By Steve Berkowitz
The scene is all too familiar: a physician in the Medical Group suddenly leaves or develops an extended illness. An atmosphere of panic pervades the clinic. Who will see that physician’s patients? How quickly can we get another physician? Where do we recruit? What do we do in the mean time?
All Medical Groups face these situations on a regular basis. Having consulted with many Medical Groups across the country over the years around the issue of recruitment and retention, here are some tips that should be considered by your Group:
1. Develop and Implement a Recruitment Plan for the Medical Group. Ideally, this plan should be in place BEFORE the event. Several factors must be considered in the successful development of this plan. Importantly, it must tie to the overall needs of the Group and must be an integral component of Group’s Strategic Plan.
There are several key issues to consider: The Group must first determine which services/specialties are needed within the Group as well as the costs/benefits of providing such services. Then it must be determined if there is a specific need within those services. Multiple issues to consider include the desired/ ideal panel sizes for primary care, productivity assessments for all current physicians, geographical or office coverage issues, and the potential for growth, to name a few. These factors determine the ideal number of physicians for each specialty in a given geography and the Group can objectively determine if there is a gap and whether recruitment is even necessary.
The recruitment plan, like the Strategic Plan, should be periodically reviewed and adjusted as the needs of the Group change.
2. Develop a Medical Group Charter. This document defines the ideal physician for the group in terms of the Group’s mission, vision, and values as well as acknowledging the cultural issues, both overt and covert, that exist within the Group. The cultural piece needs to be discussed openly and frankly amongst the providers. For example, does the Group expect high productivity/ high compensation amongst its physicians, or does the Group “set the thermostat” at a lower workload/ lower pay expectation? These cultural expectations are critical to discuss especially as one considers the compatibility of future recruits.
The Charter becomes an integral part of not only the recruitment process, but also a part of the compensation/ incentive program for the Medical Group, as those physicians who most embody the spirit of the Charter should be those most rewarded in the compensation plan.
3. Just because a physician leaves the Group does not mean an additional physician should be recruited. A recruitment plan is not a glorified replacement plan. Despite the chaos that can ensue with a sudden physician vacancy, as described above, there is now an opportunity for the Group to reevaluate the need for recruitment. Do not get cajoled into thinking that just because a physician has left, there is an automatic need to recruit another. There may be other options for the Group to consider, such as redistributing patients to other, less busy physicians.
4. Utilize a standardized process for recruitment. As new physicians are added, the Group needs to develop a consistent methodology to most insure hiring the best physician. It is imperative that the recruited physician have a reasonable understanding of what will be expected by the Group. Compatibility with the Group Charter is essential. Group expectations in productivity, on-call and work/life balance must be clearly articulated.
It is important that as many members of the Group as possible personally evaluate the applicant. Likewise, the applicant should have the opportunity to interview as many of the physicians in the Group as possible. Both parties must honestly assess the situation and make the best decision objectively. It is OK for either party to disagree and walk away.
The worst-case scenario is not the absence of the physician, but rather the “miss-hiring” of the wrong physician. The inappropriate hire can be considerably costly to the group in many ways down the road.
5. Develop a strategy for physician retention. Turnover has a considerable cost in terms of lost patient visits, lost time in diagnosis/treatment of patients, increased workload for the remaining physicians, and the time-consuming and expensive process of finding a physician and acclimating that physician to the Group. By and large, turnover should be minimized.
However, one must acknowledge that some turnover is good—not only if there is a quality or competency issue, but also if that physician does not fit in with the culture of the Group, or is not compatible with the values of the Medical Group Charter.
But the huge cost of turnover should be recognized by the Medical Group. Physician retention is the best way to minimize the need for recruitment. What is being done by the Medical Group to encourage the good physician to stay? Ideally, recruitment should be reserved for Medical Group growth.
Many groups routinely assess the satisfaction of the physicians, and adapt accordingly. Your Group should strive to be the ideal place to practice medicine in the community. Are you creating an environment where the good physician wants to stay? Are symptoms of burnout promptly recognized and addressed? Are there long-term benefits and incentives in the compensation program?
6. Leaving is the final step in the process of being dissatisfied. What are you doing to recognize physician dissatisfaction early on, and what are you doing about it? Many times, appropriate intervention can obviate the need for the physician to leave. There is a great opportunity here for "preventive medicine."
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