Life Lessons: Building an Efficient Medical Staff Engine Serving 12 Diverse Hospitals
AMGA 2013 Annual Conference March 16, 2013
11:00 am – 12:15 pm
State of Recruitment
David Knocke, FACHE
President
BJC Medical Group
2
Lori Schutte, MBA
President
Cejka Search
Introduction
State of Recruitment
3
Survey Highlights
Key Findings and Strategic Recommendations
Strategies in Action: BJC Medical Group Case Study
Close
Discussion
Take Home Messages and Tools
Road Map for the Discussion
State of Recruitment 2012 Retention Survey Highlights
Responding Groups are Getting Bigger
5
2005 2012 +/-
Number of reporting groups 95 80 -16%
Total number of physicians employed 13,893 19,596 +41%
Average group size 146 245 +60%
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment 2012 Retention Survey Highlights
63%
37%
2012
Female Physicians Drive Growth
6
2005 2012 % Increase
Total number of physicians employed 13,893 19,596 +41%
Male physicians 10,003 12,359 +24%
Female physicians 3,890 7,237 +86%
Source: 2012 Cejka Search and AMGA Physician Retention Survey
72%
28%
2005
Male
Female
State of Recruitment 2012 Retention Survey Highlights
2012 Average Turnover
7
5.4%
10.4%
6.8% 6.8%
11.5%
Primary Care Physicians
Hospitalists
Specialists
Combined Physicians
Advanced Practitioners
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment 2012 Retention Survey Highlights
Physician Turnover Rate Over Time
8
Source: 2012 Cejka Search and AMGA Physician Retention Survey
6.4% 6.7%
6.1% 5.9% 6.1%
6.5% 6.8%
5.0%
6.4%
5.5%
4.0%
5.8% 5.5%
6.2%
2005 2006 2008 2009 2010 2011 2012
Average
Median
State of Recruitment 2012 Retention Survey Highlights
Turnover Tied to Recovery
Source: MarketWatch, December 2012; National Association of Realtors, December 2012
10.9
12.3
13.3
8.5
10.5 11.6
12.2 13.2 6.2
5.7
4.9 4.4
4.6
4.3 4.3
4.7
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
1.0
3.0
5.0
7.0
9.0
11.0
13.0
15.0
2005 2006 2007 2008 2009 2010 2011 2012
Dow Jones Industrial Average (in Thousands)
Number of Existing, One-Family Home Sold (in Millions)
State of Recruitment 2012 Retention Survey Highlights
Early Years are [Still] Critical
10
Source: 2012 Cejka Search and AMGA Physician Retention Survey
5.4%
14.0%
11.0%
8.2%
5.0% 4.1%
6.2%
11.0%
12.4%
8.7%
5.7%
4.6%
< 1 1 to 2 2 to 3 3 to 5 5 to 10 10 +
2011
2012
Turnover Rate by Years of Service
State of Recruitment Key Findings & Recommendations
Competition to hire and keep top performers will intensify
State of Recruitment Key Findings & Recommendations
Under 40(27.3%)
41 to 59(48.6%)
Over 60(24.1%)
52.7% 65.8%
82.9%
47.3% 34.2%
17.1%
Female
Male
Physician Demographics Today
Source: American Medical Association Masterfile, October 19, 2012
13
State of Recruitment Key Findings & Recommendations
Retirement Will Accelerate
Compared with the prior year, do you expect the percentage of your physician workforce who retire in the upcoming 12 months to:
2010 2011 2012
Increase significantly 0% 3% 3%
Increase slightly 27% 27% 34%
Stay the same 65% 62% 55%
Decrease slightly 5% 5% 7%
Decrease significantly 3% 3% 1%
Source: 2012 Cejka Search and AMGA Physician Retention Survey
14
State of Recruitment Key Findings & Recommendations
Retirement Will Accelerate
Total Males Females
Turnover Rate: 6.8% 6.9% 6.7%
66% 17%
15%
2%
Males
Voluntary separation
Retirement
Termination
Death
84%
5%
11%
Females
15
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Demand is Growing: Physicians
Compared with the prior year, please indicate your plans as it relates to staffing in the next 12 months:
Primary Care Specialists Hospitalists
2010 2011 2012 2010 2011 2012 2012
Hire significantly more 9% 9% 22% 9% 1% 6% 8%
Hire more 74% 65% 55% 74% 73% 64% 46%
Maintain the same 17% 26% 23% 17% 22% 30% 46%
Reduce 0% 0% 0% 0% 4% 0% 0%
16
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Demand is Growing: Advanced Practitioners
Compared with the prior year, please indicate your plans as it relates to staffing in the next 12 months:
Physician Assistants Nurse Practitioners
2011 2012 2011 2012
Hire significantly more 6% 5% 6% 7%
Hire more 42% 58% 43% 63%
Maintain the same 52% 37% 49% 30%
Reduce 0% 0% 2% 0%
17
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Evolution of Care Teams
18
Source: 2009, 2010, 2011 and 2012 Cejka Search and AMGA Physician Retention Surveys
2009
• Groups describe Hospitalist Programs as “key to retention” of early, mid and late-career physicians
2010
• Two-thirds of groups say that implementing a Medical Home will increase their competitive edge in recruiting Primary Care physicians
2011
• Three-quarters of groups say that Advanced Practitioners will be more involved in their practice in the next five years
2012
• Three-quarters of groups offer an out-patient only model to Primary Care physicians
State of Recruitment Key Findings & Recommendations
Total Primary Care Hospitalists Specialists Advanced
Practitioner
Turnover Rate: 6.8% 5.4% 10.4% 6.8% 11.5%
Distribution of Turnover within Group:
Voluntary Separation 74% 74% 94% 72% 84%
Retirement 12% 12% 1% 14% 2%
Termination 12% 12% 4% 13% 14%
Death 2% 2% 1% 1% 0%
….But Hospitalist and Advanced Practitioner Turnover is High
19
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
…and Physicians / Advanced Practitioner Recruitment is Fragmented
Responsible for Recruiting: Department Chair
or Director Physician
Recruitment Office Administration or Human Resources
Physicians 16% 66% 18%
Advanced Practitioners 8% 46% 46%
Yes 73%
No 27%
20
Should responsibility for recruiting Advanced Practitioners be centralized with physician
recruiting?
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Competition to Hire and Keep Top Performers will Intensify
21
Recommendations:
Project and plan for retirement, turnover and growth
Benchmark your recruitment metrics and measure your costs
Build your care team with a cohesive recruitment and retention strategy
State of Recruitment Key Findings & Recommendations
22
Culture is the top controllable cause of turnover
State of Recruitment Key Findings & Recommendations
Culture is the Top Controllable Factor Driving Turnover
Reasons for voluntary separation (1 = most common) Mean Rating
1 Relocation for family reasons 3.56
2 Family responsibilities 4.41
3 Lack of cultural fit 4.84
4 More flexible work hours 4.98
5 Seeking greater compensation 5.10
6 Better call schedule 6.15
7 Practice ownership structure does not meet needs 6.18
8 Limited professional opportunity 6.23
9 Leaving the practice of medicine 6.28
10 Unappealing community for self/family 7.28
23
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
State of Recruitment Key Findings & Recommendations
Impact of Lack of Cultural Fit on Turnover
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
0% 10% 20% 30% 40% 50%
0 - 10%
11 - 20%
21 - 30%
31 - 40%
41 - 50%
51 - 60%
61 - 70%
71 - 80%
81 - 90%
91 - 100%
Perc
enta
ge o
f P
hys
icia
ns
24
Administrators:
How often has a lack of cultural fit been cited as one of the primary reasons a physician left your
practice?
State of Recruitment Key Findings & Recommendations
Impact of Lack of Cultural Fit on Turnover
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
0% 5% 10% 15% 20% 25% 30%
1
2
3
4
5
6
7
8
9
10
Strongly Disagree
Strongly Agree
Physicians:
“A lack of cultural fit has prompted me to leave a practice.”
25
State of Recruitment Key Findings & Recommendations
Disconnect!
“Physicians rarely leave due to a lack of cultural fit.”
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
26
“I left because of a lack of cultural fit”
State of Recruitment Key Findings & Recommendations
Cultural Fit Influences Job Satisfaction
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
0% 10% 20% 30% 40%
1
2
3
4
5
6
7
8
9
10
Strongly Disagree
Strongly Agree
Physicians:
“My fit with the organization’s culture influences my job satisfaction.”
27
State of Recruitment Key Findings & Recommendations
Poor Cultural Fit: A Difficult Challenge
“Our biggest challenge is bringing so many divergent groups together to develop a new culture that makes them feel more aligned and more like one big group even though we are in so many different locations.”
“Challenges are culture and behavior related. We desire a single culture.”
“It is often difficult for organizations to really define the working culture vs. what culture they are trying to achieve.”
Source: 2012 Cejka Search and AMGA Physician Retention Survey
28
State of Recruitment Key Findings & Recommendations
Source: 2012 Culture Survey; Cejka Search and Physician Wellness Services
Strong Cultural Fit: Worth the Investment
“I just switched organizations for all the reasons your survey is focusing on. The new ‘culture’ is much more in alignment with my beliefs and personal values.”
“Cultural fit and administrative awareness and prioritization of this would go 90% of the way to job satisfaction.”
“My organization’s cultural attributes are what has encouraged me to put off my retirement. It is a pleasure for me to work here.”
29
State of Recruitment Key Findings & Recommendations
30
Recommendations:
Determine what your organizational culture is – and could be
Recruit for cultural fit
Improve retention with enculturation
Culture is the Top Controllable Reason for Turnover
State of Recruitment Key Findings & Recommendations
Duration of Onboarding
82%
18% 20%
37%43%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% P
ract
icin
g P
art-
tim
e
When does it begin?
32
When does it end?
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Extended Onboarding Period Lowers Turnover in Early Years
33
12.4%
17.4%
12.2% 10.5%
Turnover During Years 2-3
Total One month Up to six months Full year
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Mentor Assignment during Onboarding
Yes 78%
No 22%
Do you assign a mentor to physicians in your onboarding process?
34
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Assigning a Mentor Lowers Overall Turnover
35
8.6%
6.9% 6.0%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
Turnover
No onboarding process
Onboarding without mentor
Onboarding with mentor
Source: 2012 Cejka Search and AMGA Physician Retention Survey
State of Recruitment Key Findings & Recommendations
Critical Success Factor: Onboarding
36
Recommendations:
Establish a formal onboarding program
Extend onboarding cycle to one year
Assign a formal mentor
State of Recruitment
37
STRATEGIES IN ACTION Life Lessons: Building an Efficient Medical Staff Engine
Serving 12 Diverse Hospitals
State of Recruitment Strategies in Action
1. Alton Memorial Hospital
2. Barnes-Jewish Hospital
3. Barnes-Jewish St. Peters Hospital
4. Barnes-Jewish West County Hospital
5. Boone Hospital Center
6. Christian Hospital
7. Clay County Hospital
8. Missouri Baptist Medical Center
9. Missouri Baptist Sullivan Hospital
10. Parkland Health Center
11. Progress West HealthCare Center
12. St. Louis Children’s Hospital
(The Rehabilitation Institute of St. Louis)
BJC HealthCare Hospitals
State of Recruitment Strategies in Action
39
• Staffed beds: 3,475
• Net revenues: $3.6 Billion
• Inpatient admissions: 150,460
• Outpatient surgery visits: 61,459
• Emergency Department visits: 461,182
• Employees: 27,000
• Medical staff:
– 1,200 Faculty physicians
– 262 Employed physicians through BJC Medical Group
BJC HealthCare By the Numbers
State of Recruitment Strategies in Action
BJC Medical Group -- By The Numbers
Practices at 12 of the 13 BJC HealthCare hospitals (excluding Clay County)
90 practices with over 115 locations
262 Physicians; 57 NPs/PAs
Provider : FT Support Employees = 1:2.61 (excludes PRN staff)
State of Recruitment Strategies in Action
BJC Hospital BJC Medical Group Practice
BJC Medical Group Locations
State of Recruitment Strategies in Action
What Comprises BJC
Specialty 50%
Primary Care 50%
Practice Composition
Hospitalist Programs:
• Alton Memorial Hospital
• Parkland Health Center
• Christian Hospital
• Missouri Baptist Medical Center
1 MD 1 Staff
19 MDs 3 NPs
40 Staff
Practice Size
Specialties Include:
• Gastroenterology
• Rheumatology
• Medical Oncology
• Radiation Oncology
• Endocrinology
• Obstetrics/Gynecology
• Pediatrics
• Infectious Disease
• Pulmonary Medicine
• Psychiatry
• Allergy
• Vascular Surgery
• Colorectal Surgery
• Cardiology
• Orthopedic Surgery
• General Surgery
• Neurology
State of Recruitment Strategies in Action
Adding physicians to the employed portfolio.
Challenges To Growth
• “The compensation model needs to be changed”
• “The hospitals are competing against one another for recruits”
• “Difficult to recruit positions are ignored by BJCMG recruiters in favor of working on ‘easy’ ones”
• “Because the comp model is based on collections, poor payer markets don’t stand a chance”
• “The model works for me”
Voiced Frustrations:
State of Recruitment Strategies in Action
Solution to Challenges
1. Revise the Physician Compensation Model
2. Redesign the Physician Recruitment Function
State of Recruitment Strategies in Action
“Old” Compensation Model*
Break-even approach to emulate private practice
• Physician specific revenue (cash) minus: • A share of practice expenses allocated to physician based on standard methodology
• Physician direct expenses (malpractice, benefits, billing fee)
Physician gets credit for NP revenue and charged with NP salary/benefits
Comp is adjusted quarterly
• Net Professional Revenue (NPR) X payout %
• Payout % is based on the expense ratio (operating expense as % of NPR)
Quarterly adjustments ignore changes in ancillary revenue & expense
* Sunset: April 2009
State of Recruitment Strategies in Action
Challenges with “Old” Model:
Managed Care Issues (w/ pass through billing)
Ease of Understanding
Lack of Incentive Plan for P4P and System Goals
Cliff at end of Guarantee Period
Recruitment
State of Recruitment Strategies in Action
“New” Compensation Model “Musts”
Ease of Understanding
Meet all Legal Tests—IRS, Stark, etc.
Include Incentive Package for System Goals
Provide Market Competitive Compensation for PCPs and Specialists
Create No “Losers” or Major Windfalls in the Transition Year
Is Budget Neutral, Except for Addition of Incentive Plan
* April 2009 - present
State of Recruitment Strategies in Action
Physician Compensation Advisory Committee Charter
• Comprised of Administrative and Physician Leaders
• Provide feedback on the development of the physician
compensation model to be used by BJCMG
• Make recommendation of new method of compensation
to BJCMG Advisory Board
• BJCMG Advisory Board will make recommendation to
BJC Senior Leadership
State of Recruitment Strategies in Action
• Information about physician salaries will be shared in a blind format
• Salary information must be kept confidential
• Focus will be on compensation method
• Pay rate negotiation is not part of this discussion
• Parking lot used for side issues
Physician Compensation Advisory Committee Ground Rules
State of Recruitment Strategies in Action
52
“New” Compensation Model*
Initial salary guarantee (1-2 years) for new physician or to bridge private practice physician acquisitions
Following guarantee, base salary is paid on actual physician production (wRVUs) multiplied by a market-based conversion factor – compensation is “payor neutral”
Incentive program (up to 15% of base) accessed by getting through two “gates”:
• The practice must be at targeted level of expense management
• The physician must be using the Electronic Health Record technology at least to the level as determined by a peer group of physicians each year
Elements of performance (up to 5% of base compensation each):
• Patient Satisfaction
• Access and Volume
• Best in Class scorecard performance
* April 2009 - Present
State of Recruitment Strategies in Action
• Conducted stakeholder analysis with key executives and physicians to validate that “we have a problem” and agree to develop a Physician Recruitment Advisory Committee that is tasked to evaluate necessary changes
• Facilitated Decision Analysis with committee that led to a go forward plan that included:
• Outsource candidate sourcing activities to Cejka Search
• Repurpose 2 BJC FTEs to serve as connectors between BJC hospitals, Cejka Search and candidates
• Conduct regular Physician Recruitment Advisory Committee meetings with representatives
from all facilities with the purpose of being transparent about all recruitment activities
Physician Recruitment Redesign Activities
State of Recruitment Strategies in Action
Provider Additions (above turnover) 2009 2010 2011 2012
Physicians 45 49 55 36
NPs/PAs 8 9 11 10
Total Provider Additions 53 58 66 46
Growth Results
805
900
1012
1195 1261
175 221 252
297 319
100
300
500
700
900
1100
1300
2008 2009 2010 2011 2012
Total Employees
Total Providers
State of Recruitment Strategies in Action
Process Results
Centralized recruitment platform with transparent process and results
Multi-channel, mobile-enabled campaigns engage active and passive candidates
Interactive and social media highlight hospitals, brands and healthy medical group culture
State of Recruitment Strategies in Action
First Year Results
Slide 59
191
93
54
17
0
50
100
150
200
250
September 2009 - September 2010
Presented
Interviews
Offers
Hires32%
49%
58%
Target
60%
65%
50%
Established benchmarks, candidate criteria
Targeted interview and hiring efficiencies
State of Recruitment Strategies in Action
Yearly Comparisons
Slide 60
0
50
100
150
200
250
300
January 1, 2010 -December 31, 2010
January 1, 2011 -December 31, 2011
January 1, 2012 -December 31, 2012
252
174
156
132 119
100
73 62 57
22 34
19
Presented
Interviews
Offers
Hires
52%
55%
30%
68%
52%
54%
64%
57%
33%
Target
60%
65%
50%
Metrics reflect improved results of candidate screening
Progress toward efficiency, yet….
State of Recruitment Strategies in Action
0
20
40
60
80
100
120
140
160
Facility A Facility B Facility C
158
120
105 107
68
58
66
37 39
25 19
11
Presented
Interviews
Offers
Hires
Selected Individual Facility Results
Slide 61
68%
51%
67%
62%
38%
57%
55%
55%
28%
Target
65%
50%
60%
Recruitment is never equal
Hospital locations and attributes vary and influence metrics
State of Recruitment Strategies in Action
Adding physicians to the employed portfolio.
Solutions to Challenges
• “Payor neutrality has evened out the playing field”
• “Market intelligence and benchmark reporting gives us information we can act on”
• “Communicating and collaborating – not competing internally – has been key to getting the best docs”
• “Our recruitment effort is ahead of the technology curve
Voiced Satisfaction:
State of Recruitment Close
Lessons Learned
63
Recruitment is never equal
Recruitment is a constant evolution
Today’s shortage pushes urgency on recruitment efforts
Identifying the “right fit” candidate is even more important for retention
Enhanced technology is essential candidate engagement –now and for the future
State of Recruitment Close
Contact Information
64
David Knocke, FACHE President
BJC Medical Group St. Louis, Missouri
(314) 996-7690 [email protected]
www.linkedin.com/pub/david-knocke/11/76/97a
Lori Schutte, MBA President
Cejka Search St. Louis, Missouri
314.726.1603 [email protected]
www.linkedin.com/in/lorischutte