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KENO-TIME!

THE CHALLENGES OF

RURAL PROVIDER

RECRUITMENTINCREASING YOUR ODDS FOR SUCCESS

Joe Butler Don O’Bryan Butler11@southeasternhealth.org

obryandr@msha.com

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AGENDA

The Challenges

Prepare for Rural Recruitment

Overcome the Challenges

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THE KENO FORMULA The probability that k of the n numbers (balls) chosen

by the player, i.e., occur in the twenty numbers (balls) chosen by the computer can straightforwardly be derived:

The number of possible outcomes equals the number of combinations of eighty balls taken twenty at a time.

The number of ways in which k of the n balls selected by the player occur in the twenty balls selected (putatively at random) by the central Keno computer is equal to the number of ways in which k balls can be chosen from a set of n balls.

The number of ways in which the remainder of the balls do not occur in the twenty balls selected is given by the number of ways in which 20-k balls can be chosen from a set of 80-n balls.

Combining the foregoing, one finds that:

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THE KENO FORMULA

Chances of hitting 20 numbers on a card are

1 in 3,535,316,142,212,173,800 *http://en.wikipedia.org/wiki/Keno

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QUESTION?

Are your chances at successful rural

physician recruitment any better than playing Keno?

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IMPORTANT DATA Mal-distribution - Nearly 25 percent of Americans

live in rural areas, but only about 10 percent of physicians practice in rural areas (according to the National Rural Health Association)

Silver Tsunami - Nationwide, 30 percent of family physicians are 55 or older. That’s up from 15 percent in 2000 (according to the American Academy of Family Physicians)

Shortage of Quality Candidates - According to a MH study, 4% of candidates want to live in a town with a population of 10k or less.

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PHYSICIAN SUPPLY

Year Supply Demand Shortage 2008 699,100 706,500 7,500 2010 709,700 723,400 13,700 2015 735,600 798,500 62,900 2020 759,800 851,300 91,500 2025 785,400 916,000 130,600

* AAMC – The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025 (June 2010)

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The data alone can create

a sense of desperation.

I’m toast.

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THE RURAL HOSPITAL ~~~~~~~~~~~~~~~~

~~PROFILES

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JCCH PROFILE

Hospital: Johnson County Community Hospital

Location: Mountain City, Tennessee

Beds: 2 inpatient beds, Critical Access facility

Designation: Health Professional Shortage Area (HPSA)

Population: 2,383

Nearest competition: Nearest hospital is in NC about 40 minutes

Description: *Extreme rural area near the W. NC border *Mostly primary care services *Emergency room and helicopter service*No surgical services, limited specialty services*Economically challenging, many employers have closed or

moved. *Nearest town >50k – 45 miles.

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NCH PROFILE

Hospital: Norton Community Hospital

Location: Norton, Virginia

Beds: 129 licensed inpatient beds

Designation: None

Population: 4,054

Nearest competition: Two competing hospitals within 8 miles

Description: *Rural SW Virginia location *Coal mining area *Unions *Economically challenged – mining jobs gone *Nearest town > 50k – 45 miles.

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SRMC PROFILE

Hospital: Southeastern Regional Medical Center

Location: Lumberton, NC

Beds: 337 licensed inpatient beds

Designation: HPSA and MUA

Population: 21,924

Nearest competition: 40 miles away

Description: * Rural SE North Carolina location * “Poorest” of NC’s 100 counties* Negative crime and educational statistics* Private, not-for-profit, positive bottom line* Nearest town > 50k – 40 miles.

* Over half of the 110 physician staff employed

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KEY FACTORS FOR SUCCESSFUL RURAL PHYSICIAN RECRUITING

1. Successful group practices to recruit to

2. Attractive compensation levels, when lower cost of living is accounted for

3. Favorable call arrangements

4. A hospital that values strong hospital-physician relationships

5. Local cultural and recreational opportunities

6. A stable economy, affordable housing, or a good education system

2008 Report to the Secretary: Rural Health and Human Services Issues, published by the National Advisory Committee on Rural Health and Human Services

KEY FACTORS FOR SUCCESSFUL RURAL PHYSICIAN RECRUITING

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THE CHALLENGE – FOUR CATEGORIES

Location issues

Hospital issues

Group issues

Candidate issues

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THE CHALLENGE:

LOCATION ISSUES

Housing options Education options Cultural amenities Shopping Access to metro area Access to an airport Spouse employment Special needs children Negative perception of rural living

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THE CHALLENGE:

HOSPITAL ISSUES - NATIONAL INFLUENCES

- US Physician Shortage- Healthcare Reform (new business paradigm)- Healthcare Economy (Won’t recover in the near

future)- Reimbursement (downward trend)- The changes in the physician workforce.- Compliance issues- Competition for Foreign Medical Graduates is intense.- Rural candidates require more scrutiny. (Are they

running from something?) - The LEAN Movement (removing waste, bringing more

value)

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THE CHALLENGE: HOSPITAL ISSUES - LOCAL INFLUENCES

Financial shape of the hospital Right-sizing the rural hospital Hospital/practice acquisitions and alignment

strategies. Competition (use to be only from the nearest

hospital) Coverage issues / Locums Older/outdated facility and equipment Non-cohesive medical staff Disconnected administration Recruiter has to do it all

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THE CHALLENGE: HOSPITAL ISSUES - LOCAL INFLUENCES

Financial shape of the hospital Right-sizing the rural hospital Hospital/practice acquisitions and alignment

strategies. Competition (use to be only from the nearest

hospital) Coverage issues / Locums Older/outdated facility and equipment Non-cohesive medical staff Disconnected administration Recruiter has to do it all

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THE CHALLENGE:

GROUP/SPECIALTY ISSUES Employment is preferred in rural settings.

Trying to recruit to a one physician practice,

particularly an older provider.

Group is not skilled in recruiting and/or

uncooperative; resistant to change.

Nepotism can be an issue.

Groups often don’t understand the new

compensation landscape.

Unaligned groups providing the same services in a

small market. (saturation)

Rural groups tend to have candidate criteria that

is too strict

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THE CHALLENGE:

CANDIDATE ISSUES

Geography is still the #1 priority for candidates

Meeting the candidate’s preferences for

lifestyle and practice

Fear of clinical isolation

Call issues

Negative perception of rural practice

Understanding the business of medicine

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TURNING CHALLENGES INTO OPPORTUNITES

Joe Butler

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MAP OUT THE PROCESS – 5 AREAS

Recruitment Strategy

Visit Strategy

Contracting

Onboarding

Start-up phase

Relations/Retention Strategy

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KEY SOURCING STRATEGIES Work with nearby training programs,

med schools, and residency programs to develop a pipeline strategy

Identify docs with ties to the area Use the strengths of your opportunity

effectively Stipends in exchange for early

commitment Rural born physicians are twice as

likely to go to a rural area; screen appropriately

Use the web whenever possible

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PREPARING FOR RECRUITMENTKNOW YOUR DATA

National Stats

Rural recruitment takes longer

Community Stats

Demographics

Hospital Stats

Develop relevant hospital statistics for the specialty

Payer mix

Group Stats

Determine relevant benchmarks (number of patients per day,

average number of procedures, call, etc)

Gather data to reinforce how a new provider will be

successful

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PREPARING FOR THE VISITASSEMBLE YOUR TEAMS

Don’t assume anything – discern n learn Before an interview/visit occurs, lay the appropriate positive foundation Identify and list your potential problems or

concerns Form the PIT Crew – (Physician Integration

Team) to include Hospital CEO, CMO, Practice Administrator, Physician, Service Line Leader, etc.

Determine additional members of the Interview Team

Notify the community support team (realtors, bankers, school reps, etc.)

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PREPARING FOR THE VISITTHE RECRUITMENT TEAM - ARE YOU SINGING THE SAME SONG?

Set up an Orientation/Education session for the

particular recruitment effort

Review why you’re recruiting, timeframe, goals, ideal candidate

Review the mapping of each phase of the entire recruitment process

Develop a practice overview (area information, hospital information,

practice information) and review the information with the team to

act as the “script”

Go over the interview expectations, what can be asked, what cannot

be asked, what information you want to push to the candidate and

pull from the candidate, assign information and interview questions

Develop and review the post-interview evaluation survey to gain

appropriate feedback by each team member

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PREPARING FOR THE VISITWORKING WITH THE PRACTICE

Rural recruitment usually means you’re working with a group that doesn’t recruit often

Deal with the issue of significant family members in the practice

Share the mapping of the process Discuss your concerns

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CONTRACTINGCLOSING THE DEAL WITHOUT LOSING YOUR SHIRT

Secure written approval for the opening; C-Suite and Providers “singing the same song”?

Prepare the necessary pro forma ahead of time.

Rural locations can expect to pay higher compensation than metro.

OVERCOMING LOCATION ISSUES

Rural locations often offer a better quality of life while being assessable to amenities of urban living; 5 minutes to work….priceless!

Screen for providers who’d rather be the “big fish in a small pond”.

GET THE VISIT! How often have you had a visit and hear “Wow-this place is much better than we expected!”

Community involvement- if family is involved, slower pace of life is the dream!

Catch Providers on Rebound; “Half-Backs”!

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QUESTIONS

THE O’BRYANDIFFICULTY RATINGFOR PHYSICIAN OPENINGS

  Question   Score1. Is the opening in a town of less than 20,000?

If Yes, add 5, if No, add 3 _______________2. Is the opening in a town of less than 10,000?

If Yes, add 5, if No, add 0 _______________3. Will this position be the only specialty in the town?

If Yes, add 5, if No, add 0 _______________4. Will this specialty be second physician in the group?

If Yes, add 3, if No, add 0 _______________

5.Does the practice have a significant family member of a physician in the Practice's administration?

If Yes, add 5, if No add 0 _______________6. Do you have adequate referral relationships?

If Yes, add 0, if no add 3 _______________7. Do you have significant competition in the area?

If Yes, add 5, if No, add 0 _______________8. Is there a documented community need for the specialty?

If Yes, add 0, if No, add 5 _______________

Add Your Total Score:  

(See key below)

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KEY

0 - 15: What are you whining about?

16 - 25: You can still do this.

26+: Call somebody right away.

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