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Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

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Page 1: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Physician Recruitmentis Changing…

From Defining Physician Need to Employment Contracts that Work

DAVID ANDRICKDIRECTOR OF PHYSICIAN

RECRUITMENT

Page 2: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

A Real Issue - Shortage

Association of American Medical Colleges news release Oct 2009

First-year enrollment in the nation's medical schools rose this year by 2 percent over 2008 to nearly 18,400 students.

Even with increasing enrollments we may fall short of the need• Retirements• Other career choices• Population changes

Page 3: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

The Traditional Approach

Community demographics Physician demographics Physician locations

(Accessibility) Activity levels by FTE

Physician Hospital coverage needs

Medical Staff Planning typically includes a market based Supply and Demand analysis:

Service line needs Physician group dynamics Market changes, migration and

infiltration Qualitative data from interviews Comparison to nationally

accepted ratios

Page 4: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Community Need

Changes to IRS 990 requiring greater reporting of community benefit

The Reform Bill calls for Hospitals to evaluate Community Need for services

• Need to make sure they tie together-consistent message

Leads to a more sophisticated process – including:

Community age / sex demographics – implications

Poverty levels Insurance coverage Available FQHC services

Epidemiology – major indices Impacts of innovative delivery

models (Accountable Care/PCMH) Service lines and locally available

care

Page 5: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Upgraded Need Analysis

How many IP/OP admits (on avg. and detail) are required by specialty service area to break even?

How many referring physicians are required to generate these referrals from the primary service area?

Unnecessary out-migration of cases• Changes to medical practice?

What types of physician can influence referrals to specific specialties?

Who has the data:• Service line directors/CFO• Hospital DRG/APC data• Patient migration by source with DRG/APC• MGMA physician production data

Page 6: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Changes to Medical Practice

Practice models• Employed/Independent• Multi/Single-specialty• Gatekeeper-Medical Home• Telemedicine• Use of NP/PA’s

Changes to treatment/care modalities• Use of hospitalists• Use of extenders• Technology/drug developments• Specialist services trends

Federal/State Regulations

Page 7: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Reform In the Works

• Greater emphasis on Primary Care and Prevention• Patient Centered Medical Home demonstration

projects (PCMH)• Improved Medicaid reimbursement for Primary Care

Physicians• More people with access to coverage, will they use

it?• Accountable Care Organizations to be tested• Payment bundling may affect physician contracts• Malpractice will affect recruitment (TBA?)

Page 8: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Changes to Treatment Modalities

Continuing shift to outpatient proceduresGreater use of minimally invasive surgery:

• Gastro - endoscopic procedures• Gen Surg. - use of endoscopy• Cardiac - use of coronary angioplasty • Orthopedics - arthroscopy and minimally invasive hip

replacementPrimary care use of Hospitalists for IP careOncology increasing use of Linear Accelerator and DNA

personalized treatmentRobotic surgeryTrends in birthingChronic disease management

Page 9: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Provide Supportable Calculations

Ensure consistency with Community Needs Assessments:

Keep using the traditional market driven, supply/demand data:

Understood by the government agencies Use a weighted impact on standard ratios resulting from

changes to practice modalities Recognize community need (HRSA and/or Coverage,

Service expansion) Must represent the primary service area (75% of IP) Identify Provider shortages at least over 3 year period Trended epidemiology (Regional Govt. Health Orgs) Service line need to meet future standards for care Use for Budget projections on cost

Page 10: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Greater Access May Be Problematic

Page 11: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Getting the Right Fit

Physician Recruitment is a long term investment, consider:

How competitive is the specialty Medical staff mix and characteristics Population to be served Community and recruit expectations Support structures available Hospital facilities and technology Hospital financial status Recruitment package

Page 12: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Matching Cultures

Managing expectations is made easier after

reality check:• Have you identified the recruits motivators?• What are the potential de-motivators?• What is important to the family?• What do your current medical staff say about the hospital

and administration?• Is medical staff leadership supportive?• Is there a clinical quality expectation gap?• Age and style of practice of peers and sub-specialists?• Is it a participatory environment or top down?

Page 13: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Letter of Intent - “KISS”

Key discussion points:

Page 14: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Employment Contract

Term Call coverage Indigent and charity care Outside activities Professional liability tail coverage Termination provisions Restrictive covenant Compensation Specify duties resulting in incremental compensation

Page 15: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

From the Trenches!

What’s Hot and What’s Not!• Non-competes• Call coverage and payment for coverage• E.D. Coverage and payment• CME’s• MSO services for the practice• Clinical service line directorships• Employment “v” spin off to private practice• Productivity planning• Opportunities for research

Page 16: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

From the Trenches

Be careful to avoid having an environment in which the physician spends too much time worrying about the contract terms and is not focused on patients!

Warning signs:Is my check ready?Does that include my bonus?Limited office hours

Page 17: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT
Page 18: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Employed Physicians

There is no magic bullet with employment

contracts:

Employed physicians are high level employees.As such they will thrive with good leadership

and in a good working environment where their participation is valued.

Page 19: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Income/Productivity Packages

• Straight salary

• Salary + Incentive

• RVU’s

• Net practice income

• Leasing services

• Paying for coverage

• Medical Directorships

Page 20: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

National Averages

Compensation Methods

Performance Adjusted Salary 43.8%

Fixed Salary 24.7%

Shift-Hourly-Other Time Based Payment

6.2%

Share of Practice Revenues 19.5%

Other Compensation 5.8%

Bonus Available

Yes 45.3%

No 54.7%

Sources of Practice Revenue

Avg. % of Rev from Medicare 31.4%

Avg. % of Rev from Medicaid 16.8%Source: HSC 2008 Health Tracking Physician Survey

Page 21: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Reasonable Compensation

It is all relative? A full-time Neurosurgeon generates an average of more than

$2.8 million a year on behalf of the affiliated hospital. Invasive cardiologists ($2.2 million) Orthopedic surgeons ($2.1 million) General surgeons ($2.1 million), and Hematologists/oncologists ($1.5 million) A General Internist brings in nearly $1.7 million a year on

avg. A Family physician more than $1.6 million Pediatrician more than $856,000.

*Merritt Hawkins Survey 2010

Page 22: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Reasonable Compensation?

Guidelines and sourcing information:• MGMA statistics for employed physicians• Level of previous experience• Evidence of previous productivity• References• ROI of service line• Need to maintain hospital viability

Page 23: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Physician Contracts

There are always 3 contracts per physician

Page 24: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Explaining Your Productivity Package

Before presenting a proposal, explain to the recruit:

What productivity packages your hospital usesWhy and how they workHow others have performed using themShow an example of how it could work for the

recruitWhat is expected to happen over the first yearHow will changes to contract be managed in the

future

Page 25: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Employment Model

Create a strong and sustainable business model:

• Practice management expertise and leadership• Clarity of vision• Governance processes and physician

responsibilities• Physician engagement in initiatives• Hospital strategies

Page 26: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

After the Start

The recruitment process is never really finished:

Tell them what they will get Mentor program Confirm that is happening Ensure access to administration is fluid Use liaison type services Year end meetings to confirm expectations are being

met Lay out expectations for new year Repeat…………………

Page 27: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT
Page 28: Physician Recruitment is Changing… From Defining Physician Need to Employment Contracts that Work DAVID ANDRICK DIRECTOR OF PHYSICIAN RECRUITMENT

Summary

Recruitment is a Strategic Imperative• Cost to recruit vs Cost of not recruiting• Recruitment is a revenue building strategy

Hospital strategies and community need No easing up over the next 15 years

• Look to the Community to help recruit Changes to how healthcare is and will be delivered

requires greater need analysis Managing expectations and getting the right fit Be upfront with what you have to offer The recruitment process is never over Retention, Retention, Retention


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