michigan recruitment & retention network conference
TRANSCRIPT
Craig W. HunterThe Coker Group Associate Partner
(678) [email protected]
Michigan Recruitment & Retention Network Conference
Physician Recruitment Trends and ChallengesMay 19, 2008
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Who We Are
The Coker Group is a national healthcare consulting firm helping physicians, hospitals, and other providers find answers and solve problems in management and business operations.
Coker consultants and educators provide practical, effective strategies and solutions to assist the leaders of today’s health care organizations through hands-on consulting and educational forums.
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Physician Recruitment
Are you growing your medical staff through recruitment?Do you know how many physicians are over the age of 58 right now?What works in your recruitment process?What has to change?Are our compensation models competitive?Does it take too long to sign a physician?How helpful (really) are your current physicians?Do you have a recruitment committee including physicians to help with the process?
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What Trends?
A Shortage of PhysiciansPayer Mix IssuesCall Coverage Issues & CompensationMalpracticePopulation GrowthBaby BoomersMore Female PhysiciansFewer PCP’sRetirementsQuality of Life IssuesMore Locum TenensStark Restrictions
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Which leads to:
The need for better planning and medical staff developmentMore focused resources to get “our candidate” – more long range perspectiveConnections with the market
- family- spouse’s family- training/education there
More options in practice settings- private practice- more employment by hospitals - incubator practices (employment then transition to private)- MSO – Management Services Organization
Renewed Emphasis on- recruitment- retention- service options
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Our Experience With Physician Compensation
Initial contract/guarantee (may be 1-2 years)Most hospital CEO’s would prefer private practice, income guarantee model vs. employmentMust quickly get physicians to recognize production and “break-even” mentalityMarket may determine structure
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Hospitalists
Programs will continue to growExpanded to include Critical Care/ICU and more surgical specialtiesMore physicians staying out of the hospital that still need to feel and be “connected”
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Recruiting into Employment
Much more common (and it will continue)
More productivity oriented compensation after initial contract
Expanded to include more ologists and surgical specialists
May be the only way some hospitals can attract needed physicians
Provides much greater security for physicians initially than does private practice
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Physician Contracting Trends
Income is going up—not sure production will continue to do soPhysicians are expecting to be paid as if they were productiveQuality of life is a huge issueCall compensation issue is not going awayPhysician employment by hospitals is still on the rise
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Contracting Trends (cont.)
Physicians are becoming more aware that they have leverageRVU models are in a state of flux due to CMS changes and the MGMA dataEligibility time for benefits is shorteningStark II, Phase III impact not fully known yetEveryone wants to talk quality but how will it be defined?
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Physician Recruitment Facts
Top 10 Physician Searches (Merritt Hawkins)1. Family Practice2. Internal Medicine3. Hospitalists4. Radiology5. Orthopedic Surgery6. Cardiology7. OB/GYN8. General Surgery9. Emergency Medicine10. Psychiatry
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Top Five Specialties by Growth
Hospitalists (up 73% from last year)Pediatrics (54%)OB/GYN (43%)Hematology/Oncology (31%)Family Practice (18%)
(Merritt Hawkins 2007 Review of Physician and CRNA Recruitment Incentives)
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Types of Incentives Offered
Salary w/ IncomeSalary Bonus Guarantee
2006-7 12% 67% 21%2005-6 15% 53% 32%2004-5 10% 55% 35%2003-4 9% 50% 41%
(Merritt Hawkins)
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Hospital Employment
2006-7 43% of all searches2005-6 23%2004-5 19%2003-4 11%
(Merritt Hawkins)
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Average Net Revenue Per Specialty
Cardiology (Invasive)--$2,662,600 Orthopedic Surgery--$2,312,168Cardiology/Non-Inv.--$2,240,286 Neurosurgery--$2,100,000 Internal Medicine--$1,987,253 General Surgery--$1,947,934 Hematology/Oncology--$1,624,246 Family Practice--$1,615,828OB/GYN--$1,413,436Gastroenterology--$1,336,133 Pulmonology--$1,332,534Urology--$1,272,563
(Merritt Hawkins)
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Government Regulations
You now have three main agencies to considerAnti-Kickback—inducement or payment
– Health and Human Services
IRS—individuals profiting from tax-exempt organizations inappropriately
Stark—referral relationships
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Additional Considerations
Market factors are significant (payer mix, patient demographics)Call responsibilities will impact decision processQuality of life becoming a larger considerationAncillary revenues may play a huge roleThere is no one magic bullet
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Private Physicians
Do they feel you are competing with them?Have you really discussed their goals for the next five-to-ten years with them?Do they know what they want?Are they willing to grow their own practices?How helpful are they in leading other physicians?Is there open dialogue with Administration?What else can you do to help them?Would they be open to managed services provided at fair market value by the hospital?
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Specialty Median Specialty Median Specialty MedianAllergy/Immunology $260,000 Gynecological Oncology $335,840 Ped: Neurology $220,768Anesthesiology $364,758 Maternal & Fetal Medicine $353,136 Ped: Urology $353,606Anesth: Pain Management $382,592 Reproductive Endocrinology $323,000 Physiatry (Physical Med & Re) $220,991Cardiology: Electrophysiology $434,644 Occupational Medicine $187,305 Podiatry (General) $174,373
Cardiology: Invasive $431,886 Ophthalmology $297,486 Podiatry: Surg-Foot & Ankle $206,948Cardiology: Invasive-Interv $486,157 Ophthalmology: Pediatric $280,000 Psychiatry (General) $185,957Cardiology: Noninvasive $367,704 Ophthalmology: Retina $452,648 Psychiatry: Child & Adol. $208,616Critical Care $252,619 Orthopedic (Non surgical) $168,107 Pulmonary Medicine $255,807Dentistry $121,374 Orthopedic Surgery (General) $425,000 Pulm. Med: Critical Care $275,000Dermatology $335,899 Ortho Surg: Foot & Ankle $459,580 Radiation Oncology $454,500Dermatology: MOHS Surg. $579,741 Ortho Surg: Hand $482,993 Radiology: Diagnostic-Inv. $478,565Emergency Medicine $250,030 Ortho Surg: Hip & Joint $534,969 Radiology-Diagnostic-Noninv $426,345Endocrinology/Metabolism $189,506 Ortho Surg: Pediatric $422,325 Rheumatology $199,810Family Practice (w/ OB) $176,796 Ortho Surg: Spine $545,868 Surgery (General) $306,115Family Practice (w/o OB) $164,021 Ortho Surg: Trauma $463,753 Surg: Cardiovascular $460,122Family Practice: Sports Med. $195,793 Ortho Surg: Sports Med. $540,067 Surg: Colon & Rectal $372,655
Gastroenterology $406,345 Otorhinolaryngology $324,529 Surg: Neurological $571,787Geriatrics $161,888 Pathology: Anatomic $295,014 Surg: Oncology $311,728Hematology/Oncology $362,930 Pathology: Clinical $259,126 Surg: Oral $360,980Oncology (only) $321,935 Pediatrics (General) $174,353 Surg: Pediatric $350,000Infectious Disease $201,667 Ped: Adolescent Medicine $162,822 Surg: Plastic & Reconstructive $343,638Internal Medicine (General) $177,059 Ped: Cardiology $269,529 Surg: Thoracic (only) $384,254Internal Med: Hospitalist $193,330 Ped: Critical Care/Intensivist $315,075 Surg: Trauma $344,629Internal Medicine: Pediatric $168,985 Ped: Endocrinology $179,083 Surg: Vascular (only) $362,832Nephrology $291,977 Ped: Gastro $241,725 Urgent Care $191.548Neurology $220,000 Ped: Hematology/Oncology $200,471 Urology $357,605Obstetrics/Gynecology $271,425 Ped: Hospitalist $164,913Gynecology (only) $227,838 Ped: Neonatal $248,429
Source: 2007 National M
edian MG
MA Physician C
ompensation and Productivity Survey, based on 2006 data.
Specialty Median Specialty Median Specialty MedianAllergy/Immunology $241,259 Gynecological Oncology $454,314 Ped: Neurology $211,572Anesthesiology $348,566 Maternal & Fetal Medicine $347,475 Ped: Urology *Anesth: Pain Management $405.471 Reproductive Endocrinology * Physiatry (Physical Med & Re) *Cardiology: Electrophysiology $657,800 Occupational Medicine $186,608 Podiatry (General) $176,130
Cardiology: Invasive $546,797 Ophthalmology $318,572 Podiatry: Surg-Foot & Ankle $243,037Cardiology: Invasive-Interv $591,772 Ophthalmology: Pediatric * Psychiatry (General) $179,776Cardiology: Noninvasive $396,621 Ophthalmology: Retina * Psychiatry: Child & Adol. $172,032Critical Care $240,000 Orthopedic (Non surgical) * Pulmonary Medicine $303,904Dentistry * Orthopedic Surgery (General) $481,226 Pulm. Med: Critical Care $282,591Dermatology $379,856 Ortho Surg: Foot & Ankle * Radiation Oncology $405,916Dermatology: MOHS Surg. * Ortho Surg: Hand $478,231 Radiology: Diagnostic-Inv. $561,088Emergency Medicine $267,747 Ortho Surg: Hip & Joint $399,166 Radiology-Diagnostic-Noninv $457,745Endocrinology/Metabolism $202,389 Ortho Surg: Pediatric * Rheumatology $221,780Family Practice (w/ OB) $182,689 Ortho Surg: Spine $692,640 Surgery (General) $344,605Family Practice (w/o OB) $163,188 Ortho Surg: Trauma * Surg: Cardiovascular $445,400Family Practice: Sports Med. $192,586 Ortho Surg: Sports Med. $470,045 Surg: Colon & Rectal *
Gastroenterology $486,896 Otorhinolaryngology $349,023 Surg: Neurological $676,082Geriatrics $167,314 Pathology: Anatomic $252,905 Surg: Oncology *Hematology/Oncology $320,372 Pathology: Clinical * Surg: Oral $398,728Oncology (only) $281,136 Pediatrics (General) $170,270 Surg: Pediatric *Infectious Disease $217,009 Ped: Adolescent Medicine * Surg: Plastic & Reconstructive $382,158Internal Medicine (General) $175,331 Ped: Cardiology * Surg: Thoracic (only) $370,250Internal Med: Hospitalist $178,215 Ped: Critical Care/Intensivist $291,593 Surg: Trauma $416,041Internal Medicine: Pediatric $182,725 Ped: Endocrinology $177,773 Surg: Vascular (only) $389,944Nephrology $270,816 Ped: Gastro * Urgent Care $198,000Neurology $231,318 Ped: Hematology/Oncology $200,471 Urology $393,169Obstetrics/Gynecology $292,397 Ped: Hospitalist *Gynecology (only) $273,150 Ped: Neonatal $254,331
Source: 2007 M
GM
A M
idwest M
edian Physician C
ompensation and Productivity Survey, based on 2006 data.
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Where Do We Go From Here?
Truly assess your overall medical staff development strategyRecognize the barriers that must be overcomeWork proactively with your medical staff to meet their individual needs (requires multiple strategies)Improve communicationDevelop and implement a true development strategy
QUESTIONS/COMMENTS
The Coker GroupNational Consultants to Healthcare Providers
1000 Mansell Exchange West Suite 310 Alpharetta, Georgia 30022 (678) 832-2000
Craig W. HunterAssociate Partner
(678) [email protected]