It is hard to imagine a more uncertain time for the healthcare industry in the United States.
The recession has brought an increase in charity and unreimbursed care as millions of Americans join the ranks of the unemployed and lose their healthcare benefits. Recruiting in the midst of a severe physician shortage is only going to get tougher as more doctors retire and competition intensifies for the too-small candidate pool to replace them.
And hanging over everything is healthcare reform. Just about everyone agrees that President Obama will sign some sort of healthcare reform bill this year. However, few would venture to guarantee what those reforms will contain beyond an expected expansion of health insurance coverage to some of the 46 million uninsured people in the United States.
So physicians and other healthcare professionals are looking at a very distinct possibility that they will soon be asked to work harder for more people and probably not make as much money. A little anxiety and outright crankiness is to be expected.
"It's a very trying time for physicians. There are changes going on in the entire context of the healthcare delivery system, and the fact that the economy is down, and so their practices are down," says Jeff Peters, president and CEO of Surgical Directions, LLC, a physician-led consulting firm in Chicago.
Peters says unhappy physicians should no longer be looked at as disgruntled prima donnas. "That is probably a dying concept. Clearly, the younger physicians are much more balanced and reasonable," he says. "The biggest issue is that they are working too hard. They have too many nights, too many weekends, too much call, and they aren't making enough money. So there is a general unhappiness with the level of compensation in comparison to the amount of work they are doing."
Being human, physicians take their anger out on whoever is close to them, or whoever is perceived—whether fairly or not—to be the source of their frustration, Peter says. And in a physician practice, no one is more of a lightning rod for complaints and dissatisfaction—even in the best of times—than the practice administrator.
Give physicians a say
"A lot of the other unhappiness stems from the doctor not making enough money," says Peters. "While the practice manager can't control the market forces, there is a lot they can do to drive the overall processes to help the practice be more successful."
There are several big issues that can sink a physician practice if not correctly navigated, Peters says. Probably the biggest single mistake a practice can make would be to change the compensation formula without input from the affected physicians, he says. Billing and collections issues are always hazardous. The advent of the EMR—which has the potential to profoundly reshape healthcare delivery—is another potential iceberg for physician practices.
"There are going to be lots of changes associated with EMR, and it never goes perfectly, and they are going to blame the practice administrator," Peters says.
The best way to avoid friction with physicians is to involve them in the important decisions affecting the practice. For example, with compensation, Peters recommends creating a physician-led steering committee.
"The administrator should provide the staff and support it and give them data, but the ultimate decisions need to be made by the physicians," he says. "You can't just say, 'Be happy.' You have to create a model that allows them to constructively change how things are. Part of making them happy is to let them be responsible for things that they can control and drive."
In the case of EMR, Peters says it's imperative that operating processes are not changed before the EMR goes in. "You don't want to have an EMR and broken processes and no way to track what is going on in the practice with those broken processes," he says. "That is a good prescription for disaster."
Simplify as much as possible
Barbara Berry, senior director of planning and market- ing at Northern Michigan Regional Hospital (NMRH) in Petoskey, says the 243-bed regional referral center for 22 counties has developed a management style that builds trust with physicians by clearing the hassles that distract physicians from their healing mission. "You have to do what you say you're going to do, and you have to get the bureaucratic drag away from the physician," Berry says. "A practice manager or hospital administrator who can help dissolve and compress that decision-making cycle has the ability to win over physicians. Keep the noise away from them. They are here to practice medicine and take care of patients. Really, just make their life as simple as possible."
Most recently, Berry and Peters helped nine NMRH-affiliated cardiologists change a practice business model that had been failing for two years. "A number of physicians had left the practice. They weren't able to recruit," Peters says. "Because the hospital depended on that practice as their largest service line, the market share was dropping. What the organization was able to do was acquire the practice, employ the physicians, and put in a new model for physician leadership, not just for the practice, but for the cardiology service line. And if you talked to each of the cardiologists, it has totally changed their lives."
The physicians' decision to change the business model was not pushed on them by hospital administrators, but was gently supported as the physicians realized their existing business model wasn't working, Berry says. "It took 18 months, to where they had reached a point in their practice where they were pretty frustrated with their own inability to have a succession plan and then recruit," she says. "Knowing they were really the highest contributor to our revenue, it became an organizational strategic initiative to assist them."
The cardiologists went into the affiliation with NMRH assuming they would be hired into an employment model, Peters says. "What was ultimately decided was we would create a cardiac institute where they would be a group, but they would also have a role in comanaging the cardiovascular service line," he says. "They have really stepped up to the plate. The practice is doing better. They've made changes in how they cover their patients, how they interact with primary care physicians and with staff. There is a totally positive revamping."