6 Tips to Engage, Retain and Recruit Physicians
Randal Dabbs, MD, FACEP, FAAFP, president of practice development at Knoxville, Tenn.-based physician management firm TeamHealth, saw many of the problems hospital executives faced in managing their emergency staff during his 30-year career as a physician executive and 17 years as chief of emergency services at the University of Tennessee Medical Center in Knoxville. In 1979, he and two other physicians co-founded Southeastern Emergency Physicians, now TeamHealth, to manage staffing and to develop ER physicians for their client hospitals. He says a benefit in outsourcing physician management is that it allows hospital executives to focus on running their organization, allowing TeamHealth to manage the recruiting, staffing and continuous training of physicians using best practices learned from contracting with 4,700 providers across the country.
"Most hospital C-suites have minimal experience in managing ER physicians or know the standards of care in that specialty," Dr. Dabbs says. "Also, if a hospital contracts with a hospital-based physician, there are challenges of alignment and accountability. Today, hospitals are reimbursed via 'value based purchasing' and achieving high levels of patient satisfaction scores of their physicians is critical to their survival. If the hospital is employing that physician, it can be difficult to coach up or terminate a physician who does not play well in the sandbox," he says. Holding physicians accountable requires leadership training, and coaching them up can be a challenge.
The key to addressing retention, productivity and clinical quality simultaneously, Dr. Dabbs says, is physician engagement, which will usually boost patient satisfaction scores, as well. Physicians who are part of a cohesive, like-minded team want to stay, and they attract other like-minded physicians as well, easing hospitals' burden of recruiting suitable candidates as replacements.
Here are Dr. Dabbs' recommendations for hospitals to promote physician engagement, in what he calls his "6 C's of retention."
1. Create a positive culture by the physician leader. "For TeamHealth, the medical director is the lynchpin," Dr. Dabbs says. While an organization's culture may start at the CEO level, medical directors, as physician role models, carry special authority among other physicians. "Physicians do not always follow non-physicians as leaders," he said. TeamHealth relies heavily on its medical directors to manage the contract at the facility level. The company invests heavily in their training to teach them how to understand the needs of the C-suite and how to achieve efficient integration with other service lines such as hospital medicine and anesthesia.
2. Communicate. "Looping in physicians across your system promotes a sense of community, helps brand the organization from the inside and creates a forum for all providers to address issues that are important to them," Dr. Dabbs says. On the annual survey sent to TeamHealth physicians, the most common request is for more communication with the organization's leadership and with their own hospitals, Dr. Dabbs' says. That feedback led TeamHealth leadership to send weekly updates to their providers as well as a corporate "State of the Organization" video link, email listservs and town hall meetings. This gives physicians a voice and helps them be more connected, which in turn, encourages them to stay put.
3. Connect or "round". "You'd be surprised how few CEOs get out of the C-suite to speak or round on their caregivers within the hospital," Dr. Dabbs says. "Walk the halls of the hospital, get to know people by their first names and ask how you can make their work more enjoyable. When I think of past great administrators, they did that," he says. He said research shows staff morale and engagement is higher when bosses talk to all members regularly, communicate directly and build personal connections. "Even if they are not perfect, they'll want to get there," he adds.
4. Compliment. Great things happen in a hospital every day by physicians, nurses, and even cafeteria and housekeeping personnel, but most go unnoticed or are seen as routine. The leader of a team must search for and compliment these deeds openly and with thank-you cards. This increases engagement and reinforces that type of behavior. There is no level of leadership that should not practice this strategy.
5. Coach. Perhaps the hardest piece of the puzzle for executives is whether, when and how to coach a low-performing physician. It may initially seem easier to simply "fire" the doctor, but the shortage of qualified candidates increases the importance of retention by good coaching. Again, this is why medical directors trained in this art are critical. Low performers can breed resentment among physicians who view them as a weak link, but terminating them without investing in their development can grow the same negativity. Treat your physicians as servants, commodities or vendors, Dr. Dabbs says, and you will retain neither the good nor the bad.
Coaching itself is a skill that must be taught to medical directors. At TeamHealth, Dr. Dabbs says they've recruited one of the top physician coaches in the country, giving him the primary job of teaching physician leaders how to coach up their middle-to low-performers.
"Physicians are trained to be solo practitioners, and while we inherently want to practice sound evidence-based medicine, we don't always know how to work effectively in a large organization. We are more likely to be engaged with our next patient than with the organization as a whole," said Dr. Dabbs.
6. Claims reduction. One of the greatest sources of stress for health systems and physicians alike is the fear of being sued. Rarely does one get sued without the other. Dr. Dabbs says this stress can be alleviated with robust training in risk management which builds confidence in physicians as they do their work more efficiently and with less second-guessing. He says TeamHealth has a very comprehensive risk management program that is well-informed from the 10 million patients they care for each year. "We have a great database and can find trends through our accredited Patient Safety Organization. And if we find troublesome trends, we're able to provide feedback to physicians using evidence-based medicine, with decreased worry about being sued. I would suggest any hospital develop a quality improvement program that seeks to educate and support the physician, instead of seeking to reprimand and ostracize him or her."
Hospitals' physician payrolls are huge expenses, which makes developing and retaining them all the more essential for a hospital to prevent incurring unneeded costs and weakening its clinical culture.
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