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Attracting, Engaging, and Retaining the Next Generation of Providers Mid-Atlantic Physician Recruiter Alliance Conference 2019 October 23, 2019

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Page 1: Attracting, Engaging, and Retaining the Next Generation of ...€¦ · Attracting, Engaging, and Retaining the Next Generation of Providers Mid-Atlantic Physician Recruiter Alliance

Attracting, Engaging, and Retaining the Next

Generation of Providers

Mid-Atlantic Physician Recruiter Alliance Conference 2019

October 23, 2019

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Agenda

I. Introduction and Learning Objectives

II. Generational Demographics

III. Changes in Medical Education

IV. Changes in Care Delivery

V. Provider Recruitment

VI. Key Takeaways

VII. Questions and Discussion

1

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Introduction and Learning

Objectives

2

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Introduction and Learning Objectives

The provider workforce is more diverse than ever—and not just on television.

Then . . . and now.

St. Elsewhere ER Grey’s Anatomy

Marcus Welby, M.D.Scrubs

3

Trapper John

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Introduction and Learning Objectives (continued)

» Explore key characteristics driving the multiple

generations in the medical workforce.

» Examine changes in market drivers that will drive the

preferences and behaviors of future providers.

» Discover tactics that graduate medical education

programs are using to engage the future pool of

providers now.

» Consider strategies for preparing your organization

to attract and retain the next generation of providers.

» Develop competencies in managing a diverse

workforce that will improve relationships with internal

and external stakeholders.

In this session, we will:

The entry of

Generation X into

the physician market

in the late 1990s

corresponded with

explosive growth in

the provider

recruitment market.

Over time, recruiters

have adapted their

methods and sought

to recruit and retain

millennials.

With the first wave

of Generation Z now

in their second year

of medical school, it

could soon be time

to adapt again.

4

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Generational Demographics

5

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Generation Z Born 1997 to 20121

Ages 7 to 22

Baby BoomersBorn 1946 to 1964

Ages 55 to 73

MillennialsBorn 1981 to 1996

Ages 23 to 38

Generational Demographics

Source: Pew Research Center (2019).1 A chronological endpoint for this generation may not be finalized for several years.

6

Generation XBorn 1965 to 1980

Ages 39 to 54

Our discussion will focus on Generation X and Millennials, with a preview of

Generation Z trends.

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Generational Demographics (continued)

» The “forgotten middle child”

due to baby boomers and

millennials grabbing

headlines

» Pessimistic about retirement

opportunities

» Likely to job hop

Generation X

» Sometimes called the

everybody-gets-a-trophy

generation

» Heavy technology users

» More economically sensitive

than other generations

» Diversity amplified

Millennials» Projected to be the most

diverse generation yet

» More likely to pursue higher

education—and less likely to

enter the labor force early

» Higher median income

expectations

Generation Z

Source: Pew Research Center (2018).

7

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Generational Demographics (continued)

Demographics are shifting, including a rapidly growing Hispanic population.

82%

70%

61%

52%

4%

12%

18%

25%

13%

15%

15%

14%

4%

6% 4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Baby Boomers (in 1968)

Generation X (in 1986)

Millennials (in 2002)

Postmillennials (in 2018)

Percentage of People 7-22 Who Are . . .

White Hispanic Black Asian Other

Source: Pew Research Center (2018).

8

Note: The Census Bureau did not separately identify Asians until 1988.

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Generational Demographics (continued)

Members of Generation Z are less likely than millennials to be foreign born but

more likely to have a foreign-born parent.

77%71%

32% 36%

15%22%

43%

52%

8% 7%

24%

12%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

All (2002) All (2018) Hispanic (2002) Hispanic (2018)

Percentage of People 6–21 Who Are . . .

US Born of

US Parents

Foreign Born

US Born of

Immigrant

Parents

Source: Pew Research Center (2018).

9

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Generational Demographics (continued)

Educational attainment trends are trending upward across all ethnicities.

44%48%

28%34%

53%59%

34%

47%

74%

59% 61%55% 54%

78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

All White Hispanic Black Asian

Percentage of People 18–20 Enrolled in College

Generation X (in 1986) Millennials (in 2002) Postmillennials (in 2018)

Source: Pew Research Center (2018).

10

Note: The Census Bureau did not separately identify Asians until 1988.

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Generational Demographics (continued)

Educational attainment trends are shifting by gender as well.

44% 45% 43%

53%49%

57%59%55%

64%

0%

10%

20%

30%

40%

50%

60%

70%

All Men Women

Percentage of People 18–20 Enrolled in College

Generation X (in 1986) Millennials (in 2002) Postmillennials (in 2018)

Source: Pew Research Center (2018).

11

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Generational Demographics (continued)

Generation Z is less likely to enter the labor force early than their older cohorts.

58%

19%

72%

30%

78%

41%

80%

48%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

18- to 20-year-olds

15- to 17-year-olds

Percentage of Civilians Who Were EmployedDuring the Prior Year

Baby Boomers Generation X Millennials Generation Z

Source: Pew Research Center (2018).

12

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Generational Demographics (continued)

13

Source: Pew Research Center (2018) and Claritas (2018).

Members of Generation Z are projected to be less likely to work full time once

in the workforce than millennials and Generation X.

Only 13% of Generation Z (ages 6 to 21) live in rural areas, compared to 18%

of millennials and 23% of Generation X at that same age cohort.

Generation Z members are more likely than their predecessors to have grown

up in single-parent households

By 2024, the 10 largest US counties will have majority multicultural populations,

including Los Angeles (75.5%), Miami (89.3%), and Dallas (76.4%).

These majority-minority populations will ring the southern and eastern borders

of the US, stretching from California to Florida and from Florida to New York.

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Generational DemographicsNational Physician Workforce Distribution

Source: Infogroup (2016).

Summary Specialty Millennials Generation X

Baby Boomers

(and older)

Primary Care 11% 50% 39%

Capacity-/Hospital-Based 11% 54% 35%

Medical Subspecialty 7% 48% 45%

Surgical Subspecialty 8% 49% 43%

Pediatric Subspecialty 11% 53% 36%

Women’s Health 10% 49% 41%

Mental/Behavioral Health 7% 40% 54%

Other 5% 46% 48%

Total Workforce 9% 49% 41%

Though millennials are still in medical school or completing medical education,

they will be expected to fill a large void when baby boomers and their older

counterparts retire.

The first wave of Generation Z entered medical

school in 2018. 14

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Changes in Medical Education

15

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Changes in Medical Education

47.8%

7.8%6.1%

19.3% 19.0%

51.2%

6.4% 6.3%

19.6%16.5%

58.8%

5.7% 4.6%

19.8%

11.1%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

White Black Hispanic Asian Other

US Medical School Applicants, Enrollees,and Graduates by Ethnicity, 2015

Applicants Enrollees Graduates

While medical school graduates are still likely to be white, a majority of

applications come from nonwhite aspirants.

Source: AAMC (2016).

16

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Changes in Medical Education (continued)

51.2%

6.4% 6.3%

19.6%16.5%

63.0%

3.0% 3.0%

14.6%16.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

White Black Hispanic Asian Other

US Medical School Enrollees and Faculty by Ethnicity, 2015

Enrollees Faculty

Source: AAMC (2016).

Medical school enrollees may not see their own ethnicities echoed in faculty

demographics.

17

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Changes in Medical Education (continued)

61.0%

57.9%

45.5%

63.6%

39.0%

42.1%

54.4%

36.4%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Asian

Hispanic

Black

White

US Medical School Faculty by Sex and Ethnicity, 2015

Male Female

Among most ethnicities, medical school faculty members are likely to be male.

Source: AAMC (2016).

18

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Changes in Medical Education (continued)

22.7%

33.0%

50.3%

20.5%21.7%

34.8%

56.6%

21.8%22.5%

39.2%

51.5%

22.5%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Asian Hispanic Black White

US Medical School Entrants Planning to Practice in an Underserved Area, 2015

2005 2010 2015

Black medical school entrants are more likely to plan to practice in underserved

areas than their nonblack counterparts.

Source: AAMC (2016).

19

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Changes in Medical Education (continued)

Medical schools are reevaluating their curriculum inventory to increase the

relevance of medical education to practice norms, including:

Source: AAMC (2018).

20

Use of self-directed learning.

Increasing patient care experiences earlier in the educational

process.

Requiring translational

research projects.

Instituting better

feedback procedures

to guide student

learning.

Enhanced use of

simulation labs.

Providing a smoother transition path from medical

education to residency.

Improving inter-

professional education.

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Changes in Medical Education (continued)

Primary care reported the lowest match numbers among US allopathic physicians:

» Family medicine: 93.2% total fill rate, down from 96.7% in 2018.

» Internal medicine: 97.2% total fill rate, down from 97.6% in 2018.

» Pediatrics: 97.6% total fill rate, down from 97.9% in 2018.

Several specialties reported a 100% fill rate including interventional radiology, otolaryngology,

physical medicine and rehabilitation, integrated plastic surgery, surgery (categorical) and thoracic

surgery

The number of non–US citizen international medical graduates (IMGs) participating in the Match

declined for the third consecutive year:

» 6,869 IMGs submitted program choices.

› This was down 501 from 2016.

» 58.6% matched to PGY-1 positions, however; the highest match rate since 1990.

Specialties that filled with less than 45% US trained allopathic seniors include internal medicine

(41.5%), pediatrics (40%), family medicine (39%), pathology (33.4%), and surgery-preliminary (23.9%).

The number of couples submitting program choices declined by 7.6% to 1,076.

Source: National Resident Matching Program (2019).

The 2019 Main Residency Match was the largest on record, with 38,376 applicants

submitting for 35,185 positions.

21

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Changes in Care Delivery

22

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» Industry drivers:

› Physician shortages

› Increased access to care

› Focus on value-based

care

› Cost reduction

» APP trends:

› Growing supply of APPs

› Rapidly expanding types

of positions/roles for APPs

› APP compensation

shifting to value-based

models

› Greater incentive

alignment with physicians

» APP refers to a nonphysician

clinician who furnishes some

healthcare-related services.

» These services are provided

with varying degrees of

independence and with

different levels of authority.

» APPs generally include the

following:

› Physician assistants

› CNPs/nurse practitioners

› APRNs

› CRNAs

› CNMs

› CNSs

In response to the aging population and expanded insurance coverage, health

systems are looking to advanced practice providers (APPs) to mitigate the shortage

of physicians and expand their organizations’ capacity for care.

» Given the increased prevalence

of APPs, many organizations

are defining APP roles across

various care settings.

› Physician Extender

› Independent Provider

› Hybrid

» The APP scope of practice,

level of independence, and

authority vary greatly by APP

type and by state.

APP RolesAPP PrevalenceAPP Definition

Changes in Care DeliveryAdvanced Practice Providers

23

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Depending on the care setting, specialty, and organization’s needs, APPs are used

along a continuum of roles from pure physician extenders to independent providers.

» Surgical assistance and

minor surgeries

» Inpatient rounding

» Call coverage

» Medication management

» Consults

» Medical histories

» Physical exams

» Preoperative workups

» Patient triage

» Family planning

» Patient education

» Disease management

Physician Extender Hybrid

Spectrum of APP Roles

» Primary care panel

responsibilities

» Patient evaluations

» Patient diagnoses

» Exercise of prescriptive

authority

» Care plan development

Independent Provider

Top of

License

Below

License

Where APPs fall in the continuum is not always

clear; however, this placement affects the work

provided and thus how APPs are factored into

a provider workforce model.

Changes in Care DeliveryAdvanced Practice Providers (continued)

24

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Changes in Care DeliveryAmbulatory Office Visit

» Email

» Texts

» Patient-generated

data

» Cloud storage

Communication barriers are being removed, facilitating access to information to

make better decisions, analyze results, and manage the patient’s activities outside

of the visit.

Previsit Visit Postvisit

» The patient’s

information is

automatically sent to

the provider.

» The patient

verifies/updates

information before

the visit.

» The provider reviews

the patient’s

comprehensive

medical record.

» The provider identifies specific points to focus on

during the evaluation.

» The patient elaborates on their current state.

» The provider reviews most-recent test results and

may electronically order additional tests.

» The provider uses population health analytics to

develop a custom treatment plan based on best

practices.

» The provider sends instructions to the patient’s

apps, medical devices, and care team members.

» The patient uses apps or medical

devices to manage treatment/

progress.

» Information is sent directly to

providers; if there are concerns, the

care team will contact the patient.

» Data sent to providers is aggregated

and used to refine best practice

recommendations.

» EHR

» Smartphone

» Patient portal

» HIE

» Visit triage

» Integrated orders/results

» Online registries

» Wellness apps

» Telemedicine

» Electronic prescriptions

» Clinical decision

support alerts

(EHR)

» Population health tools

25

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Changes in Care DeliveryEmphasis on Access

26

Implication: Customer preferences for low-touch care are evolving, but traditional providers are at risk of losing

profitable low-acuity cases.

Patients are demanding more-convenient access to healthcare services that mirrors

the 24/7 expectations of other consumer services. Traditional providers are at risk of

losing profitable low-acuity cases.

Call Centers: These centers offer around-the-clock access to nurse advice,

triaging of clinical conditions, and appointment scheduling.

Retail Medicine: Urgent care and drugstore-based miniclinics are the sites

of choice for many patients who appreciateconvenience.

What’s Next: This area is evolving rapidly.

Video Visits and E-Visits: These visits are on the rise as

preferred service modalities for technology-friendly patients.

Reimbursement is becoming less of a barrier.

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Provider Recruitment

27

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» They are less likely than their older counterparts to know about an organization prior to initial contact.

» They are more likely to follow an organization on social media while learning about the opportunity.

» They want to understand the culture and values of an organization early on in the recruitment process.

» They desire communication that is:

› Proactive.

› Informative.

› Frequent.

Provider Recruitment

Millennial and Generation Z recruits often have a disconnect with

organizations’ messaging regarding opportunities:

Examining what other industries have already learned about millennials and

Generation Z can provide clues to how these generations will behave in the provider

workforce.

Source: LinkedIn, 2016.

28

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Provider Recruitment (continued)

» Allow candidates to choose their preferred

method of communication. Text messaging

may be a top choice for younger applicants.

» Consider where prospects may be receiving

content, and adjust advertisement

placements accordingly. Mobile-optimized

digital content (online journals, job boards,

and email alerts) is a fast-growing segment

for candidate communication.

» Adopt a messaging style that is not too

standardized (or impersonal). Authenticity is

key.

» Instruct others participating in the hiring

process in preferred communication norms.

Update your communication style.

29

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Provider Recruitment (continued)

Polish your social media presence.

30

» Social media is a major platform to project

your organization’s mission and values.

» Focus on the local community and how your

organization serves in both workplace and

volunteer capacities.

» Showcase employees with an eye on

diversity and the qualities you wish to see

recruits exhibit.

» Partner with your employees, community,

and university partners to share your posts

and help spread awareness.

» Be authentic. Don’t rely on press releases,

stock photos, or overly engineered scenarios

to provide your content.

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Provider Recruitment (continued)

31

Find ways to highlight your mission, values, and culture throughout the

recruitment process.

» Make sure these are front and center in

all communications and your social media

presence.

» Find ways for candidates to identify a

direct connection to your mission, values,

and culture by including them in

communications (written and verbal).

» As connections are established, introduce

people into the recruitment process who

exemplify those characteristics or can

further articulate them.

» Consider opportunities during the process

of candidate communications and visits to

connect the candidate with peer groups,

formally or informally.

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Provider Recruitment (continued)

» Make introductions to others with whom

the candidate may find common ground

or intersectionality.

» Millennials and Generation Z like to

think of colleagues as an extension of

their personal network (friends, family)

and are more likely to put down roots

where they can forge those

relationships.

» Leave time in candidate visits for

interpersonal interactions. Often the

person who “closes the deal” may not

be directly involved in the hiring loop

(e.g., a medical school classmate, a

peer, or another personal connection).

Build personal connections throughout the recruitment process.

32

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Provider Recruitment (continued)

Be prepared to share a vision with the

candidate, including:

» How the recruitment process will progress

(with reasonable timelines for each step).

» What the onboarding process will look

like.

» Whether mentorship opportunities are

available and how those will work.

» How long it may take to ramp up in

practice, including compensation pro

formas.

» When performance will be reported and

measured.

» What possibilities exist for future growth

and leadership development.

Provide a clear roadmap to the future.

33

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Provider Recruitment (continued)

Understand what you can offer to new providers. Honesty in the

presentation of a practice opportunity goes a long way toward building trust

and avoiding future surprises.

Consider the total package.

34

Evaluate relocation support and how to

best assimilate providers at various

ages and life stages.

Consider work expectations (work

hours and workload), coverage norms, and time-off

policies.

Articulate how APPs are used in the

practice.

Understand the compensation

model, including use of value-based metrics, and explain

it fully to desired hires prior to

contract signing.

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Key Takeaways

35

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Key Takeaways

» Generational diversity issues are not unique to the workforce. Sociologists

and demographers study generational cohorts for patterns ranging from workforce

behaviors and educational attainment to lifestyle preferences, social trends, and

spending patterns.

» Cultural shifts in the US population will have a tangible impact on provider

demographics in the coming years. Medical school enrollment is likely to

continue to evolve based on changing demographics.

» Emerging trends in medical education will continue to alter provider

expectations and practice styles. As training programs move to more hands-on

learning and less classroom time, providers may develop practice style

preferences before ever considering recruitment opportunities.

» Changing demographics will force organizations to rethink how they

engage, recruit, and retain providers. The provider of tomorrow is not likely to

look like your workforce today. Is your recruitment case attuned to this?

» Successful recruiting requires monitoring and responding to demographic

shifts. Research on generations is ever evolving, so staying tuned in to trends and

translating them into the recruitment environment is critical.

36

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& DiscussionQuestions

37

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Meet Our Presenter

Associate Principal

[email protected]

469-729-2600

Jennifer is a dynamic healthcare strategist with a wide-ranging

knowledge of physician workforce planning, medical staff

development, and provider practice trends. ECG clients value

her guidance on health system market planning and physician

staffing issues, and they appreciate the insightful, pragmatic

approach she brings to all of her engagements. Prior to joining

ECG, Jennifer helped found AmeriMed Consulting and served

as the firm’s managing principal for 15 years. With AmeriMed,

she brought extensive expertise and hands-on management to

an array of projects for more than 300 health systems,

hospitals, and physician organizations, helping them define

goals and craft implementable solutions to challenges in

physician recruitment, market development, strategic planning,

managed care, and physician clinical operations. Jennifer works

closely with leaders to position their organizations for success in

an evolving healthcare landscape.

Jennifer Moody

38

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ECG Management Consultants

Specific Areas of Expertise

» Strategy and planning

» Physician-hospital relationships

» Organizational design and development

» Operations and performance improvement

» Academic medical center services

For 45 years, we have served

as trusted advisers to some

of the nation’s leading

healthcare providers.

» Children’s hospitals

» Information technology

» Managed care contracting

» Custom surveys and proprietary research

ECG offers a broad range of strategic, financial, operational, and

technology-related consulting services to healthcare providers. As

a leader in the industry, ECG provides specialized expertise to

community hospitals, academic medical centers, health systems,

and medical groups.

About ECGWe focus on developing and implementing innovative and

customized solutions to meet our healthcare clients’

specific challenges, no matter how complex.

Named Top Overall

Healthcare Management

Consulting Firm in 2018

ECG’s strength is built on approximately 240

healthcare professionals practicing in offices

located in Atlanta, Boston, Chicago, Dallas,

Minneapolis, San Diego, San Francisco,

Seattle, St. Louis, and Washington, DC.

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We are the nation’s leading

healthcare advisory firm,

meeting the consulting needs

of providers and payors since

1973.

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