To carry out their missions—and to maintain their financial viability—hospitals must ensure that they have the appropriate number and mix of physicians on their medical staffs. But the physician recruitment market has never been more competitive or complex thanks to the ever-growing list of service sites, problematic reimbursement, and an overall physician shortage. Finding and maintaining the appropriate physician mix is more time and resource intensive than it has ever been—but to what degree should the hospital’s chief executive officer be a part of the process?
CEOs cannot be directly involved in every stage of the process, but they also can’t take a completely hands-off approach. While delegating the legwork and logistics of recruiting, the CEO should:
Ensure a strategic framework is in place. Physician recruiting should not be an ad hoc endeavor initiated in reaction to an event such as a physician retirement or relocation. It should be a proactive process driven by an understanding of the hospital’s current medical staff and its projected needs.
The CEO should ensure that physician recruiters, medical directors, and others have a strategic basis for physician recruiting that is outlined in a formal medical staff plan. The plan should provide a portrait of the current staff, breaking down physicians by specialty, age, gender, and, through a medical staff survey, by practice characteristics, career plans and physician recruiting needs.
The staff plan provides a blueprint for current and projected staffing requirements. It also demonstrates to current medical staff through objective data the need to recruit additional physicians, addressing what can be a source of physician/hospital conflict.
During recruiting, the staff plan can help convince candidates that a real need exists for their specialty. The plan also serves as a compliance document since federal regulations require hospitals to justify their recruiting efforts on the basis of a demonstrable community need for new physicians.
Assemble the recruiting team. The CEO should assemble a medical staff development (MSD) committee to carry out the physician recruiting function. The MSD is charged with completing the medical staff plan or retaining a consultant to do so, creating physician retention programs, setting physician candidate parameters, developing incentive packages and contracts, sourcing candidates, reviewing CVs, conducting interviews, working with outside recruiting consultants, and assisting with candidate relocation.
The MSD typically will be comprised of five to 10 people, including a board member, a chief medical officer, in-house physician recruiters, and a mix of other hospital representatives such as the CFO and CNO, department heads and others. To be agile, the MSD must be able to vote with a quorum. The central figure on the committee, however, is the CEO, who is the final arbiter and decision maker regarding strategies, contracts, and candidates.
Create the optimal environment. Where physicians practice and how they practice is changing. The CEO must ensure the hospital has created a practice environment likely to meet the needs of today’s physicians, to both retain existing staff and to attract new doctors.
Tactics may include a shift to direct hospital employment of physicians, hospitalist and surgicalist programs, pay for emergency department call, physician/hospital joint ventures, gain sharing, and related strategies for enhancing physicians’ lifestyles and incomes.
In addition, the “workshop” is of primary importance to physicians. Efficient patient admission and discharge, quick turnaround of lab results, an adequate nursing staff, reliable access to operating rooms, even convenient parking are all workplace fundamentals key to retaining and attracting physicians.
Doctors today have many practice options. The CEO should objectively evaluate the hospital from the physicians’ perspective and take the steps necessary to create conditions likely to attract doctors.
Display the appropriate attitude. Success in physician recruiting is in large measure a matter of attitude. Who really wants available candidates more? Who is willing to devote the necessary time, resources, and energy needed to recruit doctors in today’s competitive environment?
CEOs can signal their commitment to physician recruiting success in two key ways: by being available and by being responsive. Despite conflicting priorities, CEOs should be accessible when key decisions in the recruiting process need to be made. They also should accommodate the interview schedules of physician candidates, which often mean weekend and night availability. Responding to candidate needs quickly—before misunderstandings or declining interest intervene—is imperative.
Perhaps most important, CEOs should display a sense of urgency about physician recruiting and instill a similar attitude in the recruiting committee. A sense of urgency and purpose is displayed through a competitive incentive package, aggressive candidate sourcing, a clear and readily available contract, and by an ongoing commitment to communicate with and respond to the needs of both existing medical staff and physician candidates. Physician recruiting today requires a responsive team approach. However, only the CEO can position the team for consistent and enduring success.
Mark Smith is president of Merritt, Hawkins & Associates, a national physician search and consulting firm and a division of AMN Healthcare. He can be reached at mark.smith@mhagroup.com.
Read our editorial guidelines to find out how you can contribute to HealthLeaders Media.
Mike Murphy, CEO of Sharp Healthcare in San Diego, describes how his organization used Baldridge criteria, Six Sigma, Disney consultants, and the input of unhappy patients to implement systemwide quality improvement initiatives. The quality focus also aligned the organization with emerging trends in the healthcare industry, including pushing providers and executives toward a greater focus on quality.
Although Michigan-based Henry Ford Health System made money in 2007, it was less than the year before as its cost of providing free care nearly doubled. The expense underscores the impact of unreimbursed care on hospitals caused by a loss of jobs and employee health benefits in the state, said Henry Ford representatives. The nonprofit Ford system earned $105.8 million in 2007, down from $134.9 million in 2006, on $3.47 billion in revenue, said Henry Ford President and CEO Nancy Schlichting.
AARP Ohio is inviting consumers, doctors, insurers and employers to provide their opions on making healthcare more affordable. The organization is sponsoring forums about the topic around the state. "What we're trying to do is bring together individuals and business owners and providers and insurance folks, people from all over the map, to talk about possible solutions," said an AARP spokeswoman.
Efforts to make the blood thinner heparin safer, and to replace supplies that were depleted by a major recall, have meant new safety concerns for hospitals, heart clinics and dialysis centers that use it. The drug was recalled in February after contamination during production in China led to as many as 81 deaths in the United States. Its leading maker has suspended manufacture of most of its heparin products. The resulting shortage of heparin means heparin from new suppliers is arriving in different quantities and strengths than medical staffs are accustomed to, and pharmacists and others worry that patients may be vulnerable to receiving improper doses.
The St. Bernard Hospital Service District will spend as much as $135,000 to study the economic feasibility of a 40-bed hospital in Chalmette, LA. District commissioners voted unanimously to contract with Eide Bailley, an accounting and consulting firm. The study is expected to take 60 to 90 days, and will help determine how successful such a hospital would be in St. Bernard Parish. St. Bernard's lone hospital was swamped during Hurricane Katrina and has not reopened.
A big union, national, state and local medical groups, a government official and a U.S. House panel have filed documents in Washington, DC, in efforts to block the $2.6 billion purchase of Las Vegas-based Sierra Health Services Inc. by Minnesota-based UnitedHealth Group Inc. Those opposing the deal include Service Employees International Union Nevada, which represents thousands of healthcare workers in Nevada, the American Medical Association, Nevada State Medical Association and Clark County Medical Association. The Justice Department has said it will allow UnitedHealth to go forward with the purchase if the companies divest assets related to UnitedHealth's Las Vegas Medicare Advantage. Opponents say the deal would enable UnitedHealth to acquire a 90 percent share of the health maintenance organization market, and that the Justice Department "dropped the ball" in letting the acquisition go forward.
Two of California's largest health plans have agreed to reinstate coverage to nearly 1,200 patients whose policies were dropped after they incurred high medical expenses. Under the deal, patients whose insurance was rescinded by Kaiser Permanente or Health Net since 2004 will be allowed to purchase new insurance regardless of their medical conditions. California is trying to reach similar deals with Anthem Blue Cross, Blue Shield and PacifiCare involving about 4,000 rescissions.
All New Jersey children would have to have health insurance and all taxpayers would have to prove that they have health insurance every year under a plan advanced in the state Senate. The legislation is designed as the first step toward universal health coverage in the state by 2011. About one in six New Jersey residents lack health insurance, according to the Henry J. Kaiser Family Foundation. Of those, 275,000 are children.
To save money, Hartford, CT, and its schools have decided to offer their nearly 3,000 retirees and retiree dependents a choice: stay with their current health plan but pay higher rates, or switch to a private, Medicare-affiliated program that has lower premiums, but potentially higher prescription drug costs. They could also leave the city's plans entirely. The move has angered the retirees and their families, who are now facing health and budget-tightening decisions many were not prepared to make.
