HFMA VIEWS

Kevin C. (Casey) Nolan
Managing Director, Navigant Consulting, Inc.

As I travel around the country working with healthcare organizations, it has become readily apparent to me that there is a “sea change” taking place in the United States with respect to physician recruitment. Virtually every healthcare provider organization has as a key component of its strategy a major focus on medical staff recruitment/physician relationship development. Most of these organizations have carefully analyzed the marketplace and identified those specialties needed in the community and developed a set of recruiting goals and objectives related to those needs—all the while being mindful of Stark and multitudinous other regulations. And most of those organizations—regardless of whether they are in highly attractive places to live/practice or significantly “challenged” places to live/practice—are having an incredibly difficult time in recruiting physicians. The reasons for these difficulties are numerous and range from the limited supply of many specialties to the different expectations of the “gen X” and “gen Y” physicians to the changes in the demographic composition of the newly trained physicians (in terms of gender and ethnicity).

While it is imperative for healthcare organizations to understand and respond to this “sea change,” it seems to me that many healthcare organizations continue to conduct their physician recruitment/medical staff development initiatives pretty much the way they have historically done. Which in today’s shifted paradigm, is essentially a recipe for disaster. Recruiting physicians today—ANY physician—needs to be conducted and orchestrated much the way a college sports team recruits high school athletes. These candidates are identified early in their development; relationships with the athlete and those close to her/him (including families, high school coaches, etc.) are developed and nurtured; the progress of the athlete is monitored and tracked on a regular basis; the athlete is made aware of the school’s interest and is made to feel wanted; and when it comes time for a visit to campus, virtually every minute is planned, as is the follow-up communication.

Most healthcare organizations defer physician recruitment initiatives to their physician practices, most of which are relatively small and while well-intentioned, have to fit physician recruiting in after the physicians are done with their office hours and hospital rounds. In addition, most physicians are not trained to perform this increasingly important function. As a result, it is imperative that healthcare organizations work with their physicians and provide them with the infrastructure and support required to successfully identify, attract, and retain physician recruits.

A recent survey we conducted of a medical staff associated with a well-regarded medical center revealed that virtually none of the practices had a formal recruitment plan. While they had identified a need, they didn’t have a formal plan (with action steps, timeframes, and assigned responsibilities) that outlined HOW they were going to go about meeting their need. And NONE of them had a plan for retaining the physicians they did (in some cases miraculously) recruit. Most of the physician practices assumed that the whole recruitment process basically ended when they got someone to agree to come. Which is clearly one of the contributing factors to the tremendously high “churn” rate in physician practices (e.g., more than 50% of physicians recruited to a practice leave within two years).

The recruitment process extends well beyond the “signing.” It is imperative to put together a plan to ensure the physician and her/his spouse/family are not only IN the community, but fully integrated INTO the community. Which entails a formally structured follow-up plan that covers at least the first 18-36 months of the recruit’s presence in your fair city.

I believe that success in physician recruitment and medical staff development going forward will require a totally different, more comprehensive set of skills and competencies than in previous decades. And while physicians need to be involved in the recruitment process, the process should not be completely delegated to them. Healthcare organizations can and should provide appropriate assistance and support in the process when requested, or drive the process if its physicians are unwilling or uninterested in recruiting needed physicians.

I also believe we can learn a lesson (or two) from those colleges that have proven their ability to recruit and retain high quality athletes (i.e., who graduate and who are the kind of “kids” you would welcome at your dinner table during a holiday) and build highly successful programs while adhering to the spirit and the letter of the law.