4 Best Practices for Supporting Employed Physicians' Independence

Physicians in private practice are accustomed to having a great deal of independence in their work. This independence comes at a cost, however; they are responsible for running the practice, which may take time away from their time with patients. For physicians looking for a relief from business management and a greater focus on patient care, hospital employment may be an attractive option. But, physicians should not have to completely sacrifice their independence for this benefit. Having complete control over employed physicians can reduce physician satisfaction and subsequently reduce their productivity, the quality of care and patient satisfaction, the opposite of physician integration goals. However, hospital executives can strike a balance between granting some independence to employed physicians and fostering a team mentality by adhering to the following best practices.

1. Build a partnership. "Successful health systems recognize that physicians are not merely employees, but rather partners in obtaining the system's long-term objectives," says Katrina Slavey, network executive at Halley Consulting Group. While the term "employee" may appropriately reflect compensation arrangements, it should not necessarily dictate how the hospital treats physicians they hire.

"Physicians seek employment for a number of reasons, but they are, generally, educated and professionally socialized with an expectation of a high degree of professional autonomy," says Bryan Warren, manager of Select International's Healthcare Solutions division. "So, while they may in fact be an employee, they don't always think of themselves as a traditional employee.  Accordingly, providing them with some level of control over their situation and a sense of autonomy will improve career satisfaction and retention. If you can engage them in a meaningful way, you are far more likely to see higher levels of efficiency, productivity and patient outcomes."

Part of the mission of every hospital is to deliver quality care for patients, and physicians' main role is to care for patients. The hospital cannot fulfill its mission without the input and engagement of care providers. "Working with doctors side by side in meeting the healthcare needs of the marketplace both in the hospital and in the field are critical to the success of any healthcare delivery system," says John R. Thomas, CEO of MedSynergies. To create a partnership between employed physicians and hospital executives, each group has to trust the other. "Building trust takes time, and that trust relationship is the key to hospitals and physicians working together today and in the future," Mr. Thomas says.

2. Align goals. A partnership will not achieve the goals of care, however, if the partners do not understand each other's goals. "If you're a hospital CEO, you better have a good appreciation of the clinical delivery of healthcare. At the same time, if you're a physician, you have to understand the business of healthcare, says Mike Soisson, senior vice president of Pinstripe Healthcare. Respecting physicians' expertise and considering their perspective may help physicians feel that they still have autonomy as employed physicians.

Hospital leaders and physicians should communicate effectively so they can focus their efforts on clearly articulated, shared objectives. "Align goals and understand what the physicians' expectations are," Mr. Warren says.

In addition to identifying common goals, physicians and hospitals need to understand their role in achieving these goals. "Educating physicians who have been in the private sector and/or recently employed by the hospital system is imperative," says Ms. Slavey. "Primary care physicians must understand their value in maintaining market share for the system. For every dollar generated, the system can then reinvest those dollars in capital to acquire equipment that will enhance existing service lines, therefore ensuring that patient needs are met." Helping physicians understand their role in achieving goals and providing them with the tools they need may give physicians a sense of independence and control in their work that will likely be reflected in their productivity, satisfaction and patient care.  

3. Establish shared governance. Involving physicians in hospital governance may be one of the most challenging, but also one of the most effective, strategies in achieving a balance between physicians' independence and cooperation in a team. "Many hospital leaders gravitate toward the employment model because they see it as eliminating physician autonomy and providing the hospital greater control over the medical staff, so it is difficult for these hospital leaders to then create collaborative leadership models that meet the physicians' desire for some control over [their] situation and career," Mr. Warren says.

From this perspective, hospital leaders' possible reticence in granting physicians some independence may be rooted in a fear that their own independence and power will necessarily be reduced. "The practice of medicine requires a lot of self-assurance and independent decision making. It's not easy for that type of person, whether a physician or [not], to then be a team player or not be in charge all the time," Mr. Soisson says. "Quite often, the same thing can be said for CEOs; they are used to being in charge as well." Successful integration and positive outcomes, however, can only be achieved if hospital executives are willing to share control of parts of hospital operations. There are several models that hospital executives can use that can give physicians some control without sacrificing their role as employer.

"We utilize a Governance Council process that ensures physicians have a seat at the table," Ms. Slavey says. "Among other things, the council is responsible for holding the network executive accountable, developing physician compensation and contract models, system demand chain management, physician and advanced level practitioner employment and developing system-wide policy. While the CEO has a seat at the table, the council is chaired by a physician, operating under a model of being partnership-led versus physician-led. This means hospital administration and physicians work together to ensure the goals of both the physicians and the hospital are being met." In this model, physicians are granted some autonomy while the hospital remains a key player in decision-making.

Mr. Soisson says many hospitals and health systems offer physicians leadership roles in working committees, such as those for quality management and patient safety. Physician leadership in the hospital's finances may be particularly important. "Physicians should be on your finance committee," he says. "As with any partnership, the more transparent the information, the better (and more informed) the decisions will be. This is particularly important in financial decisions.  Don't underestimate your physicians' ability to understand the financial implications of the clinical decisions that they make." Understanding the financial situation of the hospital can help physicians understand the reason for certain policies and their role in maintaining the hospital's financial viability.

Another option for employed physicians' leadership positions is including physicians on the board of directors. In an effort to ensure physicians' engagement in hospital governance, some hospitals have set goals of having physicians account for fifty percent of board members, according to Mr. Soisson. Although it is important for physicians to be given some power and control through leadership positions, not every physician has the ability to or should hold such a position at the hospital. "Do your homework on the qualifications of the board member [candidate]," Mr. Soisson says. "Just because [he or she] is a great physician doesn't necessarily make [him or her] a really good board member." He suggests establishing criteria for board members that exclude their clinical specialty. For example, hospitals may identify certain leadership and communication skills as necessary qualities of a physician board member.  

4. Make physicians' role part of hospital culture. Hospital leaders can also help physicians feel a sense of autonomy by creating a culture that respects physicians as partners in the hospital and that encourages physician engagement in hospital operations. As hospitals offer leadership positions to physicians, communicate with them often and solicit their opinion, over time they will create a culture that allows physicians to feel independent. Hospitals have a responsibility not only to help create a culture for physicians to thrive in, but also to hire physicians that are compatible with the hospital's existing or desired culture. "Perform a better analysis of the degree of 'fit' between the physician and the hospital," Mr. Warren says.  

"As you get more successful at [these] things, you get momentum and it starts to escalate and become the culture," Mr. Soisson says. To test whether hospital leaders' efforts are effective in making physicians feel that they have some control, Mr. Soisson suggests conducting surveys that ask questions such as "How much do you feel that your input is listened to and utilized?"

Achieving a suitable balance between independence and team mentality in physicians should become apparent in productivity, satisfaction and other outcome measures. "When we worked with [a] North Texas health system, we saw enhanced reimbursements, reduced subsidies and increased collections, which gave the entire group evidence that physicians were working towards the overall mission," Mr. Thomas says. "Too much independence would have eclipsed the mission, while too much control would have demoralized physicians, hurting practice performance."

Related Articles on Physician Employment:

When Physician Employment May Not Make Sense: How to Turn Away Physicians Seeking Employment
7 Reasons Hospitals Struggle to Align With Physicians

Physician Integration Economics: How Market Share is Captured and Retained





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