Post on 18-Jan-2016
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KENO-TIME!
THE CHALLENGES OF
RURAL PROVIDER
RECRUITMENTINCREASING YOUR ODDS FOR SUCCESS
Joe Butler Don O’Bryan Butler11@southeasternhealth.org
obryandr@msha.com
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AGENDA
The Challenges
Prepare for Rural Recruitment
Overcome the Challenges
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THE KENO FORMULA The probability that k of the n numbers (balls) chosen
by the player, i.e., occur in the twenty numbers (balls) chosen by the computer can straightforwardly be derived:
The number of possible outcomes equals the number of combinations of eighty balls taken twenty at a time.
The number of ways in which k of the n balls selected by the player occur in the twenty balls selected (putatively at random) by the central Keno computer is equal to the number of ways in which k balls can be chosen from a set of n balls.
The number of ways in which the remainder of the balls do not occur in the twenty balls selected is given by the number of ways in which 20-k balls can be chosen from a set of 80-n balls.
Combining the foregoing, one finds that:
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THE KENO FORMULA
Chances of hitting 20 numbers on a card are
1 in 3,535,316,142,212,173,800 *http://en.wikipedia.org/wiki/Keno
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QUESTION?
Are your chances at successful rural
physician recruitment any better than playing Keno?
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IMPORTANT DATA Mal-distribution - Nearly 25 percent of Americans
live in rural areas, but only about 10 percent of physicians practice in rural areas (according to the National Rural Health Association)
Silver Tsunami - Nationwide, 30 percent of family physicians are 55 or older. That’s up from 15 percent in 2000 (according to the American Academy of Family Physicians)
Shortage of Quality Candidates - According to a MH study, 4% of candidates want to live in a town with a population of 10k or less.
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PHYSICIAN SUPPLY
Year Supply Demand Shortage 2008 699,100 706,500 7,500 2010 709,700 723,400 13,700 2015 735,600 798,500 62,900 2020 759,800 851,300 91,500 2025 785,400 916,000 130,600
* AAMC – The Impact of Health Care Reform on the Future Supply and Demand for Physicians Updated Projections Through 2025 (June 2010)
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The data alone can create
a sense of desperation.
I’m toast.
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THE RURAL HOSPITAL ~~~~~~~~~~~~~~~~
~~PROFILES
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JCCH PROFILE
Hospital: Johnson County Community Hospital
Location: Mountain City, Tennessee
Beds: 2 inpatient beds, Critical Access facility
Designation: Health Professional Shortage Area (HPSA)
Population: 2,383
Nearest competition: Nearest hospital is in NC about 40 minutes
Description: *Extreme rural area near the W. NC border *Mostly primary care services *Emergency room and helicopter service*No surgical services, limited specialty services*Economically challenging, many employers have closed or
moved. *Nearest town >50k – 45 miles.
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NCH PROFILE
Hospital: Norton Community Hospital
Location: Norton, Virginia
Beds: 129 licensed inpatient beds
Designation: None
Population: 4,054
Nearest competition: Two competing hospitals within 8 miles
Description: *Rural SW Virginia location *Coal mining area *Unions *Economically challenged – mining jobs gone *Nearest town > 50k – 45 miles.
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SRMC PROFILE
Hospital: Southeastern Regional Medical Center
Location: Lumberton, NC
Beds: 337 licensed inpatient beds
Designation: HPSA and MUA
Population: 21,924
Nearest competition: 40 miles away
Description: * Rural SE North Carolina location * “Poorest” of NC’s 100 counties* Negative crime and educational statistics* Private, not-for-profit, positive bottom line* Nearest town > 50k – 40 miles.
* Over half of the 110 physician staff employed
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KEY FACTORS FOR SUCCESSFUL RURAL PHYSICIAN RECRUITING
1. Successful group practices to recruit to
2. Attractive compensation levels, when lower cost of living is accounted for
3. Favorable call arrangements
4. A hospital that values strong hospital-physician relationships
5. Local cultural and recreational opportunities
6. A stable economy, affordable housing, or a good education system
2008 Report to the Secretary: Rural Health and Human Services Issues, published by the National Advisory Committee on Rural Health and Human Services
KEY FACTORS FOR SUCCESSFUL RURAL PHYSICIAN RECRUITING
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THE CHALLENGE – FOUR CATEGORIES
Location issues
Hospital issues
Group issues
Candidate issues
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THE CHALLENGE:
LOCATION ISSUES
Housing options Education options Cultural amenities Shopping Access to metro area Access to an airport Spouse employment Special needs children Negative perception of rural living
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THE CHALLENGE:
HOSPITAL ISSUES - NATIONAL INFLUENCES
- US Physician Shortage- Healthcare Reform (new business paradigm)- Healthcare Economy (Won’t recover in the near
future)- Reimbursement (downward trend)- The changes in the physician workforce.- Compliance issues- Competition for Foreign Medical Graduates is intense.- Rural candidates require more scrutiny. (Are they
running from something?) - The LEAN Movement (removing waste, bringing more
value)
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THE CHALLENGE: HOSPITAL ISSUES - LOCAL INFLUENCES
Financial shape of the hospital Right-sizing the rural hospital Hospital/practice acquisitions and alignment
strategies. Competition (use to be only from the nearest
hospital) Coverage issues / Locums Older/outdated facility and equipment Non-cohesive medical staff Disconnected administration Recruiter has to do it all
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THE CHALLENGE: HOSPITAL ISSUES - LOCAL INFLUENCES
Financial shape of the hospital Right-sizing the rural hospital Hospital/practice acquisitions and alignment
strategies. Competition (use to be only from the nearest
hospital) Coverage issues / Locums Older/outdated facility and equipment Non-cohesive medical staff Disconnected administration Recruiter has to do it all
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THE CHALLENGE:
GROUP/SPECIALTY ISSUES Employment is preferred in rural settings.
Trying to recruit to a one physician practice,
particularly an older provider.
Group is not skilled in recruiting and/or
uncooperative; resistant to change.
Nepotism can be an issue.
Groups often don’t understand the new
compensation landscape.
Unaligned groups providing the same services in a
small market. (saturation)
Rural groups tend to have candidate criteria that
is too strict
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THE CHALLENGE:
CANDIDATE ISSUES
Geography is still the #1 priority for candidates
Meeting the candidate’s preferences for
lifestyle and practice
Fear of clinical isolation
Call issues
Negative perception of rural practice
Understanding the business of medicine
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TURNING CHALLENGES INTO OPPORTUNITES
Joe Butler
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MAP OUT THE PROCESS – 5 AREAS
Recruitment Strategy
Visit Strategy
Contracting
Onboarding
Start-up phase
Relations/Retention Strategy
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KEY SOURCING STRATEGIES Work with nearby training programs,
med schools, and residency programs to develop a pipeline strategy
Identify docs with ties to the area Use the strengths of your opportunity
effectively Stipends in exchange for early
commitment Rural born physicians are twice as
likely to go to a rural area; screen appropriately
Use the web whenever possible
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PREPARING FOR RECRUITMENTKNOW YOUR DATA
National Stats
Rural recruitment takes longer
Community Stats
Demographics
Hospital Stats
Develop relevant hospital statistics for the specialty
Payer mix
Group Stats
Determine relevant benchmarks (number of patients per day,
average number of procedures, call, etc)
Gather data to reinforce how a new provider will be
successful
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PREPARING FOR THE VISITASSEMBLE YOUR TEAMS
Don’t assume anything – discern n learn Before an interview/visit occurs, lay the appropriate positive foundation Identify and list your potential problems or
concerns Form the PIT Crew – (Physician Integration
Team) to include Hospital CEO, CMO, Practice Administrator, Physician, Service Line Leader, etc.
Determine additional members of the Interview Team
Notify the community support team (realtors, bankers, school reps, etc.)
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PREPARING FOR THE VISITTHE RECRUITMENT TEAM - ARE YOU SINGING THE SAME SONG?
Set up an Orientation/Education session for the
particular recruitment effort
Review why you’re recruiting, timeframe, goals, ideal candidate
Review the mapping of each phase of the entire recruitment process
Develop a practice overview (area information, hospital information,
practice information) and review the information with the team to
act as the “script”
Go over the interview expectations, what can be asked, what cannot
be asked, what information you want to push to the candidate and
pull from the candidate, assign information and interview questions
Develop and review the post-interview evaluation survey to gain
appropriate feedback by each team member
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PREPARING FOR THE VISITWORKING WITH THE PRACTICE
Rural recruitment usually means you’re working with a group that doesn’t recruit often
Deal with the issue of significant family members in the practice
Share the mapping of the process Discuss your concerns
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CONTRACTINGCLOSING THE DEAL WITHOUT LOSING YOUR SHIRT
Secure written approval for the opening; C-Suite and Providers “singing the same song”?
Prepare the necessary pro forma ahead of time.
Rural locations can expect to pay higher compensation than metro.
OVERCOMING LOCATION ISSUES
Rural locations often offer a better quality of life while being assessable to amenities of urban living; 5 minutes to work….priceless!
Screen for providers who’d rather be the “big fish in a small pond”.
GET THE VISIT! How often have you had a visit and hear “Wow-this place is much better than we expected!”
Community involvement- if family is involved, slower pace of life is the dream!
Catch Providers on Rebound; “Half-Backs”!
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QUESTIONS
THE O’BRYANDIFFICULTY RATINGFOR PHYSICIAN OPENINGS
Question Score1. Is the opening in a town of less than 20,000?
If Yes, add 5, if No, add 3 _______________2. Is the opening in a town of less than 10,000?
If Yes, add 5, if No, add 0 _______________3. Will this position be the only specialty in the town?
If Yes, add 5, if No, add 0 _______________4. Will this specialty be second physician in the group?
If Yes, add 3, if No, add 0 _______________
5.Does the practice have a significant family member of a physician in the Practice's administration?
If Yes, add 5, if No add 0 _______________6. Do you have adequate referral relationships?
If Yes, add 0, if no add 3 _______________7. Do you have significant competition in the area?
If Yes, add 5, if No, add 0 _______________8. Is there a documented community need for the specialty?
If Yes, add 0, if No, add 5 _______________
Add Your Total Score:
(See key below)
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KEY
0 - 15: What are you whining about?
16 - 25: You can still do this.
26+: Call somebody right away.
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