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How to Make Your Hospital a Doctor Magnet: Recruitment, Retention, and Onboarding in 2016
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”
Resident Physician Shortage Reduction
Security Act of 2013
“A bill to amend title XVIII of the Social Security
Act to provide for the distribution of additional
residency positions, and for other purposes”
Resident Physician Shortage Reduction
Security Act of 2011
“A bill to amend title XVIII of the Social Security
Act to provide for the distribution of additional
residency positions, and for other purposes”
Resident Physician Shortage Reduction
Security Act of 2009
“A bill to amend title XVIII of the Social Security
Act to provide for the distribution of additional
residency positions, and for other purposes”
Resident Physician Shortage Reduction
Security Act of 2007
“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”
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014
• 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?
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2014
• 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?
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
X
2 additional patients visits per year
=
60 million patient visits
divided by
4,000
=
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
2025
Washington
52.3%
22.6%
11.6%
4.8%
8.3%
9.8%
8.6%
6.3%
7.5%
2.3%
6.0%
What Do You Plan to Do in the Next One to Three Years?
All
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%
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
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
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
1945 and before
Baby Boomers
1946 – 1964
Gen X
1965 – 1981
Gen Y
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)
or
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
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:
Sourcing Candidates
A Candidate is on the
Phone
Now, What Do You Say?
The “Screen” is the
“Art” of Physician
Recruiting
Becoming a Doctor Magnet:
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?
Becoming a Doctor Magnet:
Screening
14 Days
THE ARC OF PERSUASION
Becoming a Doctor Magnet:
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
Becoming a Doctor Magnet:
The Interview
WHAT IS THE
INTERVIEW FOR?
Confirmation not
Exploration
THE “70/30” RULE
ONE INTERVIEW ONLY,
PHYSICIAN AND
SPOUSE
Becoming a Doctor Magnet:
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
Continue the Conversation
If you have any questions, please
contact Kurt Mosley at:
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How to Make Your Hospital a
Doctor Magnet:
Recruitment, Retention, and Onboarding in 2016
