attracting, engaging, and retaining the next generation of ...€¦ · attracting, engaging, and...
TRANSCRIPT
Attracting, Engaging, and Retaining the Next
Generation of Providers
Mid-Atlantic Physician Recruiter Alliance Conference 2019
October 23, 2019
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
Introduction and Learning
Objectives
2
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
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
Generational Demographics
5
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.
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
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.
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
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.
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
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
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.
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
Changes in Medical Education
15
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
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
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
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
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.
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
Changes in Care Delivery
22
» 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
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
Changes in Care DeliveryAmbulatory Office Visit
» 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
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.
Provider Recruitment
27
» 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
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.
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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.
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.
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
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
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.
Key Takeaways
35
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
& DiscussionQuestions
37
Meet Our Presenter
Associate Principal
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
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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.
39
We are the nation’s leading
healthcare advisory firm,
meeting the consulting needs
of providers and payors since
1973.
40