The Future of Primary Care Recruitment
WORKFORCE PROJECTIONSSupply and Demand
Physician Workforce
Active Workforce
• Approximately 767,100 physicians <75 in active practice that have completed Graduate Medical Education
• Women comprise 31% of the workforce
• Physicians ages 65-75 comprise 10% of the active workforce
• Physicians ages 55-64 comprise 26% of the active workforce
• 36% of all physicians will likely retire in the next decade Association of American Medical Colleges
Physician WorkforceActive Workforce
• 240,800 (32%) in primary care • 125,600 (16%) in medical specialties• 155,300 (20%) in surgical specialties• 245,400 (32%) in the remaining specialties
240,800
125,600 155,300245,400
Association of American Medical Colleges
Physician WorkforceNew Entrants
Using Status Quo Supply Scenario approximately 29,000 Annually
• 8,500 (29%) PC Physicians • 5,200 (18%) Medical Subspecialties• 5,200 (18%) Surgical Specialties• 10,100 (35%) Other Specialties
Primary
Care
Medica
l Sub
s
Surge
ry
Other
8,500 5,200 5,200
10,100
Association of American Medical Colleges
Physician WorkforceSupply vs. Demand
• Demand continues to grow faster than supply, leading to a projected shortfall of up to 94,800 by 2025
• Projected shortfalls in primary care 31,100
• Demand for non-primary care physicians will exceed supply by up to 63,700 physicians
66,700
133,200
2025
Association of American Medical Colleges
Supply Scenarios All Specialties
Association of American Medical Colleges
2015 2018 2020 2022 2025 765,000
775,000
785,000
795,000
805,000
815,000
825,000
835,000
845,000
855,000
865,000 861,800
848,800
833,900
810,500
767,200
800,900
Retire 2 Yrs Later
GME Growth
Status Quo
Millennial Hours
Reitre 2 yrs Ear-lier
Supply / Demand ScenariosAll Specialties
2015 2018 2020 2022 2025 750,000
775,000
800,000
825,000
850,000
875,000
900,000
925,000 911,400 906,700
890,300
864,900 861,800
848,800 833,900
809,100
800,900
D - Demo/ACA/MCD - Demo/ACAD -DemoD -APRN HighS - Ret. 2 yrs laterS -GME GrowthS - Status QuoS - MillennialS - Ret. 2 yrs Earlier
Association of American Medical Colleges
Supply / Demand ScenariosPrimary Care
2015 2018 2020 2022 2025 240,000
250,000
260,000
270,000
280,000
290,000
300,000 301,600
292,300
287,100
266,700
275,600 271,200
259,500
256,700
D - ACA / MC
D - ACA
D -Demo
D- APRN High
S - Status Quo
S - Ret 2 yrs Later
S - GME Growth
S- Millennial
S - Ret. 2 yrs Earlier
Association of American Medical Colleges
Physician WorkforceOther Stats
• 1987-2010 population grew 24%, number of physicians trained only grew by 8%
• 20% of Americans live in rural areas, only 9% of physicians practice in rural areas.
• Fewer than 1% of final-year residents prefer to practice in communities of 10,000 or less
• Female physicians practice an average of 8 hours less per week than male counterparts
• Physicians under 40 practice an average of 5.7 hours less than those over 40
Association of American Medical Colleges
WORKFORCE IN GEORGIASupply and Demand
Physician Workforce“Georgia’s drought of physicians will become a
crisis”
• 52% of graduates stay in GA to practice
• 17% practice in a wheel state (112 additional FTEs)
• 10% desire to practice in a HPSA, yet only 5.8% have an obligation or visa to do so
• 36% going into practice in ‘14 are PCP (238 FTEs)
• 42% of graduates have $200k+ in debt, up from 13.4% in ‘08
• 39th for physicians per 100,000“Without changes in state’s GME, Georgia will rank last in in
physicians/capita by 2020” GEORGIA BOARD FOR PHYSICIAN WORKFORCE
Potential Solutions toBolster the PC Pipeline
• Physician Reimbursement Reform
• Dedicated funding for PCP GME
• Increased funding for PC training (title VII, Section 747)
• Medical school debt relief
Additional PCP’s Required by 20302099
Or, 38% of current workforce, due to an aging, growing and increasingly
insured population
Current PCP Workforce7,378
Highlights: GA’s Projected PCP Demand
State’s PCP ratioof 1744:1 is
greater than the national average
of 1436:1
A LOOK INTO THE CRYSTAL BALLWhat Does the Future Hold for Recruitment?
Addressing PC Workforce NeedsWhat’s Uncle Sam Doing to Help?
Proposed ‘16 budget invests $14.6 billion through 3 Key Initiatives:
• $5.2b invested in new PC Training Programs• $4.0b invested for expansion of the NHSC• $5.4b invested for expanded Medicaid reimbursement
IS THIS ENOUGH?
Growth in PC Specialties
IM FP OBG PSYC-1.00%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00% 4.50% 4.70%
2.80%
-0.40%
Growth '08 - '14
Fighting for Smaller Piece of the Pie
Non-Clinical RolesRe-search
Big Box
Commercial Payers
Contact Provider Groups
In-Home PC
Concierge Medicine
Traditional Practice
CONTROL WHAT YOU CAN CONTROLSo What Can We Do About It?
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding
Retention
WorkforcePlanning
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding
Retention
WorkforcePlanning
Employment BrandsThe Power of a Brand
These may be a little more difficult
Good Luck!Can you Guess the Company?
Sutter HealthCommunity Health SystemMayo HealthEmoryAscension
Health
Employment Brand2014 Fortune Top 100 Employment Brands
Top 5 HealthcareWho’s on the List?
1. Google Rank
2. GE Humana 51
3. Qualcomm United 81
4. Walt Disney WellPoint 89
5. Goldman Sachs Cigna 91All C
ommer
cial
Payo
rs
Employment Brand • Career Pages
Are jobs updated? Is there multimedia content?
• Job Board Presence Positions listed on general boards as well as niche sites?
• Candidate ExperienceWhat’s Glassdoor say about your brand?What’s your goodwill in the market?
• AccoladesDo you make list(s) for “Best Companies?”
• Social media Does your company blog about its culture?
• Social responsibilityHow does the company rank on veteran, diversity, and “green” lists?
“83% of workers are wary of working with a company
that has a negative reputation”
Fortune Magazine – 2014 Top 100 Employment Brands
Employment BrandFour questions leaders need to know the
answer to1. Why would someone want to work for you?
2. What percentage of your managers have received training on how to deliver the brand experience? Employer Brand International research found only 26% have
3. What is the perception employees and candidates have about your employment brand?
4. How many of your employees would recommend your company as a great place to work?
Employment BrandGlassdoor.com
Facility Rating
Hamilton Medical Center 4WellStar Health System 3.2Archbold Medical Center 3.1Southeast GA Health 2.7Tift Regional 3.1Houston Healthcare 3.4Floyd Medical Center 3.0St. Mary’s Healthcare 2.7
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding /
Retention
WorkforcePlanning
Primary Care Job Design / Comp & Rewards
Support their Interest • Research• Academics• Missionary Work
Employment is the New Standard
In or OutNot Both
One Size Doesn’t Fit All• Flex-Schedules• Job Sharing• Part Time
Primary Care Job Design / Comp & Rewards
$ shown in Thousands 2014 2015 Increase
FP Traditional $211 $221 4.6%
FP Outpatient Only $195 $215 9. 6%
Hospitalist (FP trained) $245 $279 12.1%
Hospitalist (IM trained) $254 $264 3.6%
Psychiatry $227 $246 7.6%
MGMA
Primary Care Job Design / Comp & Rewards
How do you Compare?
Update your agreement
Student loan assistance is a
crucial KiSS
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding
Retention
WorkforcePlanning
ProcessProcurementPartnershipsJob BoardsMobile PresenceVisibility / ReachLose the Taboos
Screening / BackgroundMotivationsCultural fitSpouse / KidsGet’em on a plane
Interview ManagementMilitary PrecisionInterview TeamWOW the Spouse70% Social
ContractingLOI 48 hoursContract 7 days• w/ deadlinePrep for contract
MeasureCxPChannel SuccessCritical GapsKPIs
#1 Client Issue We See
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding
Retention
WorkforcePlanning
OnboardingThree critical periods
Signature to Start Date
• Practice Startup Planning• Communication Strategy
• Family Involvement
Start Date thru 90 days
• Welcome Sessions• Facility Acclimation
• Practice Developing Planning• Mentor Assignments
• Peer Support
90-days onward
• Practice Health / Wellness Reports• Practice Acceleration Team• Hardwired CxO Touches
• Anniversary / Milestone Check-Ins
OnboardingNeed more ammunition?
Onboarding and Mentoring Improves Retention
A significant majority (85%) have an onboarding process for physicians, yet only 33% of these groups stated their process is formalized through an onboarding committee or task force Groups who assign a mentor during onboarding reported a lower overall turnover rate of 5.8% compared with the 7.2% average turnover for all groups. Extended onboarding correlates to higher retention of physicians in the early years. Groups that provide a year-long onboarding process reported a turnover rate of 9% compared with the average 12.5% for physicians between two and three years with the practice, when turnover peaks.
Retention Facts• National average for physician turnover 7.2%
• Turnover for new grads is 12.4% by year 3
• The average physician generates $1.4 million for their organization
• For every one-point improvement in leadership score, there was a 3.3% decrease in likelihood of physician burnout and a 9% increase in physician satisfaction. - HealthLeaders
• Turn over cost estimates could average between $250,000 to well over $1.0 million depending on calculations used
• Primary care physicians receive 40+ solicitations per week
RetentionUnderstand the Psychology Behind Decisions
to Leave• Burnout• Practice is different than expected or explained• Lack of or poor feedback during first months• Desire to be closer to family• Lack of connection with community• Lack of control over practice• Lack of communication / appreciation from CxO
FP
IM
OBG
PSYC
Ped
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
RetentionPCP Burnout
MedScape
RetentionBurnout Factors
Bureaucratic TaskWork Hours
Impact of ACACog in a WheelLack of Income
Lack of Professional FulfillmentInadequate patient care
Too many difficult patientsComputerization of Practice
Difficult ColleaguesCompassion Fatigue
Difficult Employer
- 1.0 2.0 3.0 4.0 5.0 6.0
The Physicians Foundation
Key findings of the survey include:• 77.4% are somewhat pessimistic or very pessimistic about the future of the medical
profession. • 84% of physicians agree that the medical profession is in decline. • 57.9% would not recommend medicine as a career to their children or other young
people. • 35% would not choose medicine if they had their careers to do over. • Physicians are working 5.9% fewer hours/week than in 2008, resulting in a loss of 44,250
FTEs from the workforce.• They see 16.6% fewer patients per day than they did in 2008, a decline that could lead to
tens of millions of fewer patients seen per year.• 22% of their time spent on non-clinical paperwork, resulting in a loss of some 165,000
FTEs.• 60% of physicians would retire today if they had the means.• Younger physicians, female physicians, employed physicians and primary care physicians
are generally more positive about their profession than older physicians, male physicians, practice owners and specialists.
• In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.
• 82% of physicians believe doctors have little ability to change the healthcare system.• 92% of physicians are unsure where the health system will be or how they will fit into it
three to five years from now.
Retention
Control
Employment Brand
Job Design/ Comp. & Rewards
Process
Onboarding
Retention
WorkforcePlanning
Workforce PlanningIf 36% of physicians are over the age of 55, and 60% would retire today if they could, we must have a plan in place to replace them
• What skills do you require today vs. what you will need for the future> Different care models, team-based approach, ACO’s, PCMH
• What does the community need show for 3 and 5 years out
• Who on your staff falls into the nearing retirement category> Have you had candid conversations about retirement plans
• How can you retain those planning to retire
Recruit | Engage | RetainBreak Through the
Clutter!
Let’s face it, we all think we live in utopia.
You have to stand out from the crowd.
It is our job to sell candidates on why we are different.
This is a fight and your competition is sitting right next
to you!
Questions