THE PHYSICIAN
RECRUITING MAKEOVER:
HOW TO MAKE YOUR
FACILITY A DOCTOR MAGNET
Presented to: The GHA Center
for Rural Health Annual Meeting
PHYSICIAN RECRUITING IN 2013
THERE’S
GOOD
NEWS
AND BAD
NEWS
FIRST, THE BAD NEWS
THE PHYSICIAN SHORTAGE IS LIKELY TO
GET WORSE BEFORE IT GETS BETTER
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)
Does not factor
in age
demographic
75 MILLION BABY BOOMERS
BEGAN TURNING 65 IN 2011
PATIENT VISITS BY AGE
Physician Visits By Age
6.0
66+ yrs.
5.4
46-65 yrs.
3.4
35-45 yrs.
2.2
23-35 yrs.
1.5
16-24 yrs.
2.0
0-15 yrs.
0.0
1.0
2.0
3.0
4.0
# of Annual Visits
Source: National Ambulatory Medical Care Survey; www.cdc.gov
5.0
6.0
7.0
FLORIDA IS OUR FUTURE
By 2030, the entire
country will be as old,
on average, as Florida
is now.
Source: U.S. Census Bureau
SUPPLY STATIC
PHYSICIAN SUPPLY HAS BEEN STATIC
FOR ABOUT 20 YEARS
24,000 – 25,000 new doctors per year
THE PHYSICIANS FOUNDATION
New Survey
A Voice
Available
for Physicians
in September 2014
www.physiciansfoundation.org
10
SHRINKING FTEs
The Physicians Foundation reports
physicians are working 6% fewer hours
versus four years ago…
A loss of 44,000 FTEs
Source: The Physicians Foundation/ Merritt Hawkins 2012 Survey of America’s Physicians
CHANGING WORK PATTERNS
• Physicians are seeing 16.5% fewer patients per
day than in 2008
• They are working 6% fewer hours
• They spend 22% of their time on non-clinical
paperwork
Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2012
RESULT: A “SILENT EXODUS”
• A 6% reduction in work hours = a loss of
44,250 FTEs
• 16.5% fewer patients seen per = over 100
million fewer patient encounters
• 22% of time spent on paperwork = a loss
of over 165,000 FTE’s
HOW MANY MORE PCs?
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
Source: The Lewin Group
PROJECTED SHORTAGE OF
PHYSICIANS BY SPECIALTY BY 2025
Doctor Deficits
Primary care………46,000
(37% deficit)
Surgery……………….41,000 (33% deficit)
Other patient care…29,000 (23% deficit)
Medical specialties….8,000 (7% deficit)
Source: Association of American Medical Colleges/Modern Healthcare/December 1, 2008
GEORGIA
PHYSICIAN WORKFORCE
Active Physicians per 100,000
Georgia
State Median
Rank
214.7
244.5
39th
Active Primary Care per 100,000
Georgia
State Median
Rank
76.1
90.3
41st
Source: 2013 State Physician Workforce Data Book
GEORGIA
PHYSICIAN WORKFORCE
Percentage of Active Female Physicians
Georgia
State Median
Rank
31.4%
30.8%
22nd
Percentage of International Medical Graduates
Georgia
State Median
Rank
20.6%
18.2%
22nd
Percentage of Active Physicians Age 60 or Older
Georgia
State Median
Rank
24.7%
26.5%
43rd
Source: 2013 State Physician Workforce Data Book
NOW, THE GOOD NEWS
Physicians are seeking alternatives…
Is your grass greener?
Recruitment Process
• Opportunity Analysis
– Objective review of the opportunity
• What are the strengths? What are the challenges?
– Four Quadrants
•
•
•
•
Quality of Life
Quality of Practice
Geographic Location
Financial opportunity
– Practice positioning
• No opportunity is all things to all people
• How do you stand out? How are you different?
Footer Text: Detail/Disclaimer 01/07/10
How do we stand out in a
crowded market?
• In rural America, 50-60% of the
hospitals are actively recruiting primary
care.
• What differentiates our opportunity from
all of the hospitals in a 100 mile radius?
– Work schedule (5 days, 4 days, extended
hours)
– Outpatient vs. Traditional
– Daily hours
– Be flexible
Footer Text: Detail/Disclaimer 01/07/10
Inpatient care
• Hospitalist program
– Neighboring community hospitalist group
– Independent service provider
– Have local physician provide hospitalist
service
• Provide call coverage compensation
– Impacts candidate profile
– ED physician assistance
– Pediatrics
Footer Text: Detail/Disclaimer 01/07/10
How do we bring the physician
into our community?
• Hospital employment model
– New recruits looking for employed position
– Local physicians looking to leave PP
• Private practice model
– Partnering with practice groups
• Local
• Neighboring community
– Community health center
– Solo private practice
Footer Text: Detail/Disclaimer 01/07/10
Sharing Common Vision
74% of hospital
leaders say they plan
to employ a greater
percentage of
physicians in the next
12-36 months.
23
71% of hospital
leaders say they have
received increases in
requests from
physician groups for
employment.
74% Yes
71% Yes
26% No
29% No
Source: HealthLeaders Media | Intelligence
Physician Alignment in an Era of Change
September, 2010
Think outside the box
• Strategic community partners
– Community Health Centers
• http://gaphc.org/ Primary Care Association
• Duane Kavka, Executive Director
• NACHC
– Physician employment organizations
Footer Text: Detail/Disclaimer 01/07/10
Build a firm foundation
• Establish a recruitment process from the
start to the arrival of the new physician
– Finalized contract and Letter of Agreement
(LOA)!!!
– Defined roles on your team
– Have a project orientation vs. an ongoing
process
• All efforts toward concluding the search effort and
don’t stop until the search is completed.
• Have a 120 day time frame for completion
Footer Text: Detail/Disclaimer 01/07/10
Build a firm foundation
• Compensation/Benefits
– How is salary determined?
– Production bonus?
– Benefits
•
•
•
•
Vacation
Sign on bonus (forgivable loan)
Retirement
Be aware of the value of your benefit package
Footer Text: Detail/Disclaimer 01/07/10
Who are we looking for?
• Candidate profile
•
•
•
•
Cast a wide net
% of physicians are 46 and older
International Medical graduates
Candidates on visas (Shusterman.com)
– Understand what is needed to recruit a physician on
a visa
– Treat them the same as all other physician recruits
• Specialty
• Advanced practitioners (NP/PA in our top 10)
• Primary Care (IM, FP, PED, HOSP) are 4 of the top
most frequently requested specialties in our 2014
survey.
Footer Text: Detail/Disclaimer 01/07/10
ARE PA’S AND NP’s 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 of 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
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
SOURCING CANDIDATES
LEAVE NO STONE UNTURNED
Networking with staff/community/residencies
The Internet
(your site, employment sites, the
Chamber site)
Direct mail (for “passive” candidates)
Journal ads (focus on residents)
Physician conventions
High-need doctors
military, J-1s)
(residents,
SOURCING CANDIDATES
MEASURABLE ACTIVITY
=
MEASURABLE RESULTS
SOURCING CANDIDATES
SOMEONE HAS TO GET ON THE PHONE
Usually after hours or on weekends
Suggested Telephone Metrics/InHouse 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
SCREENING
HOW DO YOU GO FROM STRANGER TO CONFIDANT?
“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.”
SCREENING
A CANDIDATE IS ON THE PHONE
NOW, WHAT DO YOU SAY?
THE “SCREEN” IS THE “ART” OF PHYSICIAN
RECRUITING, AND A KEY PART OF THE “ICEBERG”
Screening/Qualifying Physicians
• Motivation(s) for change
– Why are they leaving their current position?
• Is it personal? Professional? Both?
• Candidate professional & personal goals
– Spouse goals
– Family goals
• What follows the physician screen?
– Opportunity presentation
Footer Text: Detail/Disclaimer 01/07/10
Screening, Know the Roles
Objectives Of The Screen
 Build relationship/rapport with
candidate
 Identify motivations (personal or
professional)
 Understand candidate’s priorities/goals
 Consultatively address needs vs. wants
 Determine whether candidate is a good
long-term fit for you
Screening, Know the Roles
WHO THEY ARE:
Understanding each physician is the key to
retention, and they won’t care how much you know, until they know how
much you care:
•
•
•
•
•
•
•
•
•
•
37
Family Considerations
Hobbies & Non-Practice Activities
Training & Previous Experience
Research & Subspecialty Interests
Work Ethic & Desired Schedule
Patient Encounter & Volume Preferences
Practice Management Involvement
Income Expectations
Professional Goals
Personal Goals
Screening, Know the Roles
Family Considerations
• Where were they born and raised?
• Are their parents still living?
• Do they have any siblings? What are their siblings
professions?
• Where do their extended family members live?
• How often do they travel to spend time with family?
• Are they married?
• Does their spouse work outside the home?
• Do they have any children?
• What are their children’s interests?
38
Screening, Know the Roles
Hobbies & Non-Practice Activities
•
•
•
•
•
•
•
•
Do they exercise?
Where do they vacation?
Do they play a musical instrument?
What do they do during evenings and weekends?
What are their favorite television shows?
Where do they live? How is that neighborhood?
Is their commute reasonable?
Are they a member of a local religious institution or
social organization?
• Is the physician rooted in the community?
39
Screening, Know the Roles
Training & Previous Experience
• Where did they go to medical school?
• What program provided their Residency and/or
Fellowship training?
• Are there other members of the medical staff that also
attended these schools?
• What other positions have they previously held?
• Do they have skills developed in prior opportunities that
could benefit this current role?
• Why did they relocate from any earlier practices?
• Is their present job fulfilling prior unmet needs?
40
Screening, Know the Roles
Research & Subspecialty Interests
• Do they have Fellowship training which is being under
utilized?
• What research projects and/or clinical studies are listed
on their CV?
• Have they expressed interest in developing programs or
niche services (for which they’re qualified) within the
local market?
• Is there an opportunity for them to provide these
services or does supply/demand and demographics
preclude success in this style of practice?
41
Screening, Know the Roles
Work Ethic & Desired Schedule
• Are they intent on building a practice or just in being
paid for their time? Are their expectations reasonable?
• Have they requested scaling back to part-time?
• How many hours would they like to work?
• What are the needs of the community relative to the
physician’s desired contributions?
• How can on-call responsibilities be structured in a
tolerable manner?
• Do they tend to stay until the last patient is seen, or
make sure to get home on time for personal reasons?
• Are they open to the recruitment of additional doctors?
42
Screening, Know the Roles
Patient Encounter & Volume Preferences
• What is the health system’s expectation for productivity,
and does the physician believe this is both realistic and
commensurate with the compensation model?
• How many patients would the physician like to see per
(day, week, year, etc.) in clinic and/or the hospital?
• Would the physician like a slower patient flow and
correspondingly lower income?
• Is there adequate consideration for patient appointment
times relative to new patients vs. return visits?
• Are satellite locations, and trips back and forth from the
office to the hospital causing logistical difficulties and
decreasing available time to see patients?
43
Screening, Know the Roles
Practice Management Involvement
• How much involvement would the physician like in the
day to day operations of the practice?
• Does the physician possess the necessary business
acumen to run an office with staff, or lead a team with
other doctors?
• Do they expect to show up at a designated location, at a
set time, and simply see the patients that have been
scheduled for them?
• If this physician has run a successful practice previously,
are their ideas and suggestions being solicited,
appreciated and implemented?
44
Screening, Know the Roles
Income Expectations
•
•
•
•
•
•
45
Is the originally agreed upon base remuneration still in effect? Is the
physician exceeding the guarantee?
Does the physician feel the financial potential of the practice was
honestly represented during recruitment?
Is there adequate demand in the service area for the physician to earn
the income they would like?
Does the physician have an accurate sense of financial benchmarking
data, and are they able to determine if their current productivity is
being appropriately compensated relative to national norms?
Is the demography and payer mix in the market able to accommodate
a normal income range, and if not, are both the employer and
physician open to exploring alternative compensation models?
When assessing the impact of the practice, are both the physician and
hospital cognizant of factors beyond the doctor’s Professional Charges
(i.e. non-physician providers, ancillaries, inpatient revenue, etc.)?
Screening, Know the Roles
Professional Goals
• Does the doctor aspire to a Medical Director role or a “C”
level position within the health system?
• Is the physician content with their current practice style
and apprehensive about additional responsibilities?
• Do they want to continue working in the community but
run their practice privately?
• Is it possible to build a hospital employed group around
this physician leader?
• Will the physician likely need to pursue opportunities
elsewhere to achieve this perceived advancement?
• Would the physician like to change their position, to slow
down nearing retirement, or have more time for family?
46
Screening, Know the Roles
Personal Goals
• Would the physician like to move to be closer to family?
• Do they have significant student loans or other personal
obligations motivating them to earn greater income?
• Are there changes in their marital status or children
altering their professional focus and commitments?
• Does the physician need training or support in
developing their interpersonal communication skills?
• Is there a negative relationship with a colleague,
administrator or staff that needs to be addressed?
• What are the goals of the physician’s spouse and how
are these impacting the families professional decisions?
47
Opportunity Presentation
– This is your one shot!
– Comprehensive presentation
• Community
– Broad to narrow focus on region
• Opportunity
• Hospital
• Financial package
– Salary + realistic financial expectations
– Email follow up that day with supporting
documents/web links / presentation
summary
– Telephone follow up within 4-5 days with
confirmed next steps
48
Edit Footer Text 01/07/10
The Road to the Interview
THE ARC OF PERSUASION
14 Days
Candidate Interview
• One interview process with Physician
and spouse
• 70% Social
• Recruitment team to include community
members of similar age and station in
life
• Separate spouse interview
• Confirmation, not exploration
• Goal is to secure physician
Footer Text: Detail/Disclaimer 01/07/10
THE INTERVIEW
NOW, THE STAGE IS SET
You’ve got a lot of sweat equity in this search, BUT…
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

EXPECTATIONS ARE CLEAR on both sides.
THE DECISION
THE PYRAMID OF INTEREST
Educational loan repayment
• http://nhsc.hrsa.gov/loanrepayment/
• National Health Scholarship Program
– Become an NHSC site
– $30,000 - $50,000 loan repayment over a
two year period
Footer Text: Detail/Disclaimer 01/07/10
THE VALUE OF PHYSICIANS
TO HOSPITALS
2014 Physician
Inpatient/
Outpatient Revenue
Survey
PHYSICIAN GENERATED
REVENUE
• All Physicians………… $1,448,458
• Primary Care………….$1,566,165
• Specialists……………..$1,424,917
According to the Lewin Group, the economic
value of a physician is $2.2 million
COST/BENEFITS
RETENTION
RETENTION AND RECRUITMENT ARE TWO
SIDES OF THE SAME COIN
Basic Recruiter Truth 101
Physicians are not pulled
from their practices…
They are pushed.
Candidate Retention
• Two years is the magic number
– If a physician remains for 2-3 years, he/she
will establish roots in your community
• Established retention program
– Spouse program
– Formal process to monitor physician
onboarding for the first two years
Footer Text: Detail/Disclaimer 01/07/10
SUCCESS!
Now, it is time to incorporate the new
physician into the Retention
Program while the Recruitment
Cycle begins again.
If you have any questions,
please contact Mark Conley
at:
Mark.conley@merritthawkins.com
Follow Us:
THE PHYSICIAN
RECRUITING MAKEOVER:
HOW TO MAKE YOUR
FACILITY A DOCTOR MAGNET
Presented to: