Fostering physician motivation: Compensation is just the beginning

Like most employees, physicians benefit from a supportive environment. Unfortunately, many hospitals and health systems rush right past creating such an environment, instead immediately asking newly employed physicians to increase production, optimize in-house referrals, reduce emergency department use, pay more attention to cost, and support other initiatives.

It is important to pause and consider that the transition from independent to employed physician brings numerous stressors including new organizational structures, care models, and quality goals. All of these can ultimately leave newly employed physicians feeling anxious, overloaded, “de-professionalized”, and, ultimately, less interested in responding to employer requests.

Hospitals and health systems commonly respond to physicians who react with less than optimal engagement to system initiatives by implementing new compensation plans that align physicians’ interests with those of their new employer. While the development of these plans is essential (not to mention challenging), we believe that it is just the beginning. Put simply, money isn’t everything. Incentives, as important as they are, need to be matched by essential guidance, coaching, and encouragement. Hospitals and health systems need to remove roadblocks and “get out of the way” so that physicians can provide the best care to the most patients with the highest level of patient satisfaction. In a more supportive environment, the other things will follow.

Below, we have outlined several examples of support that hospitals and health systems can provide to their employed physicians:

Helping with the transition from independent practice to employment, i.e., “onboarding”: Hiring a physician is not just a matter of setting them up in a new office and putting them on the payroll. Establish expectations for scheduling, work, staff oversight, etc. and reinforce those expectations “early and often.”

Helping physicians to practice at the top of their license: Physicians should have a team-based structure in place, with advanced practice clinicians (APCs) for routine monitoring on chronic conditions, and support staff to handle ancillary tasks, so that the physicians themselves can focus on complex diagnoses and management of patients whose conditions are unstable. Increasingly, care coordination and management also includes other caregivers (e.g., pharmacy technicians, behavioral health specialists, etc.).

Make sure support staff are skilled and have a positive attitude. Demonstrate to physicians how this will make their jobs easier.

Supporting employed physicians in promoting their practices: Ensure that your newly employed physicians are promptly added to whatever referral systems you offer. Then take the next step. Put a physician-to-physician marketing plan in place and execute that plan. This may include meet and greets and practice mini-rounds. Provide EMR support for referrals between physicians—both in making the initial referral and in sending information back to the referring physician.

Supporting newly recruited physicians in charting, coding, and optimizing patient flow: They may also need assistance in transferring patient information from their private practice records. Expectations for patient scheduling and visit flow must be effectively communicated. Provide this information multiple times, in several different formats.

Creating a positive peer environment: This starts with recruiting. It’s important to go beyond looking for clinical superstars. Look for physicians who are positive communicators, team players, eager to be involved in changing practice styles and responding to external influences (payment, regulations); and who can work effectively with APCs and support staff.

Affording employed physicians feedback on a regular basis: Real-time data showing physicians their progress towards goals has a more immediate impact than year-end compensation calculations. Reports that show how each physician’s progress compares with his or her colleagues can have an even stronger impact—most physicians are competitive! Some health systems even provide this data on a non-blinded basis, encouraging informal physician interaction about it.

Employed physicians may even appreciate regular performance reviews, such as the Cleveland Clinic provides to its physicians.

Regularly addressing physician satisfaction: Physicians need a person (or people) and a place to bring issues that are causing them dissatisfaction. They need clear practitioner governance, whether that is through the chief medical officer, a defined physician satisfaction team, or the governance structure for a Clinically Integrated Network. Someone needs to be interviewing employed physicians regularly (being sure it’s not always the same physicians), and asking them what roadblocks they are facing and what can be done to make their jobs easier. When issues are identified, they can be brought to a team charged with resolving these problems.

There is a perception that physicians who leave an organization do so primarily because of compensation issues. However, it is quite common for physicians to leave because they are dissatisfied with their working conditions or feel that they do not fit with organizational culture. Supporting physicians in the ways described above can go a long way towards keeping them happily, and productively, employed.

Stuart J. Schaff, CVA, CHFP

Stu is a senior manager with Veralon, a healthcare management consulting firm. He works with a variety of non-profit and for-profit hospitals, health systems, physician organizations, and healthcare attorneys across the United States on matters involving provider compensation, valuation, and physician-hospital alignment. Stu is designated as a Certified Valuation Analyst by the National Association of Certified Valuators and Analysts (NACVA) and as a Certified Healthcare Financial Professional by the Healthcare Financial Management Association (HFMA). He is a frequent author and presenter on healthcare finance and physician alignment topics.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars