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Recruitment, Retention and Your Hospitalist Program


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  • 1. Recruitment, Retention and Your Hospitalist Program Kenneth G. Simone, DO
  • 2. Objectives  Discuss Hospitalist Workforce Demographics  Discuss Challenges Associated with Hospitalist Recruitment  Identify the Hospitalist Candidate Pool  Discuss Physician Workforce Facts  Identify Factors Influencing Physician Supply and Demand  Discuss the Hospitalists’ Role in Recruitment and Retention of Physicians in their Local Community
  • 3. Hospitalist Workforce Facts Growth of Hospitalists ♦ 1997 23 ♦ 1999 800 ♦ 2000 1400 ♦ 2001 1750 ♦ 2002 3508 ♦ 2003 4076 ♦ 2005 12,000+ ♦ 2010 30,000+
  • 4. Hospitalist Workforce Facts Characteristics of Hospitalist Management Groups Region Midwest – 27%/ South – 26%/East – 24%/West – 22% Surrounding area Lg. urban (over 1 mill.) – 49%/Sm. urban – 33%/Rural – 18% Employment model Hospital – 34%/Acad. institution – 20%/Mgt. Co. - 19% Local hospitalist only – 12%
  • 5. Hospitalist Workforce Facts Characteristics of Hospitalist Management Groups Control/Hospital governance of affiliated hospital Not for profit – 86%/For profit – 10%/Government – 3% Teaching status of affiliated hospital Non-teaching – 48%/Major teaching (Member of Assoc. Of American Medical Coll., Council of Teaching Hosp.) – 28%/Other teaching – 25%
  • 6. Hospitalist Workforce Facts Characteristics of Hospitalist Management Groups Age Physician leader – 41 years old/Non leader – 37 years old Gender Phys.leader-80% male, 20% female/Non leader-62% Male, female 38% Median years as a hospitalist Leader – 5.1 years/Non leader – 3 years
  • 7. Hospitalist Workforce Facts Characteristics of Hospitalist Management Groups Education (Percent graduates of U.S. medical school) Physician leaders – 85%/ Non leaders – 72% Specialty training Gen. Int. Med. – 75%/Pediatrics – 11%/ Int. Med. Sub. – 4%/ FP – 3%
  • 8. Hospitalist Workforce Facts Characteristics of Hospitalist Management Groups Program growth Mean number of staff added – 1.93 FTE’s (29% growth) Program Turnover Median – 9%
  • 9. Challenges Recruiting Hospitalists  Salary  Practice model  Work hours/Call schedule  Daily workload  Expectations/Demands from hospital  Medical staff support  Specialty providers  Referral network  Hospital administrative support  Program staffing/Program stability  Empowerment and career path  Community and practice culture  Hospital culture and systems
  • 10. Challenges Recruiting Hospitalists Where are these hospitalists?  Critical access hospitals  Community hospitals  Major medical centers  Teaching programs  Involved in basic and clinical research  Administrative leadership positions (CEO, Medical Director, VPMA)  Medical staff leadership (Chief of staff, Department chair, QA Director)  Involved in medical policy making and patient advocacy (quality and safety initiatives)  Creating evidence-based clinical guidelines and protocols  Developing surgical co-management programs  Developing palliative care programs
  • 11. Challenges Recruiting Hospitalists What is the hospitalist recruitment pool?  New graduates  Internal medicine, IM/Peds, Family medicine, Pediatric residency training programs  Hospitalist fellowship programs/Hospitalist tracks  Sub-specialty training programs (e.g. Intensivists, pulmonary, cardiology, etc.)  International medical graduates (IMG’s)  Established hospitalists in other programs  Established physicians in non-hospitalist practices (e.g. private or hospital practice)  Emergency Department physicians  Locum Tenens
  • 12. Challenges Recruiting Hospitalists
  • 13. The Hospitalists Role in Recruiting Physicians HFMA NEWS Wednesday, June 21, 2006 - AAMC Calls for 30% Increase in Medical School Enrollment Concern about the growing physician shortage has led the Association of American Medical Colleges to recommend that enrollment in U.S. medical schools be increased 30% by 2015 instead of the 15% AAMC proposed in February 2005. Citing current population trends and physician retirement patterns, AAMC says the number of physicians will peak by about 2020 and then drop just as the baby boomers begin to reach age 75 if medical schools don’t accommodate 30% more students. The proposed expansion would increase the number of new MD students by 5,000 annually, and AAMC suggests that it be accomplished by boosting enrollment at existing schools and by creating new allopathic medical schools.
  • 14. Physician Workforce Facts According to the AMA:  67% of practicing physicians are over the age of 42 (Mature and boomer generations)  18% are 61 years of age or older  49% are between 42 and 60 years of age  88% are male  ~33% of practicing physicians are between 27 and 41 years of age (GenX sector)  58% are male/ 42% female  54% of new medical school graduates born after 1980 are female (Millennials)
  • 15. Physician Workforce Facts According to the COGME :  While the number of physicians will increase from 781,200 FTE’s in 2000 to 971,800 in 2020 (a 24% increase), after 2015 the rate of the population growth will exceed the rate of physician growth The US census bureau estimates between 2005- 2020:  The projected population less than 65 years old will grow 9%  The projected population 65 and older will grow 50% Keep in mind the elderly use much more services representing a significant increase in demand for physician services….
  • 16. Physician Workforce Facts What about physicians entering medicine? A review of physician and recruiting initiatives by Merritt, Hawkins and Associates in 2007 indicated: The top five specialties by growth in number of search from 2005- 2006 to 2006-2007:  73% - Hospitalists  54% - Pediatrics  43% - OB-GYN  31% - Hem/Onc  18% - Family Practice  
  • 17. Physician Workforce Facts What about physicians exiting medicine? The AAMC ‘s Third Annual Physician Workforce Conference (5/07) previewed two upcoming surveys by the AAMC and the American Medical Association of physicians over and under age 50. Preliminary findings indicate that:  One out of three doctors over 50 would retire today if they could afford to do so  Older physicians cite increased regulation of medicine as the key factor influencing retirement plans  Two out of three, or 66 percent of doctors under 50, are not interested in working longer hours for more money  Seventy-one percent of young doctors identify having family and personal time as an important factor in a desirable practice.
  • 18. Physician Workforce Facts Reasons physicians voluntarily leave a practice: (Source: 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka Search)  51% - Poor cultural fit Relocated to find a better community fit was mentioned 20% of the time  42% - Family considerations To be closer to own or spouse’s family and spouse’s job required relocation was mentioned 22% of the time  32% - Leaving to seek higher compensation Incompatible work schedule and excessive call schedule each mentioned 17% of the time.
  • 19. Physician Workforce Facts Turnover ratios (Source: 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka Search)  6.7% - Total average turnover (6.4% in 2005)  By sex  Males: 6.85% (5.9% in 2005)  Females: 6.6% (7.5% in 2005)  The first three years in practice hold the greatest likelihood for turnover  12% - First year  46% - In the first three years  23% - Greater than ten years
  • 20. The Hospitalists Role in Recruiting Physicians Hospital officials said hospitalists provide many benefits. They provide more immediate and more frequent care than primary care doctors, who are also busy with office patients. Such attentive care means quicker, often better service along with potentially shorter hospital stays. Hospitals see the arrangement as one that can boost not only recruitment and retention of doctors, but also one that helps create financial efficiencies in an era when insurance reimbursements are putting serious strains on institutional budgets. “On the wards: Hospitalists steadily bolster their ranks,” Boston Business Journal - March 24, 2006 by Mary K. Pratt.
  • 21. The Hospitalists Role in Recruiting Physicians Factors influencing physician recruitment and retention  Changing culture  Limited resident work hours  Growing ratio of women entering the medical profession  Increasing male participation in the household  Graduate debt burden  Generational (X, Millennial) expectations The new generation of doctors may view the medical profession as a job and not a calling….
  • 22. The Hospitalists Role in Recruiting Physicians Factors influencing physician recruitment and retention  Changing focus of the specialist  Consultant role  Procedurist orientation and training  Aging physician workforce  Practice scope  Medico-legal concerns  Employment model
  • 23. The Hospitalists Role in Recruiting Physicians Factors influencing physician recruitment and retention  Lawyers, guns, and money  Diminishing returns  Medicare  Medicaid  Teaching and Research  Lifestyle
  • 24. Concluding thoughts…. Although there is a large number of hospitalists nationally, recruitment of these physicians remain a challenge. A well built and managed hospitalist program can benefit the hospital and medical community in many ways, including recruitment and retention of valuable personnel.
  • 25. Contact information Kenneth G. Simone DO Hospitalist and Practice Solutions Email address: Phone: 207-949-2319
  • 26. References 1. SHM 2005 - 2006 Survey. 2. Physician Supply and Demand: Projections to 2020. U.S. Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions. October 2006. 3. Physician Workforce Policy Guidelines for the United States, 2000 – 2020: Sixteenth Report. U.S. Council on Graduate Medical Education. U.S. Department of Health and Human Services – HRSA. January 2005. 4. Coile, Jr., Russell C. “10 Factors Affecting the Physician Shortage of the Future - Next!” Physician Executive, Sept-Oct, 2003. 5. Full, James M. “Physician Recruitment Strategies for a Rural Hospital.”,,, 6. Westfall, Carol. “Strong Physician Recruitment and Retention”, Physicians News Digest, January 2004. 7. 2006 Retention Survey from the American Medical Group Association (AMGA) and Cejka Search. 8. Third Annual AAMC Physician Workforce Research Conference, May, 2007.<http:AAMC Physician Workforce Research Conference.htm. 9. Cohen, Jordan J. “Physician Workforce Trends and Expectation.” Association Of American Medical Colleges. December 21, 2006.
  • 27. References 10. Strategies for Recruiting and Retaining Top Hospitalists. Hospitalist Management Advisor. May, 2007. 11. Pratt, Mary K. “On the wards: Hospitalists Steadily Bolster Their Ranks”, Boston Business Journal - March 24, 2006. 12. Lurie, J.D., Miller, D.P., Lindenauer, P.K., Wachter, R.M., Sox, H.C. “The Potential Size of the Hospitalist Workforce in the United States”, The American Journal of Medicine® 106 (4) (1999) pp. 441-445. 13. Holton, Lisa. “Put More Than Money on the Table When Recruiting Hospitalists”, ACP Hospitalist. February, 2007. 14. 2007 Physician and Recruiting Initiatives Survey by Merritt, Hawkins and Associates. 15. Dichter, Jeffrey R., Simone, Kenneth G., Tools and Strategies for an Effective Hospitalist Program (HCPro: MA., 2006). 16. Cooper, Richard A., Stoflet, Sandra J., Wartman, Steven A. “Perceptions of Medical School Deans and State Medical Society Executives About Physician Supply”, JAMA. 2003;290:2992-2995. 17. Cooper, Richard A., Getzen, Thomas E., McKee, Heather J., Laud, Prakash. “Economic And Demographic Trends Signal An Impending Physician Shortage”, Health Affairs. Vol. 21, Number 1. Project Hope, 2002. 140 – 154.
  • 28. Bonus Slide Recruitment and retention are affected by many variables including:  Geography  Economics  Workforce supply  Population demographics  Creation of a solid recruitment and retention plan  Generational expectations  Practice and workplace culture  Presence of a hospitalist program  Communication  Collegial support  Medico-legal landscape  Community fit, family integration and satisfaction  Potential for professional growth  Practice flexibility and call  Life style requirements
  • 29. Bonus Slide Physician supply and demand are affected by many variables including:  Number of medical school graduates  Number of residency programs and seats  Number of international medical graduates  Government policy  Health of the U.S. economy  Insurance  Specialty choice  Physician productivity  Work schedules  Number of FTE’s  New medical technologies  Aging physician population/retirement patterns  Growing and aging patient population  Utilization of mid-level providers
  • 30. Physician Recruitment and Retention in New Hampshire