The head of a national physician recruiting firm characterizes the overall recruiting environment for physicians as challenging—to say the least—because of a "paradigm shift in the way we hire and recruit" in the wake of healthcare reform and the move toward Accountable Care Organizations.
In a recent survey of 200 healthcare employers and health systems related to recruiting of docs under an ACO model, an overwhelming number said they are focusing on more team-oriented physicians, more technologically-savvy docs, and physicians who are committed to quality initiatives, says Jim Stone, president of The Medicus Firm, a national physician research firm based in Dallas, TX, that released the survey this month.
No surprise there.
But what did surprise Stone is the fact that only 35% of respondents believed physician recruiting would be difficult or challenging in a move to an ACO. He is also president-elect of the National Association of Physician Recruiters.
Stone expected the figure would be much higher. With hospitals seeking physicians whose attitudes may be more in line with the change from fee-for-service to value-based care, there's no question that more difficulties are ahead in recruiting, Stone predicted in an interview.
"We're seeing increasing retirements, aging physicians and not enough physicians coming into the health care system," Stone says. "I don't think there's any way you can look at it and say it's not going to be more difficult. I think most people have come to terms with the fact that recruiting doctors is hard. Every year it takes us longer on average to fill the searches that we're engaged to work in."
Whether it's difficult or not, most execs—at least 70%—say there will be changes in goals and processes for recruitment in developing ACOs, according to the Medicus survey. Of the respondents, 66% worked at not-for-profit community hospitals, and 19% were in office-based physician practice groups.
An overwhelming majority—80%—led their organization's recruitment department or team.
At least 46% of top healthcare officials who are currently or soon to be involved in ACOs believe recruiting volume will increase slightly. Overall, 48% say the volume of recruits will increase, with 56.1% saying they will recruit more primary care physicians.
While many healthcare organizations are still uncertain whether they are heading toward Accountable Care Organizations, these medical groups and hospitals are emphatically doing one thing: recruiting non-physician providers to take over physician functions in what the head of a national physician recruiting firm calls a difficult recruiting environment, Stone says.
More than 80% of executives expect to increase recruitment of non-physician providers such as nurse practitioners and physician assistants under the ACO care model.
"I don't think there's any question that mid-levels—premium mid-levels, nurse practitioners, physician assistants—are going to have to play a vital role in this process," Stone adds. "You already have too few doctors. A lot of doctors do things that mid-level (nurses) are perfectly capable of doing. Just as I wouldn't hire a super-talented physician recruiter and pay them a lot of money to have them do data entry, it's the same concept. We are starting already to see the volume pick up of mid-levels being hired in anticipation of those changes."
When asked how physicians will be brought into the ACO, 75% of executives replied that most incoming physicians are likely to become employees of health systems. Only slightly more than half—51%—say that their current staff has all of the characteristics to be successful in an ACO model.
Of those participating in the survey, whether they actually will be joining an ACO is still a major question mark. Of the 244 participating hospital and healthcare-hiring executives, about 57% indicated they have no plans to become an ACO to their knowledge.
"I was surprised to see that number, I thought it was high. I think there continues to be hesitation, a kind of wait and see," Stone says. "Is Romney going to repeal the whole thing, or isn't he?"
"At this point, the ACO model is still a very new development in healthcare, and much of what people are telling us are simply projections and estimates," says Stone.
The survey also shows that healthcare systems are seeking a "different" kind of physician than years past.
Of those systems embarking on ACOs, 78% of those surveyed say they are seeking physicians with more team-oriented approaches; 65.9% want doctors who are more technologically savvy with EMR experience and mobile devices, and 68.3% are looking for physicians motivated by quality incentives.
"The high-volume admitters, high volume procedure (physicians) that have been very attractive to hospitals over the years," Stone says, "that's got to change. And these healthcare officials are not necessarily going to look for people just to cut first, and ask questions later. We end up with more team-oriented physicians."
"There is also an expectation today that physicians are technologically savvy. There is an expectation now that didn't exist before. It's a complete paradigm shift the way you interview, recruit and hire physicians, and compensate them. It's a huge step and without question the process is going to be more difficult for hospitals."
"The biggest challenge is that hospitals and physician groups are going to have to become better at behavioral interviewing," he adds. Years ago, hospitals may have hired an orthopedic surgeon, for instance, who was likely to deliver $2 million in patient revenues, despite a "prickly" demeanor, he says. Nowadays, that demeanor may be costly in terms of patient attitudes and overall future reimbursements. That's changing. A hospital or physician group may think twice before hiring such a doctor, and instead opt for a "team" physician whose outward credentials may not have been as stellar, Stone says.
For physicians, the anticipation in earnings in an ACO environment is a mixed bag. Regarding physician income levels, executives overwhelmingly predict that there won't be one directional trend across the board in physician income as a result of ACOs: 62% say some physicians will earn more, while others will earn less as providers for an ACO.
Only about 10% of respondents feel that physicians will earn more money under an ACO model, while about 20% say less money. Still, base compensation and incentive models will change to be more quality-focused, according to Stone.
About 5% of the respondents indicate they anticipate no change in the type of physicians they are recruiting.
That statistic also has Stone raising his eyebrows. "I think they have either already looked for the type of physicians they are going to have in the future," says Stone, "or they are completely naïve related to the way healthcare is going to be delivered in the new model."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
