Healthcare executives share insights on how to keep doctors satisfied with their jobs amid shifting practice preferences and reimbursement realities.
Finding good physicians is hard. Keeping them is Herculean.
Most physicians routinely hear from suitors about potential practice opportunities, and about 30% report receiving three to five solicitations per week, according to a survey from the Medicus Firm, a physician recruiting agency.
"I'm surprised it's not more," says Brett Waress, MHA, FACMPE, regional director for Health First Medical Group, a four-hospital, 300+ physician system headquartered in Melbourne, FL.
"Particularly for certain specialties, the recruiting firms are aggressive. For example, our hospitalists, and I'd say hospitalists across the country, receive at least a call a day, let alone the email solicitations."
So how tempted are physicians to respond?
According to the Medicus survey of 2,413 clinicians representing 21 specialties across the United States, 27.5% of respondents say they're definitely not making a career change within the next year, while only 7.6% are set on a switch.
If you count the majority of physicians falling between both extremes, however, that leaves a total of 72.5% docs who may not be looking for a different job, but who could be curious about a new opportunity, says Bob Collins, a managing partner and co-founder of The Medicus Firm.
That slice of physicians who claim they're staying put is shrinking fast, from 43% in 2014 to 34% last year to 27% in April 2016, Medicus research shows.
"For health leaders, that's a big deal because it's not just [about] recruiting physicians," Collins says.
"Now there should be as much emphasis on retaining them because the physician population has become more mobile than ever before. They're more willing to make a change if you don't meet their needs."
Get Creative About Quality of Life
The top factors that could drive physicians to change jobs are not unexpected:
- Schedule/call coverage/work hours—a top motivator for 30.2% of physicians in training and 15.8% of physicians in practice
- Financial rewards— a top motivator for 22.2% physicians in training and 29% in practice
- Geographic location— a top motivator for 22.8% in training and 12.8% in practice
Compensation matters, particularly among in-practice physicians at a life stage where they face greater financial responsibilities or are thinking about retirement. It's not just about money, however. Recruiting and retaining physicians also requires some creativity, says Collins.
"There's only so much money to go around," he says. "[Systems] can't just back up the armored truck and say 'here's more money.'"
Healthcare leaders also need to promote physicians' quality of life, for example, by hiring enough clinicians to keep call coverage to a minimum or offering flexible work arrangements, Collins says.
Waress agrees. "Employment agreements need to have the flexibility for people to make a personal choice to work less or work more."
That's still a challenge for administrators, says Waress, who is renegotiating several of his group's employment agreements. "If you've got someone who's fulltime who wants to work 0.7 [FTE], you've got to cover the other 0.3 somehow, which makes it hard to get the fit."
Keep an Eye on the Horizon
Different physicians are motivated by different compensation methodologies, which vary mostly around how they weigh base pay, work RVU/production, and quality/utilization.
"Even within the same specialty, some physicians and some groups are very comfortable with no guaranteed base or an 'eat what you heal' model," Waress says. "Others in academia may [prefer] a straight salary with a small qualitative bonus or citizenship bonus with maybe a threshold for productivity."
Administrators need to stay on top of methodology trends in their specialty and how those options are viewed by physicians.
Regardless of how motivated physicians may be by production or steady salaries now, Waress warns that those models may be short-lived.
Related: 3 Ways to Prep Physicians for MACRA's Unknowns
"Looking out on the horizon, particularly with MACRA, we're going to have to realize that the quality or utilization (meaning outcomes) component of the contract is going to have to change to align with how systems and payers, including CMS, value quality," Waress says.
"It's tough to be out ahead of it, but people in my position have to be really conscious of what drives reimbursement on the hospital side."
Get Real During Recruitment
Until then, Collins has some advice for physicians wooed by new opportunities.
"The grass may be greener on the other side of the fence, but you still have to mow the yard. In other words, it still requires work," he says. "Physicians need to be clear about what is important to them and what they're willing to sacrifice."
Physicians fortunate enough to earn in the 75th percentile, work 40 hours a week, and live in their most-desired location are the exception more than the rule, Collins says.
For most physicians it's a matter of prioritizing and conducting due diligence to ensure that a position will satisfy their needs on a professional, financial, and personal level.
"When I'm recruiting, I always try to get physician-to-physician communication," Waress says. "I leave the room or encourage them to go to dinner without me so they can really speak clinically and about what it's like to work with the group."
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.