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Retaining Providers in Rural Kentucky KRHA Annual Conference August 16-17, 2012 - Bowling Green, KY Jan Hurst, National Rural Recruitment and Retention Network 3rnet.org
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 [email protected]
thank you for all you do
