Hospitalist Recruitment and Retention: Building a Hospital Medicine Program

214 Pages·2009·1.586 MB·English

by  Kenneth G. Simone(auth.)

HOSPITALIST
RECRUITMENT
AND RETENTION
HOSPITALIST
RECRUITMENT
AND RETENTION
Building a Hospital Medicine Program
Kenneth G. Simone
Hospitalist and Practice Solutions
A JOHN WILEY & SONS, INC., PUBLICATION
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Library of Congress Cataloging-in-Publication Data:
Simone, Kenneth G.
Hospitalist recruitment and retention : building a hospital medicine program / Kenneth G.
Simone.
p. ; cm.
Includes index.
ISBN 978-0-470-46078-8 (pbk.)
1. Hospitalists. 2. Hospitals–Personnel management. I. Title.
[DNLM: 1. Hospitalists–manpower. 2. Personnel Administration, Hospital–methods.
3. Personnel Selection–methods. 4. Personnel Turnover. WX 203 S598h 2010]
RA972.S553 2010
362.11068–dc22
2009043686
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
To Matthew and Olivia, with love
In loving memory of my brother Steve, forever in my heart
CONTENTS
Preface xi
1 Physician Supply and Demand 1
1.1 The Aging Medical Workforce 1
1.2 The Growing and Aging Population 2
1.3 Decreased Medical School Matriculation 4
1.4 The Changing Demographics of Medicine 4
1.5 The Cost of Medical School and the Graduate Debt
Burden 6
1.6 The Changing Role of the Specialist 8
1.7 The Changing Scope of Primary Care 9
1.8 The Availability and Accessibility of Training
Programs 11
1.9 Technological Advances 11
1.10 The Increasing Regulatory Responsibilities Placed on
Physicians 12
1.11 Rising Practice Expenses and Diminishing Returns
from the Insurance Industry 14
1.12 Utilization of Nonphysician Clinicians 15
1.13 Government Policy 16
1.14 Generational Expectations 18
2 The Hospitalist Marketplace 23
2.1 Age, Gender, and Years Employed as a Hospitalist 23
2.2 Hospitalist Education 26
2.3 Hospitalist Practice Location 27
2.4 Hospitalist Employment Model and Hospital Teaching
Status 29
2.5 Control/Hospital Governance of Affi liated Hospital 31
2.6 Hospital Size 31
2.7 Hospitalist Staffi ng 33
2.8 Coverage Schedule and Night Call Responsibility 34
2.9 Hospitalist Program Growth and Turnover 36
vii
viii CONTENTS
3 The Role of the Hospitalist 37
3.1 Hospitalist Program Patient Type and Encounter
Type 38
3.2 Hospitalist Time Spent on Nonclinical Activities 40
3.3 Leader Time Spent on Administrative Activities 41
3.4 Hospitalist Activities Based on Location 42
4 The Hospitalist Recruitment Pool 45
4.1 Building Your Recruitment Network 45
4.2 Identifying Your Candidate Pool 50
5 Challenges Recruiting Hospitalists 57
5.1 Physician Compensation 57
5.2 Practice Model 61
5.3 Work and Call Schedule 64
5.4 Daily Workload 65
5.5 Added-Value Benefi ts 66
5.6 Medical Staff Support 66
5.7 Hospital Culture and Systems 66
5.8 Technology 67
5.9 Specialty Providers 67
5.10 Referral Network 68
5.11 Hospital Administrative Support 69
5.12 Staff Stability 69
5.13 Community and Practice Culture 70
6 Incentive Plans 73
6.1 Incentive Plan Objectives 73
6.2 Data Systems 74
6.3 Metrics 74
6.4 Benchmarking 79
6.5 Incentive Payout 79
7 National Recruitment Initiatives 83
7.1 Trend in Hospitalist Salary 84
7.2 Type of Incentives Offered for All Specialties 84
7.3 Relocation Pay, and Amount, for All Specialties 85
7.4 Signing Bonus, and Amount, for All Specialties 86
7.5 Amount of CME for All Specialties 86
7.6 Additional Benefi ts 87
CONTENTS ix
7.7 Hospital-Employed Job Opportunities 87
7.8 Assessment of Fair Market Value and Physician
Compensation 89
8 Retention Initiatives 91
8.1 Defi ning Expectations and Finding the Appropriate
Fit 93
8.2 Work–Life Balance 94
8.3 Integration of the Hospitalist Program and Hospitalist
Physicians 94
8.4 Support from the Clinical Director and Sponsoring
Hospital 94
8.5 Clinical and Operational Support 95
8.6 Opportunities for Career Growth and
Advancement 95
8.7 Financial Opportunities 96
8.8 Spousal/Signifi cant Other and Family Integration
Within the Community 96
8.9 The Orientation Program 97
8.10 The Exit Interview 100
9 Putting It All Together: The Site Visit and Interview 103
9.1 The Contact 104
9.2 The Site Visit 107
9.3 The Recruitment Team 114
9.4 Discussion Topics 119
9.5 The Interview 121
9.6 The Postvisit Phase 133
9.7 Hiring Protocol 134
10 The Contract 137
10.1 Employment Arrangement 137
10.2 Qualifi cations 137
10.3 Standards of Service 138
10.4 Physician Services 139
10.5 Duties and Responsibilities of the Employer 139
10.6 The Term of Employment 139
10.7 Hours of Employment 139
10.8 Compensation 140
10.9 Professional Liability 140
10.10 Employment Activities Outside the Practice 141
x CONTENTS
10.11 Restrictive Covenants 141
10.12 Termination of Employment 142
10.13 Patient Record Ownership 143
10.14 Confi dentiality 143
10.15 Financial Relationship Between Employer and
Physician 143
11 Practice Management Strategies 145
11.1 The Hospitalist Budget 145
11.2 Hospitalist Staffi ng 146
11.3 Program Policies and Procedures 153
11.4 Practice Support 154
11.5 Strategic Planning 155
11.6 Collaborative Systems of Care 157
11.7 Marketing the Program 165
12 Targeting Program Leadership 167
12.1 Attributes of Effective Program Leadership 167
12.2 Mentoring Potential Leaders 171
12.3 Leadership Versus Management 173
12.4 Identifying and Recruiting an Effective Leader 176
12.5 Practice Culture and Career Satisfaction 186
13 Concluding Thoughts 193
References 197
Index 201
PREFACE
Recruitment and retention of physicians in all specialties remains a
national challenge. This challenge applies to both outpatient and
inpatient physicians, primary care and specialist physicians, as well as
private, government, and hospital - owned practices. As I ’ ve traveled
across the country consulting with many hospitalist programs, it became
apparent that recruitment and retention of physicians was a signifi cant
challenge for most programs, both old and new (and an Achilles heel
for many). In my professional experience, practices and programs have
encountered a vast array of recruitment and retention problems, result-
ing in destabilization of their hospitalist programs. These problems
have included:
(cid:129) Inadequate planning. M any programs fail to appropriately esti-
mate the demand for their services (at the program ’ s onset and
over time) and thus fail to anticipate staffi ng requirements. In
addition, many programs fail to plan and time the hiring of physi-
cians (e.g., sequencing) when multiple providers are needed. They
have failed to develop short - and long - term strategic staffi ng plans.
(cid:129) Lack of a clearly defi ned recruitment process. M any hospitalist
programs have failed to create a well - planned and choreographed
recruitment process, leading to missed opportunities and/or a hiring
mismatch. Physician recruitment is a buyer ’ s market. This is par-
ticularly true for hospitalists. It has been estimated that there are
approximately 20,000 practicing hospitalists at the present time.
The Society of Hospital Medicine (SHM) projects that there will be
30,000 hospitalists by 2010 and upward of 50,000 hospitalists by 2030
[1] . These numbers are phenomenal for a specialty just over a
decade old. Yet, if you were to review the “ hospitalist wanted ” ads
in medical journals, on the Internet, through direct mailings, or on
the SHM Web site (to name a few sources), you would fi nd that
many hospitalist programs are recruiting for additional hospitalists.
Factors accounting for this are explored in the book. Thus, pro-
grams that do not clearly defi ne the recruitment process, or those
who fail to act promptly, may lose highly qualifi ed candidates.
xi
xii PREFACE
(cid:129) Hiring mismatch. Many programs hire providers who do not fi t in
with the practice “ culture. ” There is a mismatch between the
vision, values, and objectives of the hospitalist program and the
newly hired physician. This can lead to disruptive behaviors within
the hospitalist practice, low morale, and can result in poor pro-
vider and program performance.
(cid:129) Lack of retention plan. Many programs have been successful in
fi nding a good physician – practice fi t but failed in support and
integration of the new physician into the practice, hospital, and
community. A poorly developed retention plan or the absence of
one can lead to physician turnover. Physician turnover can result
in staff shortages, which may lead to program instability (e.g., be
disruptive to the “ chemistry ” of a practice), provider job dissatis-
faction, provider burnout, and subsequent poor clinical outcomes.
Provider turnover can be quite costly to a hospitalist program, as
numerous costs are associated with replacement of providers.
These costs include those associated with recruitment (e.g., travel,
lodging, sign - on bonuses, medical school loan repayment, reloca-
tion expenses, lost productivity for hospitalist and hospital staff
during the recruitment process), headhunter fees, and revenues
lost during provider shortages. In addition, programs may experi-
ence inappropriate ancillary utilization and an increase in the
length of stay as a result of being understaffed, negating two of
the major benefi ts of having a hospitalist program. This ultimately
will decrease the return on investment for the subsidizing entity.
For startup hospitalist programs, development of an effective recruit-
ment and retention plan at the onset will be invaluable in supporting
a program ’ s success. Too often, new hospitalist programs are derailed
as a result of hiring the wrong physician (especially if it is the fi rst hire).
Whereas an established program will probably survive a poor recruit-
ment choice, a new program, because of its lack of history within the
medical community, may not have that luxury. Although there are no
guarantees that a candidate will be the ideal hire, having a process in
place will provide a foundation on which a program can make a choice
objectively and effectively.
This book is designed to guide hospital administrators, hospitalist
administrators, hospitalist clinical directors, medical staff leaders (chief
medical offi cer, vice president of medical affairs, department chiefs),
physician recruiters, hospitalist physician candidates, and physician
practice managers through the recruitment and retention process. It
analyzes current trends in hospitalist medicine and explores factors