Physician Recruiting Challenges in Army Medicine, and the Takeaways for All Health
As Army Medicine continues to transition to value-based funding, it will require a focus on effective physician recruitment and retention. The Army’s recruitment agency, the Civilian Human Resources Agency (CHRA), has a special medical recruiting team, but given there are more than 30 Army hospitals across the world, it is not surprising the team’s recruitment specialists cannot articulate the needs of each hospital. Recruited physicians also must understand the financial model and the working environment to which they are applying.
To increase value and attract high-quality physicians, Army Medicine and CHRA need to work closely to employ more effective recruitment strategies. The considerations they must address in doing so also have some relevance for multihospital health systems in other healthcare sectors (e.g., not-for-profit, for-profit, governmental), although there are clearly some areas that are unique to Army Medicine.
Understand the Environment
To effectively advertise and communicate with potential physician applicants, CHRA recruiting specialists must understand each military treatment facility and its differences. They must ask questions and find ways to get each Army hospital’s specific information in front of potential applicants as early as possible.
The announcement and initial timely communication are vital to recruiting success. Unfortunately, CHRA has standardized announcements that allow for little variation from one military installation to the next. The job description must be correct to ensure there are no surprises after the physician begins the application process. CHRA must work closely with each Army hospital to ensure the job description is current, valid, and complete. Applicants quickly stop the process when they discover they are required to perform functions not outlined in the job description.
Set Competitive Salaries
Another key component to effective recruitment is setting competitive, performance-based salaries. Unfortunately, many believe the physician recruitment process is finished once the interview, selection, and acceptance is complete. In reality, this stage is a starting point and an area where Army hospital human resources departments can make a great impact. Most physicians understand the relationship between their performance and practice income, and they expect performance-based salaries where they are both held accountable for outcomes and provided with incentives for success.
It is vital for Army hospital human resources departments to conduct extensive market research to identify a competitive salary offer based on provider specialty, years of experience, and local market rates. Through this process the human resources department must identify and articulate the differences between civilian market compensation and military/government compensation. In many cases, human resources departments and physician applicants compare salary rates but miss the differences and value within the military/government benefits package. Human resources departments must incorporate the value of the entire package when establishing a salary offer to ensure the physician understands why a lower salary is competitive.
Hold Physicians Accountable
The second component to establishing physician salaries is using an annual 5 to 10 percent recruitment/retention incentive. This incentive ensures the applicant realizes the requirement to focus on performance outcomes and provides the Army hospital a tool to increase or decrease the annual salary based on performance objective attainment. The military health system’s budget is directly tied to workload production and numerous Affordable Care Act healthy outcome and population health initiatives. The physicians’ performance objectives must be tied directly to the Army hospital’s strategic direction. These specific objectives can be communicated within the first two weeks of a physician’s employment with a clinic, but the human resources department should ensure physician applicants understand that their performance will be measured and the measurement will support the annual incentive review.
Too often, Army hospitals stop the recruitment process after the new physician starts work. Many physicians never understand the Army hospital’s strategic direction and are never fully trained to use the electronic health record to utilize documentation and coding tools. The common result is physician frustration and lost organizational revenue.
Clearly, Army Medicine and CHRA must communicate. Performance-based salaries and onboarding must be leveraged for physician recruitment improvement to support Army Medicine, but leader involvement is the enabling link to success. Leaders must understand the business of health care, Army hospital strategic direction, and how to hold employees accountable for outcomes.
Physicians are the cornerstone to success in any healthcare organization, but organizations must recruit the right professionals for their mission, train them thoroughly, and communicate with them openly and effectively. Leaders across Army Medicine and CHRA work together to find new ways to reach out to high-quality applicants and ensure all efforts are nested with the strategic direction of the enterprise. The Affordable Care Act continues to tie physicians and hospitals together for all patient outcomes and with it funding streams. Recruiting and onboarding the right physician for each hospital is more important now than ever before.
Dustin P. Mullins, MBA, CHFP, CDFM, DFMCP2, is budget officer (controller), U.S. Army Medical Command, Fort Sam Houston, Texas.