While hospitals, health systems and integrated delivery networks are racing to capture patients, a key success factor in managing patient care will be recruiting physicians, particularly primary care physicians. Finding, attracting and partnering with these key players will be vital to an organization's success.
There are three necessary steps for health care organizations to successfully recruit physicians: assessment, strategy development and execution.
Every market is different in its approach to medical staffing. A health care organization needs to look at its medical staff and market position, then identify how many physicians will be required, and in what specialties, to manage the care for the people who will enroll.
Those organizations whose leaders want to transform them into accountable care organizations should determine how big they are going to be in terms of enrollees (an organization must be able to manage at least 5,000 patients to qualify as an ACO). In a small community where an organization is the sole provider, the math is relatively easy. For every x number of people in a community, you can count on x cases of cancer, x cases of hip problems, and so forth. If the market demands 50 primary care physicians and the community already has 40, then clearly, the need is 10.
Today, health care organizations predict enrollment based on a number of factors, one of which may be a competing ACO. To determine how many physicians and which specialties are needed, these organizations must consider what the competition is doing. Even organizations that have enough physicians to set up their network must predict the needs of their population to assess the necessary complement of physicians and avoid any gaps in service. These organizations need to develop a recruitment plan that uses more than simple subtraction.
Succession planning. A first step is to predict how long physicians likely will stay in practice. According to the Association of American Medical Colleges, one-fourth of the 772,687 active physicians in 2009 were 60 or older. Many of these older physicians will be retiring just as demand picks up.
Alignment. Again, the single player in a market has a significant advantage. This organization might not have to tightly manage or employ all of its physicians. In some cases, the organization can rely on staffing through community relations and joint ventures, such as affiliation agreements, academic agreements and medical directorships for certain service lines. In a competitive market, however, if two organizations are going to become ACOs of an integrated delivery network, the physicians have to choose with which ACO they are going to partner and agree to become exclusive to that partner.
In an extreme example, the University of Pittsburgh Medical Center developed its own health plan. This plan competed with insurance companies in its market. During that time, West Penn Allegheny Health System was struggling without its own health insurance product. West Penn's future viability was critical to the continued competitiveness of Highmark Blue Cross Blue Shield (the dominant insurance company that competes with Pittsburgh's health plan). To ensure local competition, Highmark purchased West Penn Allegheny Health System.
The outcome is that physicians today looking for work in Pittsburgh must choose between a health care organization that has its own health plan and a hospital that is owned by a major health insurance company.
Acquire, recruit or relocate? The most convenient strategic model is to acquire physician practices. These physicians already are known in their community, have an established reputation and come with an existing list of patients.
However, this model may not meet an organization's needs because it isn't able to purchase the desired practice, or it still may have specialty gaps. If so, the organization might look at recruiting doctors from other organizations; in the case of smaller markets, it may need to recruit physicians in other regions who are willing to relocate. The latter approach can be particularly difficult in the current economic climate due to the challenges posed by the housing market: Many physicians are held captive by unfavorable housing prices. As a result, some regional hospitals have started offering housing assistance as part of their offer package, adding expense and complications to the negotiation process.
Once an organization has determined the number of specialists it has to recruit and has laid out its strategy, it is time to execute that strategy. There are two options for successfully executing a recruitment plan: dedicating internal resources to the recruiting effort, or outsourcing the process.
An internal approach may be feasible if an organization has:
- a capable team of physician recruiters;
- access to the technology and infrastructure to find and engage physicians;
- resources to get them into town and sell them on the community and opportunity;
- experienced people who can handle being interviewed by these physicians and convince them of the benefits of joining the team;
- a demand for fewer than eight to 10 physicians per year, on average.
If an organization is hiring more than eight to 10 physicians per year, the economies of scale may favor an outsourced approach, as the organization will need to expand its internal recruiting systems and staff. On the other hand, small organizations that hire fewer than five physicians per year can't justify the cost of the internal resources. At that level, a contingency model may make the most sense.
Some innovative health care organizations are looking to other industries and proven best practices for cutting cost and delivering better results. These pioneers in health care are finding that recruitment process outsourcing becomes an effective model for finding talented professionals at a sustainable cost structure. In most instances, the RPO model reduces an organization's overall recruitment cost by 15 to 50 percent.
The RPO approach, although still fairly new in health care, is starting to catch on as more organizations take proactive measures to meet cost control demands and uncover the elusive talent critical to their survival. By selecting a partner who understands the unique hiring considerations of the health care market, organizations may expect to see such high-level benefits as a transfer from fixed to variable costs, an added resource of industry knowledge, and access to more sophisticated recruiting technologies. Additional, more specific advantages may include reduced time to fill, increased retention and greater employee satisfaction.
By taking a proactive approach to assessment, strategy development and execution, health care organizations can get a head start on physician recruitment to ensure that they secure the most qualified talent for their organizations, and the best quality of care for their patients and the communities they serve.
Mike Soisson is a health care practice leader of Pinstripe Healthcare in Brookfield, Wis., and former CEO of Good Shepherd Penn Partners, a joint venture between the University of Pennsylvania Health System and Good Shepherd Rehabilitation Network.