Recruitment, Retention and Your Hospitalist Program

Recruitment, Retentionand Your Hospitalist Program

Kenneth G. Simone, DO

Objectives

Discuss Hospitalist Workforce Demographics Discuss Challenges Associated with Hospitalist

Recruitment Identify the Hospitalist Candidate Pool Discuss Physician Workforce Facts Identify Factors Influencing Physician Supply

and Demand Discuss the Hospitalists’ Role in Recruitment

and Retention of Physicians in their Local Community

Hospitalist Workforce Facts

Growth of Hospitalists

1997 23 1999 800 2000 1400 2001 1750 2002 3508 2003 4076 2005 12,000+ 2010 30,000+


Characteristics of Hospitalist Management Groups

RegionMidwest – 27%/ South – 26%/East – 24%/West – 22%

Surrounding areaLg. urban (over 1 mill.) – 49%/Sm. urban – 33%/Rural – 18%

Employment modelHospital – 34%/Acad. institution – 20%/Mgt. Co. - 19%Local hospitalist only – 12%



Control/Hospital governance of affiliated hospitalNot for profit – 86%/For profit – 10%/Government – 3%

Teaching status of affiliated hospitalNon-teaching – 48%/Major teaching (Member of Assoc. Of AmericanMedical Coll., Council of Teaching Hosp.) – 28%/Other teaching –

25%



AgePhysician leader – 41 years old/Non leader – 37 years old

GenderPhys.leader-80% male, 20% female/Non leader-62% Male,

female 38%

Median years as a hospitalistLeader – 5.1 years/Non leader – 3 years



Education (Percent graduates of U.S. medical school)Physician leaders – 85%/ Non leaders – 72%

Specialty trainingGen. Int. Med. – 75%/Pediatrics – 11%/ Int. Med. Sub. – 4%/ FP –

3%



Program growthMean number of staff added – 1.93 FTE’s (29% growth)

Program TurnoverMedian – 9%

Challenges Recruiting Hospitalists

Salary Practice model Work hours/Call schedule Daily workload Expectations/Demands from hospital Medical staff support

Specialty providers Referral network

Hospital administrative support Program staffing/Program stability Empowerment and career path Community and practice culture Hospital culture and systems


Where are these hospitalists?

Critical access hospitals Community hospitals Major medical centers Teaching programs Involved in basic and clinical research Administrative leadership positions (CEO, Medical Director, VPMA) Medical staff leadership (Chief of staff, Department chair, QA Director) Involved in medical policy making and patient advocacy (quality and

safety initiatives) Creating evidence-based clinical guidelines and protocols Developing surgical co-management programs Developing palliative care programs


What is the hospitalist recruitment pool?

New graduates Internal medicine, IM/Peds, Family medicine, Pediatric residency

training programs Hospitalist fellowship programs/Hospitalist tracks Sub-specialty training programs (e.g. Intensivists, pulmonary,

cardiology, etc.) International medical graduates (IMG’s)

Established hospitalists in other programs Established physicians in non-hospitalist practices (e.g.

private or hospital practice) Emergency Department physicians Locum Tenens


The Hospitalists Role in Recruiting Physicians

HFMA NEWS

Wednesday, June 21, 2006 - AAMC Calls for 30% Increase in Medical School Enrollment

Concern about the growing physician shortage has led the Association of American Medical Colleges to recommend that enrollment in U.S. medical schools be increased 30% by 2015 instead of the 15% AAMC proposed in February 2005. Citing current population trends and physician retirement patterns, AAMC says the number of physicians will peak by about 2020 and then drop just as the baby boomers begin to reach age 75 if medical schools don’t accommodate 30% more students. The proposed expansion would increase the number of new MD students by 5,000 annually, and AAMC suggests that it be accomplished by boosting enrollment at existing schools and by creating new allopathic medical schools.

Physician Workforce Facts

According to the AMA:

67% of practicing physicians are over the age of 42 (Mature and boomer generations)

18% are 61 years of age or older 49% are between 42 and 60 years of age 88% are male

~33% of practicing physicians are between 27 and 41 years of age (GenX sector)

58% are male/ 42% female

54% of new medical school graduates born after 1980 are female (Millennials)


According to the COGME : While the number of physicians will increase from 781,200

FTE’s in 2000 to 971,800 in 2020 (a 24% increase), after 2015 the rate of the population growth will exceed the rate of physician growth

The US census bureau estimates between 2005-2020: The projected population less than 65 years old will grow 9% The projected population 65 and older will grow 50%

Keep in mind the elderly use much more services representing a significant increase in demand for physician services….


What about physicians entering medicine?

A review of physician and recruiting initiatives by Merritt, Hawkins and Associates in 2007 indicated:

The top five specialties by growth in number of search from 2005- 2006 to 2006-2007: 73% - Hospitalists 54% - Pediatrics 43% - OB-GYN 31% - Hem/Onc 18% - Family Practice


What about physicians exiting medicine?

The AAMC ‘s Third Annual Physician Workforce Conference (5/07) previewed two upcoming surveys by the AAMC and the American Medical Association of physicians over and under age 50. Preliminary findings indicate that:

One out of three doctors over 50 would retire today if they could afford to do so Older physicians cite increased regulation of medicine as the key factor

influencing retirement plans

Two out of three, or 66 percent of doctors under 50, are not interested in working longer hours for more money

Seventy-one percent of young doctors identify having family and personal time as an important factor in a desirable practice.


Reasons physicians voluntarily leave a practice: (Source: 2006 Retention Survey from the American Medical

Group Association (AMGA) and Cejka Search)

51% - Poor cultural fit Relocated to find a better community fit was mentioned 20% of the

time 42% - Family considerations To be closer to own or spouse’s family and spouse’s job required

relocation was mentioned 22% of the time

32% - Leaving to seek higher compensation

Incompatible work schedule and excessive call schedule each mentioned 17% of the time.


Turnover ratios

(Source: 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka Search)

6.7% - Total average turnover (6.4% in 2005)

By sex Males: 6.85% (5.9% in 2005) Females: 6.6% (7.5% in 2005)

The first three years in practice hold the greatest likelihood for turnover

12% - First year 46% - In the first three years 23% - Greater than ten years


Hospital officials said hospitalists provide many benefits. They provide more immediate and more frequent care than primary care doctors, who are also busy with office patients. Such attentive care means quicker, often better service along with potentially shorter hospital stays. Hospitals see the arrangement as one that can boost not only recruitment and retention of doctors, but also one that helps create financial efficiencies in an era when insurance reimbursements are putting serious strains on institutional budgets.

“On the wards: Hospitalists steadily bolster their ranks,” Boston Business Journal - March 24, 2006 by Mary K. Pratt.


Factors influencing physician recruitment and retention

Changing culture Limited resident work hours Growing ratio of women entering the medical profession Increasing male participation in the household Graduate debt burden Generational (X, Millennial) expectations

The new generation of doctors may view the medical profession as a job and not a calling….



Changing focus of the specialist Consultant role Procedurist orientation and training

Aging physician workforce

Practice scope Medico-legal concerns Employment model



Lawyers, guns, and money

Diminishing returns Medicare Medicaid

Teaching and Research

Lifestyle

Concluding thoughts….

Although there is a large number of hospitalists nationally, recruitment of these physicians remain a challenge.

A well built and managed hospitalist program can benefit the hospital and medical community in many ways, including recruitment and retention of valuable personnel.

Contact information

Kenneth G. Simone DOHospitalist and Practice SolutionsEmail address: [email protected]: 207-949-2319

References

1. SHM 2005 - 2006 Survey.2. Physician Supply and Demand: Projections to 2020. U.S. Department of Health and

Human Services. Health Resources and Services Administration. Bureau of Health Professions. October 2006.

3. Physician Workforce Policy Guidelines for the United States, 2000 – 2020: Sixteenth Report. U.S. Council on Graduate Medical Education. U.S. Department of Health and Human Services – HRSA. January 2005.

4. Coile, Jr., Russell C. “10 Factors Affecting the Physician Shortage of the Future - Next!” Physician Executive, Sept-Oct, 2003.

5. Full, James M. “Physician Recruitment Strategies for a Rural Hospital.”, ache.org,, 6. Westfall, Carol. “Strong Physician Recruitment and Retention”, Physicians News Digest,

January 2004.7. 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka

Search.8. Third Annual AAMC Physician Workforce Research Conference, May, 2007.<http:\\AAMC

Physician Workforce Research Conference.htm.9. Cohen, Jordan J. “Physician Workforce Trends and Expectation.” Association Of American

Medical Colleges. December 21, 2006.

References

10. Strategies for Recruiting and Retaining Top Hospitalists. Hospitalist Management Advisor. May, 2007.

11. Pratt, Mary K. “On the wards: Hospitalists Steadily Bolster Their Ranks”, Boston Business Journal - March 24, 2006.

12. Lurie, J.D., Miller, D.P., Lindenauer, P.K., Wachter, R.M., Sox, H.C. “The Potential Size of the Hospitalist Workforce in the United States”, The American Journal of Medicine® 106 (4) (1999) pp. 441-445.

13. Holton, Lisa. “Put More Than Money on the Table When Recruiting Hospitalists”, ACP Hospitalist. February, 2007.

14. 2007 Physician and Recruiting Initiatives Survey by Merritt, Hawkins and Associates.15. Dichter, Jeffrey R., Simone, Kenneth G., Tools and Strategies for an Effective

Hospitalist Program (HCPro: MA., 2006).16. Cooper, Richard A., Stoflet, Sandra J., Wartman, Steven A. “Perceptions of Medical

School Deans and State Medical Society Executives About Physician Supply”, JAMA. 2003;290:2992-2995.

17. Cooper, Richard A., Getzen, Thomas E., McKee, Heather J., Laud, Prakash. “Economic And Demographic Trends Signal An Impending Physician Shortage”, Health Affairs. Vol. 21, Number 1. Project Hope, 2002. 140 – 154.

Bonus Slide

Recruitment and retention are affected by many variables including:

Geography Economics Workforce supply Population demographics Creation of a solid recruitment and retention plan Generational expectations Practice and workplace culture Presence of a hospitalist program Communication Collegial support Medico-legal landscape Community fit, family integration and satisfaction Potential for professional growth Practice flexibility and call Life style requirements

Bonus Slide

Physician supply and demand are affected by many variables including:

Number of medical school graduates Number of residency programs and seats Number of international medical graduates Government policy Health of the U.S. economy Insurance Specialty choice Physician productivity Work schedules Number of FTE’s New medical technologies Aging physician population/retirement patterns Growing and aging patient population Utilization of mid-level providers

Physician Recruitment and Retention

in New Hampshire

Health & Medicine

Recruitment, Retention and Your Hospitalist Program