By John Couvillon, President and CEO, Pinnacle Health Group
Using the status of your local managed care market to drive the recruitment process enables you to determine a better match with a candidate.
Education, experience, and personal chemistry have long been qualities scrutinized during any recruitment process. Medical groups and hospitals involved in recruiting physicians today need to add another vital factor to the formula: how the candidate will respond to the local managed care environment. In fact, building the entire process around this criterion can improve your chances for a successful match.
The first step. Before calling a recruitment agency or designing your own campaign, you should first examine the state of managed care in your market. While penetration varies throughout the US, for quick reference our company typically defines the market as:
- Rural: Managed care is almost non-existent or minimal. There may be a Physician Hospital Organization (PHO), but in this type of environment, physicians view it as an asset. Locations fitting this description often have a population of 20,000 or less.
- Urban: Indicates a high degree of managed care or a complex mix of payors. Nearly any US city of 100,000 or more fits this description.
- Mid-sized: The population ranges between 20,000 and 100,000 and managed care penetration varies.
Recruitment techniques and candidates for rural and urban markets have distinctive characteristics. The process and candidates in a mid-sized market depend on whether the managed care profile more closely matches the rural or urban description. Once you determine the degree of managed care penetration, prepare an analysis of payors and how it will affect the physician you’re seeking by specialty. Armed with this information, you’re ready to move ahead.
The Secret Asset Rural Markets Possess. Historically, it has been difficult to recruit physicians to rural markets. Today, however, rural markets possess a magical lure. Thanks to minimal managed care, the small town stands as one of the last bastions where physicians still have an opportunity to make the money many expected when they began their careers. There are no contract and control issues with managed care organizations. The fee-for-service environment is an asset that should be waved like a banner “During the recruitment process,”.
Physicians attracted to rural markets today usually do not fit the profile many of our clients expect. They are often educated at the best medical schools, have impeccable credentials, and have been practicing in metropolitan areas for at least ten years. Many of those our company has recruited have been in their late 40s or 50s. They are frustrated with the impact managed care has had on the way they practice medicine and are disappointed that they cannot meet the financial goals they set early in their careers. They want to set up a practice where they can build a loyal patient base, work independently, and focus on delivering care.
Many physicians fitting this profile currently live in California. Health Maintenance Organizations (HMOs) and many other forms of managed care got an early start in this West Coast state. The effect has been agonizing and the impact is permanent. Many physicians can’t wait to escape.
Look Beyond the Paper Profile. Because the curriculum vitae is not what recruiters in rural markets expect, they may find themselves asking, “Why would this physician want to come here? Look where he or she was born and went to medical school! Would they fit into our town?” One of our recruiters advises clients to pick up the phone and call the candidate the minute they begin asking these questions. It’s likely a match exists. These physicians want to get in on the last days of fee-for-service. They are aggressive, hard-working, and true entrepreneurial spirits. They have experienced managed care in another market and didn’t like it. We recently recruited a physician from one of the top Southeastern cities to relocate to a rural community in a large Western state. He had been a member of an Independent Practice Association (IPA) and felt burned by managed care in a big market. He was willing to make a change in lifestyle and wanted to be “the” physician in the community.
Urban Life. Physicians seeking to work in today’s urban markets have many different motivations. For many, lifestyle is a priority. While personal circumstances vary, our recruiters find three groups of physicians are more likely to consider positions in environments where they are employed or managed care has a major impact on the way a practice operates:
- Just completed residency. Physicians emerging from residency may want a break from total devotion to their career. They are tired of constant work and are used to collaborating with peers. In addition, their expectations were different when they entered medical school. They understand managed care and are not as resentful of its impact on their career. HMOs will run the practice for them; they work with a big group of physicians who can assist with medical decisions; and there’s more security.
- Interested in starting a family. Physicians with young families or just starting out often prefer regular hours and a light call schedule. They may want access to a variety of schools that a rural market can’t offer. While they can perhaps double their income in a more distant locale, lifestyle choices dictate a more urban location.
- Physicians tired of fighting managed care. These candidates often feel, “if you can’t beat them, join them.” They may be nearing the end of their career and no longer want to grapple with the paperwork and administrative nightmares. Light call schedules and peer collaboration appeal to them.
Three Questions. These questions can help narrow your search during one phone conversation:
- Describe your career expectations for the next five years. While medical groups should recruit candidates exhibiting collaboration and negotiation skills, managed care organizations should seek physicians who want someone else to deal with the hassles of running a practice. Rural markets should consider candidates interested in making money and becoming a “big fish in a small pond.” Candidates should exhibit entrepreneurial skills.
- What type of call schedule is acceptable to you? The aggressive, entrepreneurial physician that a rural market requires is willing to be on-call all the time or perhaps share it with one other person. They are interested in a full schedule of patients or surgeries. If the candidate requires call one night out of eight or fourteen, they are a better match for an HMO or large medical group.
- What are your personal interests? Rural markets should pay close attention and make sure they are able to address the key issues the candidate presents. During one recruitment process, we contacted a physician about relocating to a rural market. When he indicated one of his requirements was ballet classes for his son, we knew it wouldn’t work. Urban markets almost always have an advantage if the candidate is interested in cultural and sporting events, access to schools, and religious options.
The Unexpected. Using the status of your local managed care market to drive the recruitment process enables you to determine a better match with a candidate. Many physicians seek to escape the demands being placed on them; some are happy with the new opportunities managed care organizations present. There is one factor that you cannot control and that is personal chemistry. Sometimes, when you least expect it, something clicks between the candidate and the people involved in the recruitment process. As one of my associates says, “magical things happen when you get people together.”