A full-blown movement by more than 200 Harvard Medical School students and sympathetic faculty is intent on exposing and curtailing drug industry influence in their classrooms and laboratories, as well as in Harvard's 17 affiliated teaching hospitals and institutes. They say they are concerned that the same money that helped build the school's world-class status may in fact be hurting its reputation and affecting its teaching. The students argue, for example, that Harvard should be embarrassed by the F grade it recently received from a national group that rates how well medical schools monitor and control drug industry money.
President Obama has named Nancy-Ann DeParle as director of the White House Office of Health Reform, rounding out the leadership of the team that will direct his administration's efforts to revamp the nation's healthcare system. Obama also formally named Kansas Gov. Kathleen Sebelius as his secretary of health and human services during a ceremony in the White House. Sebelius and DeParle will be charged with helping to craft and sell the administration's effort to revamp the nation's healthcare system and extend access to the 46 million people in the country who lack coverage, while attempting to rein in runaway costs.
A new survey released today finds that the No. 1 reason why physicians leave their job is because they don't like where they work.
The 2008 Physician Retention Survey from the American Medical Group Association and Cejka Search found that 50% of physicians who voluntarily resigned last year cited "poor cultural fit" as a primary reason.
That may sound discouraging, but it's a great opportunity because improving workplace culture can be a cost-effective process that almost any healthcare organization anywhere and any size can do. Healthcare organizations can have a greater impact on workplace culture than on many of the other leading reasons cited by physicians for leaving that included money, proximity to family, poor community fit, or spouse's job relocation.
The survey was completed electronically from October through December 2008 by 50 medical group members from across the nation representing 9,985 physicians in AMGA. The respondents represent a mix of rural, suburban, and urban physician groups of varying sizes working in integrated, private, and hospital-owned practices.
Brian McCartie, Northeast Regional Vice President for Cejka Search, say cultural fit will become even more important in the coming years as the physician shortage worsens and as physicians move away from private practices and become employees. "The biggest opportunity that exists within the employed environment is for those organizations to empower the physician and make them feel special, because they are special. These are highly skilled people," he says.
The HealthLeaders Media Industry Survey 2009 found physician leaders primarily viewed a good work-life balance as the single-most important factor determining career satisfaction. But issues like autonomy, being valued and respected by colleagues and, of course, adequate income, also were significant drivers.
The AMGA survey found that physician groups reported average turnover of 6.1% in 2008. A further breakdown showed that there was no significant difference in turnover between men and women. The biggest variables were age and employment status. The biggest turnover came from part-time male physicians (39%) over 55 years old, and part-time female physicians (32%) under the age of 39.
McCartie says turnover will grow in the coming years as more physicians opt into employment models with high demand for their services, and fewer monetary incentives to stay in one place. "Because of the competition for talent and because the employers are often hospitals that are trying to drive revenue, the physicians that are accepting positions are accepting incomes that are more at the 80th to 85th percentile of what they'll totally make eventually," he says. "They don't have to build the practice to be given the same kind of money. In the old days there was a bigger hook. If you left the practice you'd take a large hit economically so you'd think twice about moving."
McCartie says the ongoing recession is a double-edged sword for physician recruiting. "First, it's driving more physicians to be employed. So, they are less likely to be in solo or small private groups due to the risk and the costs of operation, and they are more likely to join larger groups or integrated systems," he says. "The negative side is the inability of those physicians to sell their houses. A lot of physicians are upside-down, and they don't buy the small houses. They may be interested in relocating but they're not going to take a $300,000 hit. So they are somewhat restricted."
McCartie says there has been a growth in physician retention programs at healthcare organizations as the industry comes to realize—often through first-hand experience—the long-term implications of the physician shortage, the fierce competition for those physicians, and the expenses associated with replacing them. The AMGA survey for 2006 found that 40% of respondents reported having a designated retention program. In 2008, that number grew to 48%. The AMGA survey found that respondents with defined retention programs reduced the percentage of physicians leaving during the first three years to 44%, as compared to those without a defined program at 50%.
Common retention program financial incentives include signing bonuses, guaranteed income, moving expenses, medical school loan forgiveness, malpractice coverage, and even mortgage assistance and rental plans to help physicians trapped in overvalued homes. The financial incentives should be designed to tie the physician to the community. "Don't give them $200,000 to pay off their loans. Give them $200,000 over 10 years so there is an incentive to stay. It's setting the hooks that will keep them," McCartie says.
The details of a retention program are less important, McCartie says, than the message the retention program sends to physicians. "There is no gold standard," he says. "Having a retention program is more about a commitment to listening to the physicians."
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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The Health Care District of Palm Beach County (FL) has named Brian P. Gibbons hospital administrator for Glades General Hospital in Belle Glade. In addition, Gibbons will become Administrator of Lakeside Medical Center, the $73 million regional hospital that the Health Care District is building to replace the 65-year-old Glades General. Scheduled to open late this year, Lakeside Medical Center, located on a 50-acre campus near the western Palm Beach County communities bordering Lake Okeechobee, will feature all-private patient rooms.
Los Robles Hospital & Medical Center President and CEO Jim Sherman has resigned after more than four years on the job to pursue other opportunities. Administrators at the Thousand Oaks, CA, hospital announced Sherman's resignation last week. COO Natalie Mussi will serve as interim CEO until a successor is hired.
When President Barack Obama delivered his 2010 budget outline to Congress just days ago, he included some $630 billion in spending to pay for healthcare reform, to be paid for in part through higher taxes on the affluent.
Never mind how you might feel personally about the new taxes required to finance the plan. Or the fact that details about how that money might be spent are somewhat sketchy at this point.
There is one interesting provision that does come with some detail in the budget. It's a proposal to switch to bundled payments for hospitalizations of Medicare patients. Under the model, providers would receive a single bundled payment to cover both a hospital stay as well as care for the patient for 30 days after release. The change intends to reduce the 18% of hospitalizations that result from readmissions, and the administration claims it will save $26 billion of wasted money over 10 years, in part by reducing payments to hospitals that have high rates of readmission. In theory, that switch would keep hospitals from discharging patients too early only to have to readmit them when the patient relapses. Of course currently, the hospital bills and receives payment from Medicare for both admissions. To put things in perspective, that amount of money at current market conditions would keep General Motors going for about another three months, but that's another story entirely.
Allow me to tell a little personal story to highlight a potential problem with unintended consequences a rule like this might bring.
I have a great aunt on Medicare who had to be readmitted to a hospital last week. She won't mind me sharing her story here to make my point. Originally, she broke her hip. Once that was taken care of during a short hospital stay, she was discharged to a rehab facility nearby. I won't get too much into the ruckus she and her daughter had to raise to even have her temperature taken when she felt she was running a fever a few days later, but suffice to say, the fever was real at 103, and she had come down with pneumonia. Clearly, she needed to be readmitted to the hospital, but because there were no beds immediately available, she was held for several hours in the ER until one came free. There she remains, recuperating from an unrelated illness to her original problem. Unfortunately, I don't think hers is an unusual story.
I'm getting way ahead of the game here, but assuming this provision in the budget makes it through Congress—an extremely iffy proposition, given the way Congress works—I wonder if a new entity might spring up to take care of patients who need to be readmitted to a hospital but are still within the 30-day window. Something that in acuity, lies between a hospital and a rehab center? That's the hopeful possibility.
A darker possibility might involve hospitals finding ways to avoid the technicality of readmitting patients during the 30-day window. That's what's called an unintended consequence. Legislation will have to be carefully written to try to avoid this outcome. In any event, you'll certainly see length of stay creep up for this group of patients as the legislation would make exceedingly more difficult the decision on when to release a patient.
In my aunt's case, let's assume her pneumonia was not acquired during her hospital stay, but in the rehab facility. It could have happened at either place, obviously. But under the new system, the hospital would clearly have to "eat" her treatment costs even though it may not have been at fault. How does that strike you as a hospital chief financial officer or CEO?
Many hospitals already have bed shortages, at least at certain times. I want to assume the best of our hospitals and medical decision-makers, but what kind of pressure will this requirement put on hospitals that have two patients, for example, who need to be admitted, with one open bed. Who gets it? The one whose treatment will be reimbursed or the one whose treatment won't be reimbursed? These are painful questions, but incentives, even perverse ones, cause consequences, and they need to be asked.
If, as the president's budget intends, this provision sticks and hospitals are paid for episodes of care under the reforms, it's a big step toward eliminating some of the perverse incentives hospitals have to readmit patients who perhaps shouldn't have been discharged so early, but we have to think about the other incentives a rule like this would encourage.
Tread carefully, Mr. President.
Philip Betbeze is finance editor with HealthLeaders magazine. He can be reached at pbetbeze@healthleadersmedia.com.Note: You can sign up to receiveHealthLeaders Media Finance, a free weekly e-newsletter that reports on the top finance issues facing healthcare leaders.