4 steps to keeping physicians in a time of shortage
Aging populations. Recently insured individuals (the uninsured rate dropped to 9%). The onslaught of new and complex patients adds up to a lack of trained physicians taking on caseloads. A study by IHS conducted for the Association of American Medical Colleges predicted by 2025, the U.S. will be short 46,000-90,000 physicians. And because it takes between 5 to 10 years to train a physician, some experts are worried there are not enough people being trained to make up for the estimated shortage.
AAMC Chief Health Care Officer Dr. Janis Orlowski told Healthcare Dive the US is already in the midst of a physician shortage, with problem areas in the primary care and psychiatry fields. However, she said the shortage isn’t as severe as it was five years ago, because nurse practitioners and physician assistants are being called upon to help physicians with their workloads.
But that doesn’t mean the problem has gone away. Recent grads and new physicians are pushing for a better work/life balance while retaining a reasonable amount of job security. And with the shortage, hiring and retention are key. Healthcare Dive and our sister publication HR Dive tracked down experts to discern what hospitals and healthcare providers can do to abate some physician hiring and retention issues. Below are some best practices:
Be honest about the organization’s operations
As fee-for-service is turned over to value-based care, some hospitals are in a state of unrest. Because of this, there’s bound to be some confusion operationally.
Dr. Jonathan Niloff, vice president and CMO for McKesson Connected Care & Analytics told Healthcare Dive it’s imperative to be honest and upfront with physicians during the hiring courtship about where the organization truly stands in terms of its restructuring development.
“Physicians are concerned what their daily life will be in the practice,” Niloff stated. If technology is being implemented, make sure the organization has actually aligned workflow to make the physician’s job easier, he said. For example, in an EHR, does the workflow follow logical steps or does a physician has to exit the program to continue work?
“Physicians are starting to look at [those sorts of details],” Niloff stated. “They want to know they are going into a work situation where there is a clear direction.”
When hiring, don’t discount the 'significant other'
“You can’t underestimate the power of the significant other,” Dr. John Ward, president and CMO of VCU Medical Center/MCV Physicians, told Healthcare Dive. Even if a practice really wants to hire a physician, if the significant other isn’t sold, the practice is not going to get the hire it wants, Ward stated. This can especially be the case when hiring for a physician in a rural setting.
Root out toxicity and unhappiness
Many problems that just about any employee has with the workplace (physicians included) can be linked to structural problems – indirect communication, reporting to multiple people, ineffective decision-making processes and not including employees during those decisions, said Dr. Paul White, author of the Toxic Workplace Prevention and Repair Kit.
“Hospitals are a really tough place to work,” he added. “One of the top five most toxic.”
White suggests that one of the top actions healthcare providers can do to improve a workplace environment is to simplify the reporting structure. Essentially, a doctor shouldn’t have four or more people to which they are totally accountable. This move may require paring down of bureaucracy present within an organization.
“Increasingly, physician job satisfaction is a major concern for all healthcare organizations that employ doctors,” said Tim Hoff, professor of management, healthcare systems, and health policy at the D’Amore McKim School of Business. “Existing evidence shows that physicians are unhappy with the amount of administrative demands, paperwork requirements, and quality-related oversight in their everyday work.”
Find out what encourages physicians
Doctors are educated in an environment that focuses on memorization and technique, said Dr. David Solot, senior vice president of client services at Caliper, a talent management company. But that often comes without any training in managing a team, leadership styles or developing employees.
So when physicians are promoted to leadership positions and in turn must take on more administrative work, job satisfaction plummets.
“The doctor who loved what she does but now has to go to meetings once a week slowly starts to feel like this isn’t what she got into medicine for,” Solot explained.
Orlowski stated physicians enjoy working in an inter-professional community. For example, if a physician sees a patient with diabetes who can’t afford medication or healthy foods, the physician can work with a social worker or dietician. “Physicians feel they work best with peer settings,” she said. Niloff echoes this sentiment, saying it is important that physicians want to find their work professionally rewarding.
For many physicians, control is an important aspect of their job satisfaction, including control over their environment and schedule. And many physicians feel they are losing that coveted control.
“Successful physician retention now and in the future will depend on having a deep appreciation for what a specific group of doctors prefer and need in terms of job- and career-related benefits, and then structuring those benefits to deliver value as defined by the individual physician,” Hoff added.
Caliper noted through their research, about 20% of physicians studied are amenable to making the shift to a more administrative, leadership role. But another 20% have absolutely no desire to make the shift at all, and would rather be left taking care of patients. Solot recommends finding other ways to bestow prestige upon talented doctors who would prefer to remain in practicing roles. Speaking arrangements, teaching fellowships and conferences are all potential ways to recognize skilled physicians without removing them from their roles.
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