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How will healthcare groups contend with the physician shortage and other recruiting difficulties to develop a successful hospitalist program?
Recruiting hospitalists is a brisk business. Hospital medicine has driven most of PCPs’ growth, and it’s no wonder that 500-bed and even 100-bed and rural facilities are overwhelmed by the demand for hospitalists, which exceeds today’s supply. Even when equipped with the financial resources to train, recruit and manage their practice base, many healthcare groups are feeling the tight competition as they seek to expand their practice base and filter through an oversaturated market.
The consequence of its own success
The importance of hospitalists is further encouraging the growth and demand for them. They can now be seen co-managing surgical patients, performing glycemic control, DVT prevention and antibiotics prescriptions, as well as evaluating elective surgical and pre-admission patients who would’ve otherwise seen cardiologists, endocrinologists, neurologists, intensivists, orthopedic doctors and emergency medicine physicians.
The unique hospitalist specialty may be a success in itself, with the American Medical Association citing its cost and quality benefits to healthcare facilities, but its growth has confounded even large hospitals like the Arizona-based Mayo Clinic into finding where to look for hospitalists. Kristen K. Will, MHPE, PA-C, related, “We found it difficult to recruit and find people who had training in hospital medicine. PAs are trained in primary care. If PAs have hospital experience, most of it is in the subspecialty area, but that doesn’t necessarily carry over in knowing how to take care of general medicine patients in the hospital.”
Additionally, healthcare systems, facilities and hospital medicine groups in Texas, California, Tennessee, Washington, Georgia and North Carolina grew and expanded to become major employers of hospitalists. At a time when hospital medicine expanded, from quality improvement to practice systems, training and workload, industry leaders predicted a demand for 50,000 hospitalists.
In 2007, there were 10,000 unfilled hospital medicine positions. Society of Hospital Medicine’s (SHM) CEO Larry Wellikson, MD, FHM, remarked on the situation, “The flow is but a trickle and we need a rapid current. About 8% of internal medicine residency graduates enter hospital medicine. While 3% of hospitalists have been trained as family practitioners and general internists becoming hospitalists, we have a shrinking pool of potential new hospitalist.” In the next decade, the Occupational Information Network expects a demand for 260,500 hospitalists.
Getting creative
Physician recruitment and retention is a long drawn-out challenge for every hospital, particularly for hospital medicine. For many market leaders and administrators, improving clinical results, as well as developing and maintaining an efficient hospitalist program, requires an effective recruitment plan that thinks outside the box. Michigan, for instance, recruits hospitalists through residency programs and advertises in national medical journals, but what made them successfully recruit 75% of physicians in their community is through a loan forgiveness program.
Scott A. Flanders, MD, Associate Professor and Director of University of Michigan’s Hospitalist Program, explains, “Hospital medicine is a young field, so by definition the physicians are young. You’re not going to attract 40 or 50-year-old physicians who want to go into academics, but this might apply to young hospitalists.” Their loan forgiveness program pays back student loans capped at $10,000 annually for five years, and with the added value of benefits and loan forgiveness, it adds over $50,000 to a hospitalist’s compensation. Flanders added, “Our group of hospitalists went from zero to 16 by the end of this year—all in two years. We’ve literally doubled each year.”
Hospitals in Columbus, Ohio, Albuquerque, New Mexico, Coeur d’Alene , Idaho and Murphy, North Carolina, which targets smaller and tighter markets, appeal to physicians by advertising the quality of life in their communities, to which over 80% of total physicians are particular about. Grant Medical Center’s Medical Director Rohit Uppal, MD, on the other hand, uses hospital medicine fellowship programs to recruit potential doctors for their facility.
In Springfield, Massachusetts, they have configured their compensation plans to meet their productivity and retention goals. Conversely, hospitalist services in Staten Island, New York, are considering putting housing, relocation and mortgage in their staffing plans. Aaron Gottesman, MD, FACP, CHCQM, its Hospitalist Services Director, added “that creative solutions are imperative, but a signing bonus alone would either have to offset the potential mortgage payments as well as take into account the potential for further home value deflation and prolonged distant homeowners’ anxiety.” While an added $50,000 signing bonus does not appeal to hospitals, financial investments turn into creativity, which can result into successful recruitment.
Hiring the Bad Hire
Recruiting for a hospitalist program under a tight marketplace should also consider the community and practice fit for the physician.
Florida-based Synergy Medical Group’s CEO Chris Nussbaum says that physicians with “such callous behavior would send shock waves through any group.” In fact, hospitalist directors are reporting physicians who, despite their clinical experiences, upset their organizational structure simply because they professionally do not match with their facility.
Seattle’s Swedish Medical Center’s Medical Director Per Danielsson, MD, says, “We work hard, and, if we have a position vacant, we’ll work even harder for short periods of time until we find the right person. The CV and interview are important.”
For many hospitals, hiring quality physicians for their facility is critical for their success. It also prevents the direct costs as well as the spent time and effort entailing from hiring “the bad hire.” Hospital leaders must also consider their own role in managing their employees, which translates into spending the time needed for the hiring process and recruitment decisions.
Outsourced hospitalist management groups
Hospital administrations seeking to reduce costs and increase productivity by handing away their hospital medicine to external management groups (hospital management groups / HMGs) is a business model in itself. For many hospitals, it is an opportunity to measure how these management companies align with their own hospital goals while continuously providing inpatient care to their own facilities.
HMGs have an integral independence and flexibility that large hospitals invest to. Moreover, outsourcing the practice to an external management company lessens regulatory risks as well as administrative and recruiting burdens. They also have the business infrastructure and technology such as recruiting, QA, physician performance and billing among others. This includes a fixed expense for the hospital, as well as a constant supply of hospitalists who would cover their program.
On the other hand, other hospitals would recruit and employ their own physicians to take control of their own alignment goals. This is particularly true for hospitals that do not want the larger risk of misaligning their facility’s quality inpatient care, utilization and patient satisfaction, along with recruitment and retention. HMGs usually offer little control to the doctors they bring in, which often translates to concerns about the quality of physicians brought into the community. Although they can fully cover the program, HMGs do not necessarily bring in physicians who fit the facility and community. Additionally, hospitals usually are not legally empowered to terminate these physicians—they are often compelled to concede more rapidly with the HMG’s contract, or stand the risk of losing all their hospitalists at once. Hospitals are also confronted with priority concerns because these external management companies have conflicting interests with the hospital, like in admission rates, compensation, scheduling and resource use.
Recruiting on your own gives you back the freedom to develop and expand your own practice. In fact, the Society of Hospital Medicine reported that there is no perceived difference in physician performance and productivity metrics such as admission, readmission and length of stay for hospital-employed hospitalists. Whatever the strategy of the hospital is, its business model should adapt and fit into the hospital’s goals.
Helping hands
Medical groups have many different recruiting strategies, and large healthcare systems are banking on their previous experience with outsourced firms as they align their hospitalist programs with in-house recruiting methods, such as those in Richland, Washington and Somerset, Kentucky.
Jeffery Hay, MD, Senior VP for Medical Operations and CMO of Lakeside Comprehensive Healthcare at Glendale, CA, also remarks that recruiting initiatives differ between bigger hospitals and smaller facilities. While the former has the financial stability, small hospital medicine groups can be niches for long-term physicians. Although they do not differ much in compensation, the size of the facility often involves shift coverage, the facility’s rate of growth, the number of hospitalists in the program and the scope of support from subspecialists. Norfolk, Nebraska-based Faith Regional Health Services’ Hospitalist Director Joe D. Metcalf II, MD, said, “A smaller institution is often more amenable to the introduction of change, which may be attractive to a hospitalist who has an interest in medical processes, quality and safety.”
Healthcare systems that have the required financial resources may be more successful at it, but according to the IPCs The Hospitalist Company, Inc.’s CEO Adam Singer, MD, “A hospital attempting to go it alone will quickly discover that its options for finding local inpatient physicians have dwindled to the point where it would be forced to recruit regionally and even at the national level in order to achieve and maintain its staffing quota.”
Conversely, recruiting firms are capable of improving and fine-tuning staffing development in a timelier and low-cost manner than what many groups can do for themselves, particularly to smaller facilities that have limited recruitment metrics, reporting and measurement capacities integrated in their systems. “Additionally,” says Singer, it “ensures that regulatory hazards such as corporate practice of medicine and self-referral laws are effectively managed with minimized risk to the hospital.”
Building a successful hospitalist program means contending with the challenges of the industry and the future realities that will come into play. With the right approach and resources, hospital medicine groups can maintain a successful practice.
References:
“Are Hospitalist Physician Assistants the Answer to Shortages?” Karen M. Cheung, HealthLeaders Media, February 16, 2010.
“Getting creative with compensation,” Deborah Gesensway, Today’s Hospitalist, July 2010.
“Hospital medicine’s management shuffle,” Bonnie Darves, ibid., May 2007.
“In Demand,” Ann Kepler, ibid., July 2008.
“Is Anybody Out There?” Richard Quinn, ibid., June 2009.
“One Size Does Not Fit All,” Andrea Sattinger, ibid., November 2008.
“Real estate slump can affect hospitalist shortage,” Karen M. Cheung, Hospitalist Management Advisor, July 2008 Vol. 4, No. 7.
“Recruiting hospitalists could help primary care workforce shortage,” Sarah Green, KHI News Service, June 14, 2010.
“Recruitment, Retention and Your Hospitalist Program,” Kenneth G. Simone, DO.
“Recruitment Revised,” Jane Jerrard, Today’s Hospitalist, April 2006.
“The Bad Hire,” Marlene Piturro, PhD, MBA, ibid., October 2007.
“The State of the Hospitalist Industry: Today and Tomorrow,” Adam Singer, MD. Volume 21, Number 23, December 1, 2008.
“Where Will We Find 50,000 Hospitalists?” Larry Wellikson, MD, FHM, Today’s Hospitalist, August 2007.