5 Best Practices for Successfully Retaining Those Hard-To-Recruit Physicians

With the latest movement of physicians being employed (again) by hospitals and healthcare systems around the country, physician retention is critical to creating any sort of return on investment with this venture. Hospital leadership must be proactive in developing a retention game plan in order to differentiate their organizations from other healthcare organizations.

Many times the person responsible for physician services is also strapped with other duties within the hospital and the organization does not dedicate enough resources to appropriately manage the new physician line of business. For the hospital to thrive, physician retention should take top priority with the CEO leading the charge.

Expediting the retention strategy often involves making a larger investment in the following five critical areas.

1. Community physician needs assessment (CNA). A CNA can provide assistance on several fronts. Initially, hospital leadership should have such an assessment performed in order to determine the surpluses and deficiencies in the current physician specialties as it relates to the service area to ensure that their community will be properly staffed for the immediate and long-term future. The CNA will detail which specialties are at the greatest deficit, further solidifying the need to recruit that specialty. For many years, hospitals just recruited those specialties that filled a need; however, today, many hospitals are creating a referral foundation by bringing in primary care.

Further, it provides documentation for existing physicians that the hospital does not intend to compete with local practices if they are not willing to bring in a new physician. A CNA can also assist hospitals with compliance issues as they relate to federal regulatory agencies (OIG, IRS, etc.) as well as the Joint Commission. Any financial relationship between a hospital and a physician draws the attention of Health and Human Services, OIG and other governing bodies as it relates to Stark legislation.

2. Appropriate "on-boarding." The creation of a successful physician on-boarding process will greatly enhance the overall initial experience of the physician and do much to create trust between the two parties. Studies show that the top three elements physicians seek in their careers are meaningful work, sense of community, and positive feedback. Refining the recruitment process to focus on these issues will strengthen the opportunity for retention. Creating a mentoring partner relationship with another senior physician to coach the new physician on the organization's culture and "ways of doing things" will better position the physician to reach these goals. Nurturing the relationship by taking into consideration the family/spouse needs, ongoing communication, assistance with practice development (other than just a picture in the paper) and an encouraging word from time to time goes a long way to building a long-term relationship.

3. Consistent practice startup activities. Developing a consistent model for practice startups will create goodwill and comradery amongst the other employed physicians while setting an example of how to properly manage a physician practice in the independent medical community. Production and business expert Edward Deming's thesis that reducing variation in a process usually improves the overall quality of the product assisted Japan in creating some of the finest cars on the road today. The same thesis can be made in healthcare … especially in a physician practice. If the practice is set up appropriately from day one to ensure that the many processes that make up the practice are efficiently managed, the long-term cost to operate and grow the practice will be at minimal levels.

Inefficient systems can cause physicians and administrators to spend unnecessary funds when, if processes are streamlined, it may not be necessary. Many practices are outsourcing certain functions (billing, payroll, etc.) when the practice is not large enough to justify having valuable staff performing same. If a physician has an income guarantee from the local hospital, many times it creates a false sense of security because cash flow may not take top priority. Appropriate funding to expedite credentialing and practice development activities will enable the practice to get off on the “right foot” and allow the physician to focus on the clinical aspects of the new practice. A constant evaluation of all processes through benchmarking will enable the practice leadership to make sound decisions as the organization evolves.

4. Investment in information technology. With the recent upsurge in focus on health care IT, the provision of an up-to-date billing and electronic medical records system is critical to retaining physician partners. Physicians need assistance with accurate billing, coding and the ability to share information and a strong IT solution can make these demands feasible. The key to successfully establishing an appropriate IT structure in order to glean accurate dashboard reporting is to research the very best system for the physician services division … not just what is good for the hospital.

Selecting a CCHIT-certified product will enable you to position your physicians to gain access to American Recovery Act Stimulus Package incentive funds while providing the physicians with a common platform for scheduling, billing, clinical documentation and data sharing. Providing this IT solution will negate that capital expenditure by the physician and provide the appropriate tools to ensure solid reporting of physician productivity and quality.

Most hospital executives want the physician financial information to flow into the hospital's general ledger and this can be done with many of the systems even though they may not be a part of the hospital's IT system. Adding a physician services division creates the need for a superior IT solution that will enable both the physician and hospital executive to gain the information they need to be successful.

5. Effective management structure and staffing. Professional physician practice management is now a necessity to ensure that the hospital's investment in physician services will not result in substantial red ink that flows onto many hospital's financials as a result of employing physicians. Hospitals are doing a much better job of what they pay for a practice along with how they pay that new physician; however, the need for professional management and appropriate staffing levels is still great.

Many hospitals assign the responsibility for the new physician practice to a hospital executive that already has inpatient responsibilities and may not have the time to appropriately lead and manage said practice(s). The hospitals/health systems that are successful at managing physician practices treat them as a separate business line and allocate the appropriate resources to ensure their success. Since most healthcare entities are suffering from higher costs and reduced revenues, the physician practice(s) now aligned with the hospital/health system may not get top priority from a management and resource allocation standpoint, As a result, losses must be justified in order to maintain the relationship(s).

Another reason hospitals fail at the physician practice management venture is that their community may not possess the talent and skills set necessary to successfully lead and manage physician practices. Hospital leadership also discovers that the political issues that are exacerbated from said relationships may create the need to interject a third party in order to effectively deal with the myriad issues that can are created once the physician and hospital form a bond. As a result of these issues, many hospital CEOs now outsource physician practice management to professional practice management companies who are better situated to deal with the many "moving parts" of a physician practice. .

Mr. McDonald (amcdonald@phybus.com) is a principal with PhyBus, a physician practice management consulting form. Learn more at www.phybus.com.