Who would have guessed that the drop in home sales would dramatically affect how hospitals and physician practices recruit physicians? It may not have seemed like an obvious connection when the first news of a real estate crisis broke, but facilities are quickly learning that the bad housing market is directly affecting physician recruitment efforts, and many are looking for ways to adapt.
In some cases, the facility may be unable to work around the problem and must be prepared to lose a candidate. But some have already found creative ways to convince physicians to move. Consider the following options:
Pay a physician's mortgage. Delta Physician Placement, a national healthcare staffing agency in Dallas, recently placed a female neonatologist from Northwestern Oregon—an area hit particularly hard by real estate problems—in a program in Appleton, WI. The physician wanted the job, accepted the offer, but then backed out because of concerns about selling her house. "She was deathly afraid of not being able to sell her house," says William Scott Hurst, MBA, director of consulting at Delta. "There were 12 houses on her street, and six were for sale."
The hospital convinced the physician to sign the contract by agreeing to pay her mortgage for nine months, with the intent that the physician could sell the house during that additional window of time. This was arranged in lieu of a traditional signing bonus, so the hospital didn't take a dramatic financial hit because of the incentive.
Buy a physician's home. Although it is rare, Hurst says at least one hospital he has worked with has purchased a physician's home in order to bring a physician into the community. This isn't feasible for routine searches, but it may be a last resort to bring in a high-value physician.
Partner with realtors. Many recruiters are working more closely with realtors to address physicians' housing concerns. "What we've seen is more local engagement with local realtors here to work with previous home area realtors for [a] coordinated effort to get a home sold," says Danilio Davila, employment manager at Parkland Health and Hospital System in Dallas.
In some cases, this involves paying realty fees or shouldering expenses related to relocation and selling the original home.
But professional recruiters are also taking simple steps to become more familiar with real estate markets in areas they're recruiting from early in the process and are reaching out to realtors in those areas.
Target searches. An ideal solution is to limit searches to local candidates who don't need to sell their home in order to switch practices.
However, that isn't always feasible because of regional shortages or noncompete clauses that prevent physicians from moving to a practice within the same area.
Facilities will likely have more success recruiting candidates from regions with relatively stable markets, but few recruiters have actually begun targeting searches in those areas. That may change if the housing problem intensifies.
This story was adapted from one that first appeared in the July edition of Physician Compensation & Recruitment, a monthly publication by HealthLeaders Media.
Yesterday's vote on H.R. 6331—the bill to halt a Medicare physician pay reduction—made for great political theater.
Midway through the roll call the Senate stopped the proceedings and stood for a standing ovation that lasted several minutes. In walked Senator Ted Kennedy, for the first time since he was diagnosed with a brain tumor, to belt out an "Aye" in favor of the bill.
After falling one vote shy two weeks ago, the legislation was approved—a great victory for the nation's physicians. Right?
Not according to some physician bloggers. I came across a post at The Happy Hospitalist arguing that it's time to let the cuts stand in order to enact real change. Kevin Pho agrees and says that dropping Medicare en masse, which would possibly happen if the cuts passed, is the closest physicians can get to a strike. Andy at Surgical Diversions sums up the argument best when he writes that "the system needs to undergo some catastrophic collapse before it will get better."
You won't hear these statements coming from physician representatives like the AMA, who have been fighting and lobbying for months (years, really) to stop the cuts. Officially, physicians are celebrating (and assuming that President Bush won't follow through on his threat to veto the legislation).
But it's easy enough to see the hollowness of the victory and the appeal of such a drastic approach.
If the cuts had gone through, the path was clear—physicians would begin opting out of Medicare, and the flaws in the reimbursement system would be exposed. It may be an undesirable outcome, and painful, but at least it would have been a new approach.
Now, the way forward is less certain. Congress has for the umpteenth time patched a band aid on a gaping wound, and physicians are still left with the problem of finding a long-term solution or facing another cut in 2010.
Ultimately, those hoping for cuts to spur reform are a little premature. If Congress is still struggling to stop another payment reduction at the 11th hour in a year and a half, then I can buy the bloggers' arguments and say rip off the band aid, let the cuts go into effect and force the hand. But that 18-month window provides a final chance to change the structure of the payment system, and what happened over the last two weeks proves that it can still be done politically.
In the end, Kennedy's vote was only symbolic. The bill passed 69-30 (with only presidential candidate John McCain absent), and physician lobbying had a lot to do with the swing. Take Senator John Cornyn, one of the Republicans to switch his vote. The Texas Medial Association publicly revoked an endorsement of him after he voted against the bill two weeks ago, and considering his dropping poll numbers and a potentially close reelection bid in the fall, that probably had a lot to do with his change of heart.
All across the country, physician organizations went on the offensive. The AMA broadcast advertisements calling out several Senators who opposed the bill by name. Those who, like Cornyn, face tough reelection bids felt the pressure.
Physicians may feel powerless against the insurance and HMO lobbies, who were the primary parties opposed to the bill, but two things helped them take down the Goliath.
First, they had help—senior citizens organizations (i.e., the AARP) and veterans groups also had a stake in the Medicare bill and lobbied for doctors. Physicians are quickly realizing the value of enlisting patients in their efforts for change. Second, their backs were against the wall, forcing them to put all they had into the effort—they lobbied, spent money, contacted legislators, wrote letters to the editor and op-eds, and talked to their patients.
Payment reform can happen, but physicians can't get too comfortable with this temporary win. They will still be competing against some powerful lobbying forces for Congressional attention. To keep a spot at the table, industry associations and individual physicians should be a little skeptical of this victory—all they really won was pay stagnation, after all.
If the physician community treats every day as if Congress is on the verge of cutting their pay by 10.6%, this might be the last time it is actually a possibility.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
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