revenue

over $1 million per FTE

$50-75,000 recruiting costs

Downstream revenue loss

$900,000

New practice startup

$211,000

‘soft costs’

employee morale

more training

recruiting effort

rush & hire bad fit

practice reputation

workflow disruptions

patients defect

community dollars

Community benefit of adding

ONE family medicine physician

in Kentucky: $878,642

shortages drive competition

• AAMC predicts shortage of 159,300 by 2025

• 30,000 more primary care physicians needed in next three years for health reform

practice determinants

Geograph

ic loc

ation

81%

Call / person

al tim

e

68%

Lifest

yle

64%

seek hospital jobs

2001 • 3%

2011 • 32%

job satisfaction

• 43.5% employed

• Only employed group were significantly happier with practice than 3 years before

kentucky

primary care to population

49% below US average

28%doctors

43% population

RURAL

KY

metro not spared

2012• Primary care physician shortage looms even in Louisville

2020• Must replicate entire

current cadre just to replace those retiring

• Study did not include extra needed if health reform enacted in 2014

expansion plans 2012

83% plan hiring more PCPs

78% will hire more specialists

78% hiring NPs & PAs

2 demographics display highest turnover

Males close to retiring Young female doctors

Part time workforce 62% since 2005

1 in 4 doctors part-time

12% of

males

26% of females

offer options

• 4 day work week• Job sharing

• Floating schedule• Extended days

groups vs. hospitals 2011

75% groups offer 4-day workweek and 30% allow job sharing

5% of males & 7% females in hospital based practices worked part-time

retention strategy

Medical group plans:

76% developing hospitalist programs

65% actively hiring NPs & PAs

nurse practitioners and physician assistants

13% turnover or double current physician rate

nursing workforce

•Median age 46

•Over half ready to retire

•Recent growth in•23-26 year-olds

nurse turnover

Over $50,000

Recruit & train new nurse

To replace Critical Care nurse

Can cost as much as $120,000

greatest turnover occursin first 3 years

12.9% in second year

34% leave within 3 years

in better economic times

left in first 5 years

60%

left in first 3 years

47%

rural maybe more

rural Michigan 50%new

residentsleft first job in 3 years

causes of turnover

Practice different than expected

• Lack of feedback during first months

Poor cultural fit

• Never joined the community

practice different than expected

Longer hoursWeekend hours

Evening hoursIn-patient duties

Patient overloadScheduling

poor cultural fit

Physician or spouse never became part of community

Desire to be closer to family Respect, appreciation missing

Little two-way communicationAbsence feedback honeymoon

strong rural predictors

Hire rural raised

Or community- minded

top talent leaves

when they are badly managed

& the organization is confusing & uninspiring

those in charge

Manage

Hire ability then support

Hold accountable

Reward

leadership

•First rule of leadership: everything is your fault. -from A Bug’s Life

drive

• Control over their work

autonomy

recruit •source•hire

onboard •orientate•integrate

retain •manage •engage

optimize onboarding

Integrates new staff

Prepares them to succeed-

orientation and

includes

first year

action plan

Time line

First day, first week

At 30, 60, 90 days

Dissatifiers

Address each issue

Report on progress

Mentor / buddyProvider

Clinical mentor

Social buddy

“mentees”

More mobile workers

Social networking

Build corporate loyalty

socialization

Introduce key stakeholders (let both know in advance)

Assign cross-functional projects (helps prevent silo behavior)

Host events to connect provider & family to other physicians & community

when do you interview?

before hire

??????

exit as leaving

structure monthly

be great listener

neutral setting

take notes probe

ask

stay leave

stay interviews

What do you like about working here?

Do you feel can advance career here?

Anything I can do more of to keep you?

create culture of retention

Value employees as people• respect• support

Build strong teams• sense of

community• have fun

Empower employees• involve in

decisions• adequate

resources

be visible

accessible

openly &

honestly

practice thankfulness

crave

praise

recognition

seek out positives

chaos

sincere

encourage exercise

wellness

half said more productive

40% said more likely to stay

dealing with adversity

kindness

inner peace

resiliency

little steps mean a lot

FloorUnitOne

happiness is contagious

you

to

them

“Our greatest assets walk out the door every night, and the company desperately hopes that they return the next morning.” - Google

presenter

• Jan Hurst, MSPH, RN, FMSD, CMSR National Recruitment & Retention Network 3rnet.org Director University of Louisville Physician Placement phone 270.821.4516 fax 270.821.3647 jan.hurst@louisville.edu

thank you for all you do