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    Christian Green
    Christian Green, MA
    The physician shortage in the United States is expected to get worse before it gets better. The population growth rate is projected to be 11% by 2030, at which time half of the U.S. population will be 65 or older. On top of that, 33% of active physicians today will reach retirement age during the coming decade.

    Couple this coming physician shortage with increasing physician employment by hospitals and large health systems, along with a move rate that’s reached an all-time high, and it becomes imperative for practices to find ways to stay ahead of the competition when recruiting and retaining physicians.

    Kurt Mosley, vice president of strategic alliances, Merritt Hawkins and Staff Care, Dallas, Texas, says practices should not differentiate between the two and treat recruitment and retention as two sides of the same coin. The key to successful retention is through recruitment.

    To distinguish your practice, it’s important to focus on making the environment efficient, open, remunerative and appealing, Mosley recommends.

    Efficient

    An efficiently run practice is one that allows physicians to devote more time to their patients. Whether that entails having adequate nursing and ancillary support, an on-site lab to reduce result wait times, an EHR system that communicates with hospitals and specialists, access to patient data or even specialists who handle pre-authorizations, physicians ultimately want to eliminate tasks that can affect their efficiency and take them away from their patients.

    These factors also contribute to why physicians leave a practice, Mosley says, referring to them as the “primacy of the workshop.” Without enough support, physicians are likelier to look elsewhere.

    Open

    According to Mosley, practices need to emphasize formal and informal communication at the beginning of the recruitment process. “Retention really starts when you lay out the expectations when you first talk to the doctor; [you need to] make sure you are on point. You should go through the contract with a fine-toothed comb, making sure expectations are clear on both sides.”

    A standard contract can be used as a basis for negotiation. It should include details on job requirements, contract term, benefits and compensation, vacation, termination criteria and other factors that define the physician-provider relationship.

    Once a practice hires a physician, open communication needs to continue. Retention issues often arise during the first 180 days, so it’s crucial to provide feedback to physicians during this time. As Mosley notes, it’s critical to “make sure the doctor is happy and give them appropriate feedback early on. If you’re happy with what they are doing, let them know that. If there are concerns, let them know that so it doesn’t manifest itself into a problem later down the road.”

    Remunerative

    Physicians are in high demand, particularly in specialties such as family medicine, urology and orthopedic surgery, which reflects the need to deliver care to an aging population. According to the 2018 MGMA DataDive Provider Compensation, salaries for primary care physicians increased by 10.6% during the past five years, while salaries for specialists such as neurological surgeons and invasive-interventional cardiologists rose 15.7% and 15.1%, respectively.

    Higher salary expectations make it more difficult to attract physicians and places the onus on a practice to stand out from the competition, making it very important to identify the type of physician needed and budgeting for that physician ahead of the recruitment process.

    Beyond offering competitive salaries, practices also need to tender benefit packages that appeal to physicians’ quality of life. As reflected in the 2017 MGMA DataDive Provider Placement Starting Salary data, some of the top benefits include higher signing bonuses, relocation expense reimbursement and continuing medical education stipends.

    However, as Mosley relays, practices are also getting a jumpstart on the hiring process, targeting recent medical school graduates. “We’ve seen a lot of savvy groups that sign on doctors right out of medical school. They pay off their student loan [if they agree to work with the group] right out of medical school, so they don’t have to worry about interest accumulating while they are in residency. It’s a way to engage doctors early and get them committed to your group.”

    Appealing

    As part of the recruiting process, practices should determine how a physician will fit with the practice culture and vice versa. This dynamic has become even more significant now that there are four generations of physicians in the workplace.

    Because Traditionalist (born before 1946) and Millennial (born after 1979) physicians are now working side by side, it’s essential for physicians to be comfortable with each other and have an esprit de corps. According to Mosley, each group can help the other; for example, Millennials can offer their expertise in technology and work-life balance, while Traditionalists can share their clinical expertise and bedside manner tips, which can be quite helpful for Millennials. “Emotional intelligence is a positive trait for Traditionalists in that they do not have the filter of technology, so they really learned patient rapport and interpersonal skills,” Mosley says.

    Emotional intelligence (EQ) has recently become a significant factor in determining culture fit and ultimately physician performance and leadership. For example, the MCAT exam now tests individuals on EQ, which is valuable for assessing physicians’ empathy for patients amid a shift toward value-based care.

    In addition, practices can incorporate questions during the interview process to address EQ. For example, “Tell us about a time a patient disagreed with you or a time when the group manager and you had an argument. How was it resolved?,” Mosley says. “Empathy is very important in a group because … we’re going to be paying for quality.”

    By pairing EQ data with a carefully considered recruitment and interview plan, practices can be more decisive during the interview process and identify the right candidate. “Groups have to know that it’s a competitive market out there,” Mosley says. “We do a resident survey every two years, and the average resident in our survey had 80 practice opportunities presented to them.”

    When recruiting a physician, practices should also appeal to his/her family during the recruitment process. Consider some of the following questions:
    • What does the physician’s spouse do for a living and are there opportunities in the area?
    • What hobbies and interests does the family have?
    • What schools could be the best fit for their children?
    Taking an interest in the physician’s family can help personalize the recruitment and differentiate a practice from the competition.

    Finally, younger physicians aren’t as concerned with location when considering a position; instead, lifestyle is often the key factor in their decision. “Time off and time with the family is key. It’s not good or bad, it’s just a different era. You had doctors 30 years ago working 60 to 70 hours a week, but it’s not going to happen with this new group,” Mosley says.

    Onboarding physicians

    Once a practice has done its due diligence and hires the right physician, taking the time to properly onboard that individual will go a long way in retaining him/her. Practices can start by creating onboarding checklists, which should include such topics as benefits, licensing and credentialing, materials management, training and IT setup.

    In addition, practices can ensure that the physician’s family is properly onboarded to their new environs by preparing a packet with information about the community to help make them feel comfortable and acclimate them to their new home.

    It’s also vital to acquire feedback from the physician to determine whether he/she is comfortable with the office dynamic. To do so, practices should make the most of stay interviews during the onboarding process. These informal, one-on-one meetings can help determine how the physician is getting along with other providers and staff, both clinically and philosophically. These interviews can also be a way to gain insight regarding how the physician is acclimating to the community.

    As physician salaries continue to increase in response to the growing physician shortage, practices will need to be vigilant in finding enterprising ways to attract and retain physicians. Being intimately familiar with your practice culture and ensuring that your practice is efficient, open, remunerative and appealing can give you a leg up on recruiting and retaining physicians.

    Additional resources

    • An onboarding checklist can be an invaluable tool for practices when new physicians join. Access MGMA’s member-benefit Provider Onboarding Checklist.
    • For more on physician recruitment, engagement and retention, particularly as it relates to OB/GYN, attend Kurt Mosley’s MGMA18 | The Annual Conference session, “Make Your Group a Doctor Magnet,” in Boston, Oct. 3.
    Christian Green

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