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www.greenbranch.com | 800-933-3711 223 MANAGEMENT BRIEFS W e all understand that healthcare has dra - matically changed in recent years, and phy - sician recruitment has evolved with it. It has been my impression that most physicians with whom I speak believe that they have little influence on the direction of healthcare and have little ability to effect change. In general, older physicians feel more powerless to effect change than do younger physicians, and specialists feel less powerful than primary care physicians. Physicians’ perspectives may be tainted by the fact that Medicare and private insurers have been putting downward pressure on physician reimbursement for years. Physicians in general would like more input and posi - tive solutions to control healthcare costs, and they believe that less government regulation would be a positive so - lution to costs. Many are angry that they have to justify the medical treatment for their patients to a nonmedical person who can and does determine which services will be paid for which patients. They do not believe that Account - able Care Organizations will enhance quality of care and reduce costs through better physician/hospital alignment, aggressive use of information technology, and reimburse - ment that rewards providers for quality and managing risk. It is important to recruit physicians with a positive outlook.

The interesting issue is how physicians perceive these changes. Some seem to embrace them, preparing for the new environment, while others resent them. Physicians are leaders, and healthcare systems in particular require phy - sicians to be effective and efficient leaders. Increasingly, doctors will be the driving force in a successful system.

The type of influence physicians exert will evolve, but their influence will continue to be tremendous. These changes require practice efficiencies that I believe are here to stay, so it is important to recruit physicians with a positive outlook. Successful recruitment of physicians requires a strategic plan that incorporates outlining the steps to take, making the time commitment, and patiently completing each step.

Physician retention is the opposite side of the same coin and also requires planning and commitment. If a good hospital needs physicians, be prepared to pay higher salaries.

Before incurring unnecessary expense and opportunity costs, determine if there is a need for additional physicians.

Resources from the American Medical Association, Ameri - can Hospital Association, Medical Group Management Association, and national and regional physician recruiting firms can assist you in determining how many and what types of physicians are needed in your area. If your practice is seeking a physician, you should objectively measure your opportunity in the context of the national physician market.

The key factor is the supply and demand for physicians.

A study by the American Hospital Association projects a shortage of 56,000 primary care physicians and 7000 or - thopedic surgeons by 2015. 1 Shortages in these specialties have resulted in higher salaries paid by hospitals than these physicians can make in private practice. If a good hospital needs physicians, be prepared to pay higher salaries. While you might initially think that there is a large pool of physician candidates from which to choose, finding the can - didate who culturally, educationally, and professionally fits into your established practice is a time-consuming process. THE RECRUITMENT PROCESS To start the recruitment process, establish a budget for the undertaking, and commit the financial resources and personnel to the project. Will you use a recruitment firm or an in-house team? Regardless of which you use, it will be Overcoming the Physician Shortage: Steps to Successful Physician Recruitment and Retention Debra Cascardo, MA, MPA, CFP* *Principal, The Cascardo Consulting Group, and Fellow, New York Academy \ of Medicine; phone: 914-358-9553; fax: 914-358-9554; e-mail: dcascardo@aol.\ com.Copyright © 2014 by Greenbranch Publishing LLC. 224 Medical Practice Management | January/February 2014 a long-term process, requiring a minimum of two years or longer to recruit the right person. Allow yourself plenty of time to find the candidate and complete the interviewing and contracting processes. Steps to follow include:

77 Appoint a recruitment coordinator.

77 Budget funds for advertisements, job postings, and can - didate travel expenses.

77 Start now!

If hiring a recruiter, interview several firms and make sure that all of the details of your professional relationship are spelled out in writing, including:

1. Your fee agreement with the recruiting firm; 2. When the fee is due; and 3. Whether or not the firm offers to recruit a replacement physician if the initial recruited physician does not work out. Determine the Contract Elements Before Beginning Your Search Begin with an end amount in mind. Successful practices have always had the advantage of developing the physician contract prior to the beginning of the search. A proposed contract is important in both selling the opportunity and avoiding miscommunication after the interview. As more physicians become employed, the contracts between hos - pitals and physicians should be less complicated than in past years. Transparency is important among the partners because you do not want any partners not “engaging” in this process. Make sure you spell out in writing exactly what is expected of the physician, and make sure you ac - curately project the financial potential for the practice so that expectations are realistic.

Develop a Competitive Financial Package In today’s market, candidates have access to data on aver - age salaries and benefits across the nation. Similar to the real estate market when a house is listed above the market price, your job listing may be overlooked if it is not com - petitive with the rest of the industry. Shorter work weeks, no on-call hours, and other quality-of-life benefits may bring additional candidates if your finance package can - not be increased. It is important to consider the following before starting your recruitment process:

77 What is a competitive compensation range and benefits package?

77 Will there be partnership opportunities?

77 Are signing bonuses customary in your area?

77 Are moving expenses, medical school loan repayments, or other special compensation expected? Determine the Qualities of Your Ideal Candidate Consider the following attributes that you are looking for:

77 Specialty and clinical qualifications; 77 Experience (just out of residency or with a few years of practice); and 77 Personality to match your work ethic and customer service ideals. Screening the Candidates With or without an outside recruiter, your in-house recruit - ment team should be composed of staffers with a mix of positions and responsibilities so the viewpoints of different departments and personalities can be obtained. Determine the professional opportunities, technologi - cal advances, research opportunities, and other aspects of your practice that make it stand out from others that the candidates might be considering.

Determine the Best Outlets for Your Recruitment Process A strategic screening campaign incorporates all of the following:

77 Advertising; 77 Job boards; 77 Residency outreach; 77 Direct mail; 77 Professional association job postings; 77 Medical school career offices; and 77 Social media.

Social media and other recent advances in recruitment software have made the task of reaching physicians much easier. However, contacting them is only half the battle because you need a sophisticated professional to start the process by screening the résumés. As a practice manage - ment consultant, I often get involved with the process because of the professional and personal relationships that I have developed with the senior partners that give me an added advantage of understanding culturally exactly what their needs are.

Interview and Close Once you have received résumés:

77 Review them for those that meet your “ideal candidate” criteria.

77 Conduct initial screenings with candidates by telephone to determine:

— What are their medical interests?

— What are their strengths?

— What are their goals?

— Might there be compatibility issues? 77 “Sell” your practice to those who are potential candidates:

— What does your practice and community have to of - fer the candidate?

— Is your compensation/benefits/advancement pack - age adequate?

www.greenbranch.com | 800-933-3711 Cascardo | Management Briefs 225 77 Verify the credentials and references of candidates you would like to take to the next step:

— Education; — Work history; — Hospital affiliation; — Clinical competence; and — Performance. Arrange Interviews Use the interview process as an opportunity to confirm what has already been discussed with the candidates. The details of the position, call schedule, financial package, duties, and other matters should be agreed upon before the visit. The more in-synch the practice and the candidate are regarding the parameters of the position, the more the interview becomes a social event to see if the candidate and his or her spouse/significant other fit into your practice cul - ture. While there is no hard-and-fast rule about paying for the travel expenses of prospective candidates, it certainly increases your chances that candidates will accept your invitation if you offer to pay for reasonable expenses. Of - fer to make the arrangements directly, and clarify up front what expenses the practice will cover. Bring the final candidates in for interviews with the physicians and recruitment team. For the best possible interview:

77 Have an agenda for the candidates and their spouses.

77 Plan to include social situations where you can get to know the candidates and they can get to know the physi - cians and staff.

77 While they are selling themselves to you, you are also selling your practice and community to them.

77 Have a tour of the hospital and other facilities where your physicians spend a good deal of their time.

77 Consider a tour of the community, spotlighting the area’s attributes and attractive housing areas.

77 Make sure at the end of the interview process that you extend to the candidate the opportunity to contact you with additional questions regarding your practice.

77 Let the candidate know when you most likely will make a decision about whether or not an offer will be extended.

When a final choice is made, act quickly to provide an employment contract and a deadline for acceptance by the candidate. As with all negotiations, there may be a request for additional compensation or incentives. The same qualities that attract physicians are the same that keep them in a new practice.

If the first candidate does not accept, go on to the next one or be prepared to start the process over if necessary. GOOD RECRUITING LEADS TO GOOD RETENTION Physicians are unique among professionals in the length and difficulty of the training they must complete and in the severity of the clinical, administrative, operational, and moral challenges that they must face. It is critical that you understand the mindset and priorities of today’s physi - cians. The same qualities that attract physicians are the same that keep them in a new practice. Most employees want to feel appreciated, and physi - cians are no different. It has been observed that the most important aspect of a physician retention program is the practice environment. Physicians generally will stay in a setting where they have quick access to the equipment and patient data they need, reasonable schedules, and profes - sional colleagues. Even perks as seemingly small as a park - ing space can become an important piece of the retention puzzle. In addition, communication between physicians and administration is essential. New physicians are often under stress to “fit into” their new position, so keep that in mind once they are hired. You should conduct an annual physician satisfaction/retention survey to make sure that you have addressed their con - cerns such as marketing needs, specialty support, retire - ment plans, and any other issues in which you can facilitate their integration into the culture of your practice. You need to know how physicians feel about their work and where they live. You want to prevent any issues from becoming insurmountable. Most physicians that are unhappy feel that they do not fit in emotionally, philosophically, and/ or clinically with the others in the practice. Other concerns are that their expectations regarding practice parameters and compensation do not correlate with the actual work - ing conditions in the practice, poor communication with management, minimal input into decision-making, and lack of appreciation. THE EXIT INTERVIEW While it can be disappointing to lose a physician, it is critical that you learn from the experience. Schedule an exit interview with departing physicians to understand their motivations and gain insight into what policies and procedures you may need to adjust. I always conduct exit interviews with every departing staff person because I learn so much from their responses since people tend to be more open once they have given their resignation. PHYSICIAN RECRUITMENT AND RETENTION SUMMARY The steps above indicate the importance of the prelimi - nary work that takes place before candidates are recruited.

Without this preparation, most physician searches are www.greenbranch.com | 800-933-3711 226 Medical Practice Management | January/February 2014 bound to take much longer than necessary, or even fail.

The key to successful recruiting is to be prepared, start your search early, and communicate with your legal advisers your concerns and priorities in the employment agree - ment. It is important to build a strong positive relationship from the onset of employment. Make sure that the candi - date uses his or her own legal counsel when reviewing the contract so that can be no conflict of interest. To the extent possible, remain flexible and open to this entire process.

Organizations that start with a clear plan, including an understanding of the types of physicians they need, how much money they need to offer, and how the candidates should be sourced and interviewed, have a much better chance of success in finding and keeping the ideal addition to their staff. Y REFERENCE 1. Can You Explain Practice Losses to Your Board? Physician Strategy News. October 2012; http://www.healthcarestrategygroup.com/ newsletters/article.php?show=can_you_explain_practice_losses_to_your_board_. Order Phone: 800.933.3711 Fax: 410.329.1510 Web: www.greenbranch.com Email: [email protected] Today! NEW! RVUs at Work: Relative Value Units in the Medical Practice NEW—Second Edition in print or ebook!

Many medical practices judge productivity by charges, receipts, collecti\ ons or the number of encounters. Fees, however, can differ from payer to payer. Plus, a practitioner can see 25–35 patients a day and still not be “produc\ tive” in terms of what those encounters actually contribute to the bottom line. For medical pra\ ctices today, there’s a far better way to measure productivity — and benchmark performanc\ e year- to-year and practitioner-to-practitioner: Relative Value Units (RVUs), the measurements originally developed to standardize Medicare payments.

Now, in the new book RVUs at Work: Relative Value Units in the Medical Practice, 2nd Edition, experts from The Coker Group — a leading healthcare consulting firm — give practice administrators step-by-step guidance on how to use R VUs to gain profitable new control over physician productivity , costs and expenses, operating margins, resource allocation, compensation and even managed-care contract negotiations.

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✺ Huge “upside” potential — by applying the RVU approach, practice managers gain a consistent and impartial way to align how money is spent and how staff and providers use their time with the maximum benefits for both patients and the practice. Table of Contents Chapter 1: History and Background of RVUs Chapter 2: CMS and RVU Considerations Chapter 3: The Effect of RVUs on Physician/Hospital Alignment Chapter 4: RVUs and Compensation Chapter 5: RVU Compensation— Legal Aspects Chapter 6: RVUs and Productivity Chapter 7: Utilizing RVUs in Practice Management Chapter 8: RVUs and ACOs/CINs Chapter 9: Increasing Productivity via wRVU Measurements Chapter 10: The Future of RVUs Chapter 11: Conclusions and Summary Max Reiboldt, CPA President and CEO, Coker GroupFor more than a decade, Max Reiboldt has led The Coker Group, one of the leading healthcare con- sulting firms in the US and abroad.

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This includes the development and redesign of physician compensation plans for both private practices and hospital-employed settings as well as providing guidance to hospitals, physicians and legal counsel as to the appropriateness of transactions between a hospital and a physi- cian. Prior to joining Coker Group, he worked as a senior associate for PricewaterhouseCoopers in their audit practice. $84 print, $67 ebook www.greenbranch.com | 800-933-3711 R epro duce d w ith p erm is sio n o f th e c o pyrig ht o w ner. F urth er r e pro ductio n p ro hib ite d w ith out p erm is sio n.