Kansas Board of Healing Arts Director Larry Buening and general counsel Mark Stafford have resigned amid criticism that they were slow to investigate complaints, including those against a doctor who lost 56 patients to overdoses. The agency oversees and licenses doctors and other medical professionals in the state, and the board vowed to continue improvements to make the agency more responsive.
Physician shortages are typically discussed in terms of quantity. We look at the static number of physicians entering the work force in relation to the rising demand for medical services. Last week I wrote about this topic by examining different specialties' effectiveness at recruiting medical students.
But there is a quality angle to it as well. A portion of the manpower shortage is tied more to how physicians work than the sheer number of physicians. The problems in care delivery wouldn't entirely vanish even if we somehow increased medical school enrollment overnight and injected new physicians into the work force. Today's doctors simply aren't collectively as productive as in the past, which means we need more physicians to treat the same number of patients as before.
This trend is partly due to a generation gap--Senior Online Editor Rick Johnson wrote a few months ago about Generation X and Y doctors' preferences for shift work and work-life balance. But the change can't be explained by that alone. Physicians of all ages are fed up with the business aspects of medicine and revolting against expectations of providing call coverage. More physicians, both older males and younger females, are also working part-time--nearly one in five according to the Cejka Search/AMGA 2007 Physician Retention Survey.
So facilities must adapt. I've been listening to Laura Boehlke Bray, MD, tell her story over the last few weeks as we've been preparing for next Wednesday's audioconference about part-time physician compensation, and I am impressed by how physicians and the administrators at her facility have been able to overcome some of these productivity challenges. She is a clinic chair with Duluth Clinic in Minnesota, which operates with one-third of its physicians working part-time. That's a lot of part-time employees for any business, let alone a physician organization. And the proportion is expected to increase in the near future, Bray says. Many of the clinic's physicians are in the demographic groups most likely to work part time; 45% of physicians are already 55 or older, and 60% recruited in 2007 are female.
How are they able to operate on a model that would have been inconceivable a few years ago? Duluth Clinic leaders have adapted by changing their attitudes about part-timers, she says. Without accommodating part-time schedules the clinic wouldn't be able to remain open, so leaders have made a conscious effort to value these physicians by redefining full-time equivalent and developing new operational and compensation plans.
Granted, with more than 400 physicians, it is easier for an organization like Duluth Clinic to diffuse potential costs associated with part-timers than it would be for a smaller medical practice (though managing roughly 130 part-timers isn't a simple task). But organizations of all sizes are going to feel the effects of the growing part-time trend and the lower productivity of today's workforce.
It's better to plan now before it becomes a full-time problem.
Note: If you'd like to hear more about how Duluth Clinic compensates its part-time physicians, there's still time to sign up for Proven Strategies for Part-time Physicians, a HealthLeaders Media audioconference on April 9 at 1 p.m. (EST).
Former New York Gov. Eliot Spitzer proposed a new loan-forgiveness program that would entice new doctors to rural communities, and his newly sworn-in successor, Gov. David Paterson, has expressed support for the initiative. But many in the medical community say it isn't enough, because the program doesn't address the overarching problems such as exorbitant malpractice insurance premiums, flat Medicare reimbursement rates, and a lagging rural economy.
Many of the same market forces that have made recruitment more difficult and a higher priority recently--physician shortages, demographic changes, and generational attitude differences--have also increased many facilities' focus on physician retention.
Retaining physicians begins with a concerted effort to address retention issues within the organization on an ongoing basis, says Kevin Donovan, FACHE, FACMPE, vice president of physician and ambulatory services at Elliot Health System in Manchester, NH.
Groups that have formalized retention initiatives tend to have lower turnover rates than groups without them. Although any retention-targeted initiatives are a step in the right direction, Donovan recommends outlining a dedicated retention plan that involves senior leadership and is based on routine reporting, analysis, discussion, and accountability.
The plan should also address cultural-fit issues, which are frequently identified as the top cause of voluntary turnover, and establish a plan to identify at-risk physicians and intervene before turnover becomes a probability.
"The plan doesn't have to be a 20-page document, but it has to be a set of actions you agree to and actually implement," Donovan says.
Focus on the first three years Physicians are at the highest risk of leaving during their first three years at a new practice. In fact, roughly 46% of newly hired recruits will "fail" within 18 months, Donovan says, adding that "communication is key" to keeping newly hired physicians content and engaged. Provide physicians with answers to the following questions upon hiring and throughout the first few months:
Where is the organization going?
How do you expect me to contribute?
How am I doing?
How do I improve my skills?
"Communication starts with mentorship or mentors, but it goes all the way up to the highest level of the organization and meeting at set intervals," Donovan says.
This story was adapted from one that first appeared in the March edition of Physician Compensation & Recruitment, a monthly publication by HealthLeaders Media.
A federal court has dismissed a whistle-blower lawsuit alleging that hospital owner Iasis Healthcare allowed unnecessary medical procedures to be performed and illegally compensated doctors for patient referrals. The suit was filed against Iasis Healthcare in 2005 in the U.S. District Court of Arizona.
Jamaica says it has successfully launched free healthcare for all adults in public hospitals across the Caribbean country. The abolition of user fees at hospitals was going smoothly this week, with patients forming orderly lines while waiting to be seen, according to Health Minister Rudyard Spencer.