Five Ways to Move the Needle on the Physician Shortage

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Five Ways to Move the Needle on the Physician Shortage

For the healthcare industry, the COVID-19 pandemic is raising new challenges that no one expected in our lifetime. It is also shining a spotlight on challenges that have been around for a while—like the physician shortage.

Many people wonder whether the easing of out-of-state licensing restrictions will remain once the crisis subsides. But there is also debate about other interesting approaches that might help address the shortage once our world gets back to normal. Here is a recap of five key approaches I believe will be front and center in the coming months whenever the discussion turns to: How do we solve the physician shortage post-COVID-19?

1. Make Licensing Waivers Permanent

If anything good can be said about the coronavirus, it’s that it is providing a beta test for doctors licensed in one state to practice just about anywhere. The Federation of State Medical Boards reported April 23, 2020 that 48 states and the District of Columbia had adopted waivers to licensure requirements in response to COVID-19.

That helped make possible, for example, the more than 21,000 out-of-state healthcare professionals to volunteer their services in New York, the state with the most U.S. coronavirus cases at the time of this writing.

Will the waivers continue once the pandemic is over? I know there is much debate over the possible move to a single national standard for physician licensing. But who can argue with slashing red tape to make it easier to provide care to those who need it?
As the author of a recent Forbes magazine article puts it: “Why should a doctor who’s good enough to practice in California be unable to do so in New York?”

Licensing Waivers

Why should a doctor who’s good enough to practice in California be unable to do so in New York?

If one does view the waivers as the de facto adoption of a national standard, it will certainly be of interest to see the data on how it impacted the practice of medicine during the pandemic.

The rise of telemedicine, especially its value during the pandemic, will no doubt fuel the argument that we should continue to make it easier for physicians to care for patients in other states. At the very least, some sort of lasting mutual recognition agreement, in which states honor each other’s physician licenses, might be in order.

Streamlining the licensing process would also ease the way for international medical school graduates, who make up almost 25% of today’s physician workforce.

Streamline the process

2. Do Something About Physician Student Debt

Physicians have shown their heroic stripes during the pandemic, especially Millennial physicians who volunteered to work in high-impact areas because of their reduced risk of catching the virus. Federal government hazard pay such as New York Governor Andrew Cuomo’s proposal for front-line workers is one way to recognize their effort, but young doctors point out that the few extra thousand dollars is pocket change compared with the hundreds of thousands of dollars of student loan debt they owe.

We endorse the American Medical Association’s April 7 request to Congress extending federal student loan forgiveness for doctors caring for patients on the frontlines of the COVID-19 epidemic, but it doesn’t address what happens once the epidemic is over.

According to the Association of American Medical Colleges (AAMC), median medical school debt was $200,000 in 2018. That debt pressure can steer new doctors away from research, community-based work and general practice, which may not be as highly paid as medical specialties

Student Debt

Not every school can do what the NYU School of Medicine did to be the first private U.S. medical school—and the only one ranked in the top 10—to offer free tuition to all its students. The yearly tuition costs covered by the scholarship are $55,018. While few institutions have the endowment for this kind of undertaking, it raises an opportunity for others to explore. The free-tuition initiative began more than a decade ago, when NYU created the endowment and began raising the roughly $600 million it estimates will be needed to keep the program ongoing.

What about public medical schools? The student debt burden isn’t as high as private medical schools, but still substantial. The average four-year cost for public school students is $243,902, according to the AAMC, compared with $322,767 for private school students. Still, paying off loans for those four years is a big burden to carry.

The average four-year cost for public school students is $243,902, according to the AAMC, compared with $322,767 for private school students

Sure, there are tools like the federal government’s income-driven repayment program where monthly payments are a percentage of discretionary income, rather than traditional repayment plans where students make payments based on the amount of money they owe. By working for nonprofit facilities or the government, working in medically underserved areas, or joining the military, students can reduce medical school debt, as well.

While such programs offer some relief, they don’t get to the heart of the problem that medical school costs are simply out of reach for many qualified students. Shortening the path to becoming a doctor is one approach to bringing costs down.

3. Make Becoming a Doctor More Affordable

In the 1970s, rising gas prices were one of the factors that led the auto industry to redesign American cars to be smaller and more efficient. That same kind of evolution is brewing among some medical schools today.

The Forbes article mentioned earlier points to the lengthy path in the U.S. for a student to become a physician. While in the U.S., the typical doctor spends four years in college, four years in med school and anywhere from three to seven years in post-graduate residency and fellowship, students in almost every other developed country can earn a medical degree in six years or less—and then begin residency.

While in the U.S., the typical doctor spends four years in college, four years in med school and anywhere from three to seven years in post-graduate residency and fellowship, students in almost every other developed country can earn a medical degree in six years or less—and then begin residency

As the article points out, some U.S. medical schools have responded to the pandemic by graduating students ahead of time to help fight COVID-19. Measures like these don’t have to temporary, writes the author of the article.

Three-year M.D. programs that started before the pandemic—like those at Texas Tech, NYU and Duke—have shown strong signs of success, helping cut student debt and produce grads faster.

The savings are significant. An AAMC report quotes research showing that, with tuition cuts and an extra year of salary, the lifetime savings afforded by a three-year program is about $250,000.

Skeptics argue that the shorter cycle robs young doctors of valuable experience before they begin practice, adds to stress that can lead to early burnout, and limits the time students need to explore all the specialty options available. Proponents of the shorter programs cite research showing that three-year grads perform on par with traditional four-year grads.

Three Year Programs

We feel certain the debate will continue, but momentum is growing for a wider range of three-year programs for young hopefuls to choose from.

The same AAMC report states that there were 150 three-year program grads in the U.S. in 2019, compared to fewer than 10 in 2013. And the Consortium of Accelerated Medical Pathway Programs, launched in 2015 by eight schools in the U.S. and Canada with funding from the Josiah Macy Jr. Foundation, grew to 16 last year.

4. Increase Residency Slots

One bright piece of news in the stories about the physician shortage is that U.S. medical school enrollment has increased by 31% since 2002, according to the AAMC. Combined with first-year matriculation at osteopathic schools, medical student enrollment is now 52% higher than in 2002-03.

It’s the result of an AAMC initiative begun in 2006 that called on medical schools to increase first-year enrollment by 30%. That target was reached in 2018-19, when first-year matriculation reached 21,622 students. Osteopathic schools increased their enrollment by 164% during this same time period, with 8,124 first-year students enrolled.

Residency Slots

The next step is to increase the number of residency slots

The next step is to increase the number of residency slots. “From a supply side perspective, what we really need to focus on now is the residency slots,” says Atul Grover, MD, PhD, executive vice president of the AAMC. “We’ve done everything we can on the medical school front to reduce the physician shortage, and I think the numbers bear that out. The federal government needs to resume covering its fair share of the costs. That starts by lifting the caps.”

Residency Expansion

Residency training positions have expanded at a rate of just 1% a year, due in large part to a congressional cap on federal funding in the Balanced Budget Act of 1997. Most of the costs of residency training — about $171,855 per year, per resident on average, according to AAMC data — are supported by teaching hospitals and their faculty. Medicare (U.S. Department of Health and Human Services) has historically paid for 21% of the training.

However, that support has been largely frozen since 1997 with the unfortunate state of gridlock in Washington, D.C. A house bill introduced last year – the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763) – would add up to 15,000 Medicare-funded residency positions over five years as a means to increase the number of practicing physicians, and is similar to an AHA-supported bill introduced in April in the Senate. The Senate bill has been referred to the Senate Finance Committee and the House bill to the Subcommittee on Health.

It’s shameful that an adequate number of residency slots for a nation struggling with a physician shortage has become a political issue, but that’s the way of our world today.

Some teaching hospitals are supporting residency positions over their caps without any federal support. They are also working with hospitals that have never been teaching hospitals to establish new residency training programs.

5. Change Payment Mechanisms

Public opinion is a fickle thing, but I think the COVID-19 crisis, and the heroic role physicians have played in it, might very well sway public opinion regarding how doctors get paid in the future. I also think it might very well embolden doctors—and rightly so—to demand better payment for their services—or at least demand a greater choice of payment options for their services.

The days of COVID-19 are rough for physicians. With elective surgeries put on hold across the country as hospitals grapple with the influx of patients infected by the coronavirus, group practices are struggling. Physicians are temporarily shutting their doors

Let’s face it. The days of COVID-19 are rough for physicians. With elective surgeries put on hold across the country as hospitals grapple with the influx of patients infected by the coronavirus, group practices are struggling. Physicians are temporarily shutting their doors or—those who can afford it—retiring in response to the pandemic. This will in turn pose a challenge to hospitals already grappling with staffing gaps and attempts to return to normal once the crisis subsides.

The American Medical Association opposed a California price-fixing bill that would have set rates for all health services covered by commercial health insurance plans using Medicare rates as a benchmark, and the bill eventually failed. But that doesn’t mean other states might not consider similar measures in an attempt to lower healthcare costs after the height of the COVID-19 crisis. Our doctors deserve better.

The AMA argued eloquently that physician payments are not a major driver of increasing health care costs and have risen only 1.2% from 2006 to 2016. Other complicated issues such as long-term care, lack of access to preventive care, chronic disease, prescription drugs, cost transparency and others contribute a larger share to rising costs. Maybe the COVID-19 crisis will help the public—and its lawmakers—understand those issues better—and pay physicians what they are worth.

It has been encouraging in recent years to see hospital payment models shift from being based not only on productivity goals but also to reflect the physician’s contribution to quality improvement as the value of care is measured. And hospital administrators are becoming creative by including flexible scheduling, reduced or no call hours, signing bonuses and student loan forgiveness to attract candidates to ongoing vacancies.

Rising Costs

Build a better house

I heard a great analogy the other day that went something like: If your house burns down, are you going to rebuild it exactly the way it was, or are you going to build your dream house? It’s obvious that old ways need to change if we’re going to seriously tackle the predicted shortage of nearly 122,000 physicians by 2032. The ideas presented here are a starting point, at least, for building a house that everyone in the healthcare industry can be proud of.

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COVID-19: Stories from the Healthcare Leaders Bring Hope, Inspiration

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It’s clear that COVID-19 has changed our world.

The days are more stressful as we respond to challenges we’ve never faced before. Many people find that sheltering in place is a challenge in itself. Long days offer more time for self-examination and worry about what the future holds.

Speaking for myself, I’ve spent much of the time listening.

Heroes in our midst

Over the past few weeks, I’ve spoken with physicians and other healthcare leaders who are tirelessly working during the pandemic. Their stories are amazing—heartbreaking, stressful, yet encouraging in the emotion,  commitment and collaboration all these individuals share.

While our recruiting work goes on at Jackson Physician Search, we’re sharing these stories in a series of online interviews to show how COVID-19 is impacting the physicians and healthcare leaders we work with.

Professional impact

First and foremost, the pandemic is taking doctors far outside their comfort zones.

Dr. Gene C. Liu, president of Cedars-Sinai Medical Group and an ENT practicing at Cedars-Sinai Medical Center in Los Angeles, says one of the biggest challenges for him as a surgeon is not being able to charge in and fix a problem like removing tonsils or straightening a septum.

“There’s not that instant gratification,” he says. “You’re really a bystander, making sure patients get enough oxygen … giving their bodies the medical support they need to fight the bug.”

Dr. Richard Bowe, an anesthesiologist for nearly 32 years with Phoebe Putney Medical Group in Albany, Ga., also found himself transitioning to a completely different clinical role when COVID-19 cases rose to alarming levels in the town of 80,000.

With elective surgeries on hold, Dr. Bowe has joined other anesthesiologists and nurse anesthetists in helping to staff one of the two new ICUs created to handle the influx of the critically ill.

Family impact

With his wife and children away from Albany to avoid possible infection, Dr. Bowe finds the loneliness compounds the challenge. “It’s a challenge to see these patients as sick as they are, and then coming home to an empty house at night, trying to decompress without having anybody to talk with.”

For Dr. David M. Gonzalez, an interventional cardiologist in a program that has saved countless lives over the last decade at Portneuf Medical Center in Pocatello, Idaho, it’s a similar story of living at home alone, away from his wife and family of seven children. He acknowledges it’s part of the new reality.

Dealing with fear

“Every time you go to the hospital, there is an element of fear and anxiety that strikes you before you walk in,” Dr. Gonzales says. “The biggest thing is dealing with your own fears. Not only for yourself, but also that you could spread it [the virus] to your family or someone else.”

Making it particularly difficult is working in the protective gear and the discomfort of the N95 masks. He manages the stress by keeping to his exercise routine and starting each day with a stop at the coffee shop where he has been a customer for 14 years. “It’s nice to see some smiling faces first thing in the morning.”

Cory Ferrier, executive of business development with Adventist Health in Los Angeles, says he’s been amazed by the ingenuity the hospital’s physicians have shown in the face of fear and uncertainty. “I had no idea how many of our physicians had 3-D printers at home,” he says. Working together, the physicians used the printers to build intubation kits that protect clinical teams from aerosolization during the intubation procedure.

Recruiting impact

Ferrier says recruitment is on stand-by at the hospital, but that doesn’t mean he isn’t reaching out to candidates via Zoom, Skype or Facetime. “I’ve learned whenever there is a change or shift or a disaster, that’s where the most opportunity is. While we might not be able to send a contract to a physician now, I make sure they know when this settles, we’ll be able to make them an offer.”

Dr. Gonzales predicts the pandemic might bring more doctors to rural areas. He has recently recruited a new doctor from New York who will start in July. Working in a big city hospital dealing with a severe outbreak, the physician “can’t wait to get out,” Dr. Gonzales says. “He’s worried for his family. He can’t get here fast enough.”

Financial impact

The financial side of the crisis is harrowing, too.

In Albany, Dr. Bowe says, “We don’t know what reimbursement will be like for these COVID patients. The health system has taken an attitude of ‘we’ll work that out later and take care of people first,’ and I agree with that completely.”

Instead of furloughing staff, the system has them taking temperatures at hospital entrances and cleaning computer keyboards and door handles, so they’ll be ready to resume their normal jobs when the crisis subsides.

Despite the challenges, Dr. Bowe says he finds rewards in what he is doing today. “I can’t imagine doing anything differently than what I’m doing now,” he says.

A lesson in sacrifice, a reason for hope

As I speak with these physicians and other healthcare leaders, I’m humbled by the stories of courage and sacrifice I hear. They’re giving up family time, sleep and personal safety to ensure our healthcare system keeps moving forward.

Listening to them gives me hope.

May it do the same for you.

IMPORTANT COVID-19 MESSAGE FOR CANDIDATES FROM OUR PRESIDENT, TONY STAJDUHAR

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Hello,

Just when I thought I’d seen it all, COVID-19 hit. I continue to be inspired by the way you, other healthcare workers, and first responders are responding to this crisis. Your dedication doesn’t really surprise me. But it seems when life is most difficult and people need help, you are the very people who transform into superheroes right before our eyes. It’s remarkable.

I want to reassure you that our entire Jackson Physician Search team is working overtime – day and night – to support you. One of our guiding values is to be an ‘Others First’ organization, so if you receive a call or email from us, I hope you will trust that our intent is not to be disrespectful or insensitive.

By nature, recruiters are great listeners. We want to listen and meet your needs – even if what you need most at the moment is to vent about the day’s challenges! We are committed to being the best matchmakers in the industry, but if in trying to meet your immediate needs, we happen to catch you at an inopportune moment, please let us know. We will always respect your wishes.

Our team has transitioned to a fully functional work-from-home model, allowing them to continue to connect you to our hundreds of clients across the nation – uninterrupted. We will continue to provide Nordstrom-level service and to think outside-the-box. We have been asked to adapt our process and assist with complying to new hospital policies. Some of these changes may include scheduling video interviews, or scheduling interviews outside of the medical campus.

Hopefully, sooner, rather than later, this crisis will pass. And as we all know, there is already a physician shortage that COVID-19 isn’t going to improve. While you focus on you and your family’s most pressing needs, we’re still focused on your future career goals.

I am praying for everyone daily, and our thoughts are with you and your family – please take care of yourself and feel welcome to call us at any point. Together, we will get through this and, hopefully, come away with valuable lessons learned.

Be well,

Tony Stajduhar
President

[White Paper] The Realities of Physician Retirement: A Survey of Physicians and Healthcare Administrators

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One of the major factors of the impending physician shortage is the aging physician workforce. We recently conducted a survey including practicing physicians and health administrators to better understand the situation. This whitepaper includes our findings and conclusions. Feel free to download and share.

By 2020, one in three physicians will be over age 65 and approaching retirement. For hospital administrators, recruiting an experienced physician is a complicated process that takes significant time. An open position is costly in terms of lost revenue and the potential loss of both patient satisfaction and staff morale.

Given that a hospital can easily lose $150,000 per month if a specialist leaves and that a search for a medical or surgical specialist takes five to 10 months, the stakes are high. New research from Jackson Physician Search―that surveyed both practicing physicians and healthcare administrators―highlights the importance of creating the right culture and processes around physician retirement, including effective transition processes and ongoing recruiting efforts, to avoid the negatives of a vacancy or understaffing situation.

Among the key findings:

  • Physicians’ drivers for retirement include lifestyle, financial stability, burnout and frustration with the current state of medicine. While physicians cited lifestyle issues (44 percent) as the most important reason driving their retirement decision, followed by financial stability (23 percent), comments from nearly 20 percent of them noted burnout and frustration with the increased focus on paperwork and patient volume as well as decreased focus on patient care.
  • Physicians feel it’s their responsibility to initiate the retirement conversation, but they are less comfortable doing so than administrators. A large majority of physicians (80 percent) said it’s their responsibility to broach the subject compared with 37 percent of administrators, yet less of them (52 percent) are comfortable discussing retirement plans than administrators (74 percent).
  • Physicians and administrators have vastly different opinions on what the ideal notice period is for a retirement timeline. Almost 50 percent of administrators indicated the ideal notice was one to three years, while 40 percent of physicians felt six months or less was sufficient. Also, 34 percent of physicians said they weren’t required to give any notice of retirement, while 81 percent of administrators said they were required to give more than three months.
  • Administrators assume that many physicians will fully retire, but a number of them plan to work elsewhere. Almost 40 percent of administrators named full retirement as a top retirement transition method at their organization, but just 17 percent of physicians were planning to do so. In contrast, 28 percent of doctors say they will work part or full time somewhere else.

Although there is hesitancy about initiating a conversation about retirement, it is clear that both administrators and physicians feel that it’s a beneficial discussion for both parties. Differences remain on length of notice and whose responsibility it is to bring up retirement, but when handled respectfully and conducted in a non-discriminatory way, both parties can find the ideal way to transition the retirement with proper planning and processes.

Survey Methodology and Demographics

To find out how both physicians and hospital administrators approach physician retirement and transition planning, we surveyed both groups on a range of related topics. These included the age of retirement, drivers for making the decision, requirements and timeframe for giving notice, comfort with having the conversation and whose responsibility it was to initiate it. Other questions were related to the retirement transition itself and interest in employer retirement incentives.

A total of 567 physicians and surgeons from a wide range of specialties responded to the survey. Physician respondents were distributed throughout the United States, roughly based on state population. Half of them described their communities as suburban and just 15 percent noted rural. Most respondents (61 percent) were between the ages of 50 and 69, and the majority were male (71 percent).

There were 100 hospital administrator respondents to the survey, many of which were C-level executives, followed by directors and administrators in a variety of recruiting and human resources functions. The administrators were distributed across the country, but a larger proportion (40 percent) were from self-described rural communities. As with the physician respondents, most were between the ages of 50 and 69 (63 percent), although the majority of administrator respondents were female (55 percent).

Drivers for Physician Retirement

In the survey, administrators report the average age for retirement at their healthcare facility as 65, which is in line with the age of 63 as determined by analysis of U.S. Census data. Not surprisingly, physicians named lifestyle (44 percent) and financial stability (23 percent) as top drivers for retirement. Likewise, administrators also perceive lifestyle (48 percent) as a top driver, although they found health reasons (15 percent) the second most prevalent motive, which was close to three times more than what physicians cited. Administrators were also less likely to think that financial stability (14 percent) was the most common reason physicians made a retirement decision.

More than 17 percent of physicians indicated “Other” as the top reason for retirement, compared with just 10 percent of administrators. Many physicians indicated burnout and frustration with the state of medicine in the United States, as noted in the following comments:

  • Managed care, whether private or government, has made the practice of medicine too adversarial to enjoy enough to consider delaying retirement.
  • Medicine has turned into a quagmire of regulatory burdens, collecting data, and the destruction of physician’s autonomy and authority in individual patient care.
  • Doctors are no longer able to practice medicine with the primary objective of patient well-being!!
  • It has become too onerous to practice. The focus is on increasing volume with less and less pay. Also, the practices are running leaner which shifts more and more clerical work onto doctors. Add to these issues the increasing testing and “boutique” results reporting and you have a formula for high stress with diminishing satisfaction and diminished returns.

Having the Retirement Conversation

When it comes to initiating the retirement conversation, survey results show that the topic weighs more heavily on the physician, and that there is room for administrators to make the discussion more comfortable, both for the benefit of the physician and the organization. A large majority of physicians (80 percent) said it’s their responsibility to broach the retirement subject compared with 37 percent of administrators, yet less of physicians (52 percent) are comfortable discussing retirement plans than administrators (74 percent). One physician noted that “succession should always be a part of the hiring discussion and empowerment to plan and mentor over time.”

On the administrator side, almost 30 percent cited “Other” when asked whose responsibility it was to start talking about retirement. The following comments from physicians in this category indicated an acknowledgment that they had difficulty broaching the subject―and that there is a need for a more formal, yet inviting process, especially given the long lead time needed to recruit a physician:

  • MDs usually initiate, but if they are having trouble, the administrator or group president will initiate the conversation.
  • I believe our physicians are not very comfortable with the conversation, so we (HR) have provided them with a script and talking points to assist with these conversations.
  • Ultimately, it should be the physician, but there is a hesitancy to do so. Therefore, we have tried to make it a collaborative discussion between the physician and the physician leader.
  • We periodically send surveys to the physicians, asking that they let us know if they are considering retirement in the next 1 to 3 years, as the recruitment process is lengthy.
  • The organization views it as the physician’s responsibility. However, as a recruiter needing lead time, I’d like a plan to approach the physicians and have administration address succession planning. I’ve been pressing for this almost five years without success.

The Realities of Giving Notice

Physicians and administrators have vastly different perspectives on what the ideal notice period is for providing a retirement timeline, a finding that might partially be explained by the lack of conversation and practices regarding retirement in general. Almost 50 percent of administrators indicated the ideal notice was one to three years, while 40 percent of physicians indicated it was 6 months or less. Also, 34 percent of physicians said they weren’t required to give any notice of retirement at all, while 81 percent of administrators said they were required to give more than three months.

When administrators were asked how much notice they typically receive when a physician plans to retire, their answers ranged from a high of three years to a low of one month, with an average of 10 months. The most common notice period cited was six months, which was in line with what physicians reported as the ideal notice period. Given the timeline for locating a physician and the fact that 40 percent of physicians thought 6 months or less was an ideal notice, administrators should consider the practice of ongoing recruitment of candidates to make sure there are no gaps in care and revenue.

The Retirement Transition

Physicians in the survey indicated some differing ideas about the retirement transition than administrators might assume, which possibly indicates they are looking for greater flexibility in their transition process. Almost 40 percent of administrators named full retirement as a top retirement transition method at their organization, but just 17 percent of physicians were planning to do so and almost 28 percent of doctors say they will work part or full time somewhere else. Some of the doctors listing “Other” planned to pursue locum tenens work or pro re nata (PRN) and telemedicine options that let them dictate their own schedules, while others looked to potentially help with recruiting, mentoring and managerial tasks at their current practice.

Many physicians (47 percent) were interested in retirement information planning services, but only half of administrators indicated those are offered. Comments from physicians indicated the vast majority of them were, not surprisingly, most interested in financial and healthcare planning. Physicians in the survey were also looking for help with the general process of retirement, along with ways to explore part-time or non-clinical options, as noted in these comments:

  • There is a need for an outline and timeline of what needs to be done, as well as the contact people to facilitate the process.
  • I would like to know the steps for the retirement process and how/when to transition to Medicare health coverage. I am also interested in opportunities for part-time work with the same employer, along with pay/benefit information.
  • It would be helpful to know how to manage before full retirement age.
  • I would like to know what part-time work is available once I retire that may or may not include clinical care.

When asked if employer-sponsored incentives would induce them to start an early retirement process, 50 percent of physicians agreed it would, with most requesting financial and/or healthcare benefits. Others were looking for part-time employment opportunities. However, nearly all administrators (95 percent) indicated they offered no incentives to initiate an earlier retirement approach so that staff planning was more seamless.

 

 

Conclusion

The survey results indicate that there is a need for more formal processes surrounding physician retirement, especially given the ongoing shortage of doctors in the United States. To help both hospitals and physicians with the retirement transition, administrators should:

  • Develop non-discriminatory ways of approaching the retirement conversation. HR and physician leaders should work together to create a step-by-step process for when and how to approach the conversation, which might even occur as early as during the hiring process. Having such a process makes the physician feel less singled out for the discussion. In addition, routine surveys on retirement plans can open the lines of communication.
  • Offer incentives to initiate an early retirement process. To encourage earlier notice of retirement from physicians, administrator should consider incentives like a percentage of pay for earlier notice, health benefits for a specified time period, and relief from call duties.
  • Create flexible offerings like part-time or non-clinical work. For financial and other reasons, such as benefits, many physicians would like to continue working, which could ease the burden during the onboarding process for a new physician. Having a process for scheduled conversations about retirement can help prepare for a situation where several physicians retire at once, which would include extra scheduling activities and other administrative tasks. However, given the high costs of a full vacancy, these costs could easily be justified.
  • Adopt a continuous recruitment process instead of treating a physician vacancy as a one-off occurrence. This will ensure that the physician candidate pipeline is full in the event that one or more physicians are transitioning to retirement. By maintaining relationships with qualified candidates, the organization is not starting at the ground floor of recruitment and can quickly adjust to unforeseen issues with retirement transitions.

With the proper planning and processes built on more open communications, hospital administrators can avoid understaffing and continue to provide the best possible patient care. Starting early in a physician’s career with these processes can make the transition and succession planning more comfortable for all parties and support more optimal recruiting efforts.

Rural Recruitment Whitepaper

[White Paper] Rural Recruitment: Results from the 2019 Rural Physician and Administration Survey

President of Jackson Physician Search, Tony Stajduhar, reviews the results of our recent rural physician and administrators survey and provides a summary…

Guide to Strategic Digital Recruitment

Our Regional Vice President of Recruiting, Christen Wrensen, presented the Digital Recruitment Strategy Guide to members of the Texas Hospital Association…

Need Help Recruiting Physicians?

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How to Solve the Impending Physician Shortage

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While we continue to see news stories that illustrate the impending physician shortage that is impacting communities all over the United States, the thing we don’t hear enough about is what can be done about it.  The main reason for the lack of information about ways to reverse the doctor shortage is because much of it relies on federal intervention.  To refresh your memory, in 1997 as part of a Balanced Budget Act, Congress enacted legislation to cap the number of residency training slots to be funded through Medicare.  Now, twenty-two years later, the limitations are effectively inhibiting the training of enough new physicians to keep up with the increased care demands of a growing population and an elderly population that is living longer.

A recent comprehensive study presented key findings to include, a projected physician shortage by the year 2032 of up to 121,900, and population growth of 10% with those over age 65 increasing by 48%.  The report did identify that there would be a continuation in the growth of physician assistants and advanced practice RNs.  Good news on the surface, but the report found that emerging health care delivery trends in addition to the increased use of advanced practice providers would only contribute to a physician demand reduction of about 1% overall.  Considering all of these factors, let’s look at what can be done to solve the physician shortage.

  1. Enact legislation to reverse the residency training limits.

There are currently two bills that were introduced in the House of Representatives and one bill introduced in the Senate that will increase the numbers of residency slots by up to 5,000 per year for the next five years.  While this should be welcome news that physician shortage relief is on the horizon, the current ultra-partisan state of our legislative branch means that like so many other pieces of legislation, no action is being taken on the bills.  All three of these legislative items are sitting in a preliminary status after having been introduced earlier this year. Concerned citizens can take action and contact their federally elected representatives and ask them to move on the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763, S. 348) and also the Opioid Workforce Act of 2019 (H.R. 3414).

  1. Continue to develop ways to improve physician utilization.

As previously mentioned, there is a growing utilization of advanced practice providers, such as physician assistants and other specialty practice providers, like certified anesthesiologist assistants and others.  Extending a physician’s reach through improved and increased utilization of technology solutions, like telemedicine, is another cost-effective way to improve access in underserved communities. One interesting advancement currently being used in France is a standalone telemedicine booth, called a Consult Station.  Inside, a patient is connected with a physician, via video, and has access to an array of diagnostic medical devices. Guided by the physician, the patient can perform a variety of health checks, including vital signs, blood oxygen levels, an electrocardiogram, and other tests.  These stations are in use throughout France and have improved access to medical care for many underserved rural communities.

  1. Embrace the utilization of new technologies.

Like France has done with the implementation of the Consult Station, the United States must take action to embrace and increase the efficiency of implementing new technologies.  From streamlining the training, licensing, and certification process for new innovations to increasing the utilization of computer-assisted medicine, artificial intelligence, and sensor technology.  As today’s healthcare consumers become more and more connected, they are increasingly active in monitoring their own care and are more open to accepting technologies as part of their healthcare experience. Technological innovations can supplement the increased utilization of advanced practice professionals and help bridge the gap in direct physician interventions.

There is no simple answer to the challenge of alleviating the physician shortage in the United States.  It is going to take a multi-faceted approach that includes participation and funding from both the private and public sector.  What can’t be overstated, however, is the fact that the trending pace of the shortage is far exceeding the pace of actions being taken to address the matter.  Until, a concerted effort is taken at the federal, state, and local level, access to care gaps will widen, and healthcare consumers will continue to bear the burden of the inaction.

 

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[White Paper] Physician Workforce 2030: Getting Ahead of the Recruitment Curve

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The physician workforce shortage creates a competitive recruitment marketplace. This white paper offers practical advice on what to do today to focus your recruitment strategy for long-term success.

 

Physician Workforce through 2030: Get Ahead of the Recruitment Curve

There’s been heavy discourse the last few years about the growing physician shortage in the United States. Based on a recent detailed study, the Association of American Medical Colleges (AAMC) now projects a shortage of between 40,800 and 104,900 physicians by 2030.

A complex set of assumptions factor into the models resulting in projected shortage that vary in degrees of magnitude depending on the location, specialty and population served.

The Affordable Care Act has helped push the percentage of insured Americans to nearly 90 percent, creating a greater need for primary care physicians to see new patients.

At the same time, uncertainty around healthcare legislation and the sheer complexity of reimbursement is enough to steer many physicians – both aspiring young doctors and those with years of experience – away from patient care.

Our population is shifting older; the Census Bureau project that the population 65 years and older will become larger than the population under 18 years old by 2056. And while America ages, so do its doctors. Nearly 30 percent of active physicians are now over the age of 60.

Specialties with the Greatest Demand

Family Medicine, Internal Medicine, and Psychiatry

Jackson Physician Search compared open jobs by specialties from ten top job boards and compared them to the number of third-year residents for those specialties, as provided by MMS data. Assumptions that played into our research model: The turnover rate for doctors hovers around 6.8 percent, according to the American Medical Group Association. We recognize that retirees – and practicing physicians who change jobs – both leave vacancies that will most likely be filled fro the pool of graduating residents. Some are advertised on multiple job boards, while others are not advertised at all.

Based on this analysis, the specialties with the greatest demand are: family medicine, internal medicine, and psychiatry. Young medical students are forgoing these for more technical specialties that result in more defined hours, high mobility, higher incomes, and the perception of greater prestige than primary care. The stigma of mental health may be a factor in turning medical students away from psychiatry, in which only half of residency programs in the U.S. are filled, according to Dr. Adam Brenner, a psychiatrist and associate professor at UT Southwestern Medical Center.

The Disparity of Physician Workforce Coverage

Not only are there not enough doctors to go around, they aren’t evenly distributed. The resulting barriers to accessing specialty care creates significant – even tragic – disparities in health and well-being among many rural Americans.

Nationally, there are, on average, 91.1 active primary care physicians per 100,000 people, but some states fared better than others, according to the AAMC, which based their distribution map on census and American Medical Group data.

 

Read the full whitepaper by clicking the download button.

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3 Traps to Avoid When Recruiting Physicians

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For every month it takes to fill an open physician job, thousands of dollars in potential revenue may be lost. For instance, average annual revenue for an internal medicine doctor of $823,900 equates to more than $68,650 in lost revenue per month while you’re waiting for a new internist. Keep reading to learn what to avoid when recruiting physicians so you don’t miss out on potential revenue.

Consider, also, the potential long-term impact if patients are forced to visit competitors because your facility lacks important services while waiting for a new physician. You may be losing ancillary revenue from specialist referrals and services provided by your hospital.

The sense of urgency to hire is important as the physician shortage intensifies. But, it is also important to balance the cost of a vacancy with the risk of a poor hire. While it’s more difficult to measure, it’s more expensive in the long run.

Avoid these three critical – but very common – mistakes, and you will become more efficient, effective and strategic in hiring. Your overall return on investment will increase as a result.

  1. Failure to Continuously Recruit

Once candidates are identified and interviews are being scheduled, the natural instinct is to stop recruiting in that specialty. But we caution: keep recruiting until you have a signed contract and are assured a physician is coming on board. Letting the engine “go cold” at that point in the process can prove fare more costly than the investment in continued sourcing.

One reason is practical: any number of unforeseen events can derail even the most promising candidate, and place you back at square one. The other is psychological: when your candidate of choice sees your efforts to recruit have stopped, their negotiating leverage goes up and their sense of urgency goes down.

Continuing to engage candidates is a smart move for other reasons. Even if multiple candidates do not advance to finalist, if they have a favorable and memorable experience with your organization, they will help you build your network of referral sources for future needs and in other specialties.

  1. Onboarding Too Little, Too Late

In most organizations, onboarding is merely a fancy word for “orientation.” With the clock ticking toward a start date, too many physicians receive a packet of paperwork rather than an “easy button” for getting ramped up for practice and moved into the community.

It is important that you start the onboarding experience before you hire. Deliver an experience that will help the candidate and their significant other envision their future with your practice and your community. Keep the lines of communication and information flowing throughout the negotiation process. Once they are signed, be sure they are assigned a navigator who guides them through a holistic onboarding program that includes mentorship and family integration into the community. For rapid ramp-up to productivity and long-term retention, the most successful onboarding programs start early and last up to one-year post-hire.

  1. Fixating on Cost Per Hire

The days of open-ended recruitment budgets are long past. Recruitment is not exempt from the need for transparency and accountability. However, viewing recruiting expenses as “costs” adversely influences thinking and behavior. If you measure only the cost but not the quality of a hire, then you have prioritized cost as more important than quality. This can be extremely expensive in terms of turnover, disruption to the practice and loss of patient loyalty.

Engage Resources that Drive ROI

Engage resources that can increase your efficiency. For example, an extensive array of job board postings may be too costly for a single hospital, as can be the new digital, social and mobile technology platforms that reach passive candidates effectively. However, a trusted recruitment partner can cost-effectively deploy these tools for you.  Let them cast a wide net for qualified candidates and apply their “fit for hire” skills on your behalf, while your internal team focuses on the quality of the interview process, engaging key decision-makers, and keeping the contract and credentialing details on track.

In the race against time, the winning strategy leverages both efficiency and a focus on fit and retention. This approach will enable you to measure value per hire over time and deliver a sustainable return on your recruitment investment.

A basic rule of thumb is: Don’t get caught up trying to cut corners in the short term, only to have it negatively impact your bottom line in the long term.

Working with an experienced search consultant can improve your competitive advantage by empowering you to find, hire and keep physicians to meet your community needs. Contact us to learn more about what to avoid when recruiting physicians.

Tony Stajduhar is president of the Jackson Physician Search. With more than 25 years in the industry, he is a sought-after speaker for national medical associations and residency programs. Tony can be reached here.

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