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    There’s one thing most medical practices have in common regardless of their specialties or how well they perform: They all face an uphill task in recruiting top physician talent and holding onto them for the long term.

    By 2034, primary care is projected to face a physician shortage between 17,800 and 48,000 physicians, according to data from the Association of American Medical Colleges (AAMC); in nonprimary care specialties, that range is 21,000 to 77,100 physicians, with particularly high estimates for surgical specialties and areas such as anesthesiology, neurology, emergency medicine and addiction medicine.1

    While any medical group that’s growing will need to eventually recruit and hire from that increasingly competitive field of candidates, the role of minimizing turnover can be a vital part of overall success.

    As Mitzi Kent, RN, BSN, partner with Barlow/McCarthy, and Chris Hyers, MBA, FACHE, vice president of strategy and business development, UConn Health, noted in their presentation at the 2021 Medical Practice Excellence: Leaders Conference, the components of a physician alignment process should match the strategic goals for physicians and the organization so that onboarding becomes very effective in ensuring newly hired physicians’ success.

    Hyers’ example of how to do this comes from his experience at UConn Health, where there are more than 600 employed physicians — and an average of about 40 new ones for the past five years.

    With so many new faces, it’s crucial that their first impressions of the organization aren’t just about orientation — where to find key people and things — and instead a true onboarding experience that has “an intentional strategy to make that provider successful in the practice’s eyes and in their eyes,” Hyers said. Kent added that a successful onboarding increases retention, decreases ramp-up time for the physician, increases productivity and boosts system alignment.



    But the difficulty is organizations living up to their hopes of effectively onboarding new physicians. Kent noted that those successful programs often require a formalized process that is followed for every physician and develops over months as opposed to just days or weeks. Elements such as assigned mentors are usually crucial for success.

    Bringing together parties from across the organization in a coordinated way is key in starting those efforts, Hyers said. “Unless you think about this from a holistic approach, what you’re going to get is a physician moving from place to place, falling in gaps,” Hyers said, as it’s easy for various departments (such as credentialing, IT, scheduling) to only do their part and move on.

    Hyers reflected on his initial challenge in joining UConn Health: Despite being an attractive university with new facilities being built, it was still taking three years or longer for new providers to reach expected productivity levels. With that problem came millions in lost revenue, unhappy providers, high turnover and a lot of blame.

    Recognizing that issue, the UConn Health team set out to get physicians up to productivity levels quickly, while reducing dissatisfaction and the associated turnover. To aid in those objectives, the organization created ambassadors — physicians who had been through new processes and were champions of how the organization functions.

    Additionally, the solution needed to be standardized and a priority placed on the first 45 days of a new provider’s work at the organization. Recognizing that everyone faces some degree of uncertainty in starting a new job, UConn Health focused on overcommunicating important information in those early weeks so new physicians quickly felt comfortable “and nothing is left to chance,” Hyers added, whether that’s finding a local bank branch or a place to eat.

    Onboarding alignment: Marrying the technical and the tactical

    Hyers’ team breaks down the work on onboarding and alignment into two areas: A formal, standardized technical orientation checklist, and then tactical pieces that build upon that foundation to grow business and help new physicians reach expected productivity as quickly as possible.

    The technical side

    A standardized orientation checklist — in UConn Health’s case, it’s eight pages— contains a list of everything that needs to be done across all areas of the organization. The list is maintained centrally by physician relations to ensure consistency, especially as individual departments experience turnover and may not have a firm understanding of the existing processes as new workers join.

    Hyers noted that the checklist is reviewed annually by checking with various departments to understand what’s working and what needs updating.

    In addition to that checklist, Hyers’ team maintains what he calls a “traffic control” spreadsheet, which includes each physician, when they started and information on each of the technical elements of onboarding in process. “If something’s not happening on time, we know it,” Hyers said. “We don’t leave it to chance.”

    New providers also receive communication of their meeting and training schedule for the first week, which includes standard elements of onboarding such as orientation with HR, diversity training, EHR training, a photo shoot and meet-and-greet meetings with various other doctors, coding team members and visits with other areas (e.g., surgical centers, technicians). “I never want them to guess what’s going to happen,” Hyers said. In most cases, Hyers wants a newly hired provider to have their schedule in hand three days before orientation starts — that often ends up being on the first day they arrive in town after moving.

    All of this is in service of the 45-day goal of completing the checklist so that the new physician can start being promoted as open for new patients via business cards, website placement and publicity via monitors in public areas of the hospitals. “When I started here, people were getting [photos taken] nine months after they started,” Hyers said. “I’d love to have this down to 15 days,” but UConn Health — as a state agency — is limited in how much engagement it can have with physicians before they’re physically there.

    The tactical elements

    “Busy physicians are happy physicians, especially if they’re on productivity,” Hyers said. “And the sooner they’re off productivity and onto incentives, they are happy.” To that end, the other side of the onboarding alignment work is pivoting to building business for new physicians.

    Understanding where the new business will come from is crucial to the physician relations team’s work, whether it’s based on going direct to consumer for a new primary care physician, or generating visits from referrals, and whether the business is coming from within the system or outside.

    The two most important tools to use as you answer those questions, Hyers noted, are a CRM system and the EHR. In the case of UConn Health, the EPIC system allows them to see where every employed physician refers patients. Introducing new physicians to those top referrers is very effective, and using this approach gives insight into referral patterns and “where hotspots are” for business, Hyers added.

    This is especially important to understand amid the COVID-19 pandemic as fewer physicians connect in person. Making sure the onboarding work reaches internal audiences is vital, as “meeting your peers is powerful,” Hyers said. “We have to remember that it doesn’t happen naturally anymore” and that it’s an important step to make new providers “feel connected.”

    There are some simple, effective methods to achieve this in an era of virtual meetings, Hyers said:

    • His team handles internal promotion via a weekly email each Friday afternoon, welcoming new physicians and sharing information about that doctor. Even if the recipients don’t open the email, their email preview panel will give them a sense of whether there’s someone new in a certain specialty. That same “welcome ad” is part of TV programming in the waiting rooms and the information monitors in the buildings.
    • UConn Health also produces an annual physician referral guide with the content they develop for each physician. “Every year, we hand [these] out to the community,” Hyers said, noting that despite the instinct to make this exclusively digital, many of the recipients appreciate having a hard copy.
    • Every instance in which a physician sees the organization putting its face out into the community works toward enhancing the relationship. “We want them to feel like they’re valued and involved,” Hyers said. Tracking pageviews on physician listings on the website and sharing those results after a round of promotion is one way to demonstrate that effort and investment.

     
    With these components in place, it then becomes a question of tracking productivity. In Hyers’ case, the team has a faculty production report that tracks the percentage of year-to-date wRVU budget performed by new providers (grouped by how long they’ve been with the system). Watching that report allows the physician relations team to spot issues, ask questions and proactively offer support to get first-, second- and third-year physicians on track to meet their goals on or ahead of schedule.

    The bigger picture

    With the professional elements addressed, Kent noted that the other major consideration for making a new physician successful and engaged is ensuring that their family has also made the transition to the new setting successfully.

    “We know that 85% of the time, if a family is dissatisfied, that will influence a physician’s decision to relocate,” Kent said. The fit within the community can be just as important as the clinical and cultural fit within the organization.

    Practice leaders charged with ensuring successful hiring and onboarding should start by working with a physician and family to establish links to the community (e.g., school enrollment, cultural amenities) and offer a welcome basket containing:

    • Local information on dining, shopping and entertainment
    • Local retail areas to send business cards
    • Other professional services available (e.g., dentists, pediatricians)
    • A social calendar (e.g., book clubs, summer camps).

    Mapping it out virtually

    Especially with the ongoing COVID-19 pandemic, practices should map out all elements of the process so all parties understand which types of activities will be conducted by video conference (e.g., EHR trainings, introductions), and which important portions can’t be done remotely (e.g., hospital tour).

    In some instances, the video visits often end up being more productive than the previous, in-person meet and greets. For example: Initial doctor-to-doctor visits have time set aside without either party needing to travel. As Kent noted, the in-person visits sometimes resulted in someone simply stopping by to say “hello” rather than spending the full time allotted for a video call to discuss what each person wants to learn from the other.

    The degree to which physicians are willing to embrace these virtual introductions and visits is likely only to continue with each new class of physicians who were raised in a digital world. “There is a generation of physicians out there that is comfortable with what they learn and do virtually,” Hyers said, noting that at least three of about 30 new physicians UConn Health brought in recently never even visited the area before starting.

    Learning goes both ways

    As much as the onboarding process is about educating your new physician, Kent urged that the process of confirming expectations with the physician is an opportunity for the organization to benefit from a doctor’s previous experience or knowledge elsewhere.

    “If they came with something that worked in another place, let’s leverage that,” Kent said.

    One of the ways to capture those ideas is appointing a mentor for that physician — “somebody they can talk to and get advice on different things,” Kent said. “It doesn’t have to even be [someone] in their particular service line — it could be somebody that they just connect with” based on similar experience or background.

    Those mentor conversations can then evolve into discussions about the right path to attract the ideal patient population for that specialty or practice. That setting might ultimately be safer for a new doctor to ask questions rather than going to a department chair or senior leader, Hyers said.

    Allowing new physicians to go through this process also gives them the awareness of what is expected of mentors so that they can later serve as a mentor in a year or two.

    Course correction

    Even when all these elements are in place and there is a comfortable environment for learning and asking questions, sometimes the hiring process isn’t perfect and there are new physicians who don’t make expected progress.

    When that happens, Kent suggests four key action steps:

    1. Exercise some patience. If you have done all the steps you’ve identified as vital and had success with your processes with other newly hired providers, it’s possible that it’s only a matter of time before the results you’re after materialize.
    2. Examine your institutional barriers. Especially in a tight labor market and the challenges of a pandemic, physicians don’t always start with everything working as it should. If there were operational issues in a clinic, scheduling issues or a lack of surgical work to keep surgeons as productive as expected, those factors might be as influential on the middling results as anything.
    3. Repeat key onboarding steps as needed. As Hyers noted, there often are new physicians that might have skipped over some steps, such as cancelling meet and greets with other physicians. If you start to notice signs of trouble, re-engaging that physician with peers can be helpful.
    4. Reassess the fit. Get feedback from other physicians and patients about a provider who might not be making progress, either in terms of performance goals or cultural fit. If all the pieces are in place to make the doctor successful and issues remain, it might be time to reevaluate their spot in the organization.

     
    Instilling these plans for newly hired physicians’ growth may not be tremendously innovative; in fact, Hyers noted that a lot of these steps are “old school.” They are intended to nurture the doctor and the relationship he or she has with the organization over time and provide clear touchpoints for ensuring that things develop as intended, Kent said.

    As Hyers said, the holistic approach to onboarding and alignment “can differentiate you” from other healthcare organizations that might have a more transactional approach to bringing in new doctors. “We have to remember that this isn’t just a professional decision” for these physicians. “It’s a personal and family decision.”

    Note:

    1. AAMC. The Complexities of Physician Supply and Demand: Projections from 2019-2034. June 2021. Available from: bit.ly/3lkxDx4.
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