THE PHYSICIAN RECRUITING

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THE PHYSICIAN RECRUITING ICEBERG
Presented by Merritt Hawkins Associates
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ONE THING WE HAVE LEARNED
Tip of the Iceberg
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WHAT IS THE PHYSICIAN RECRUITING ICEBERG?
ITS THE KNOWLEDGE, PREPARATION AND
EXECUTION THAT TAKE PLACE BENEATH THE
SURFACE LEADING TO A SUCCESSFUL PHYSICIAN
PLACEMENT
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THIS PART OF THE PHYSICIAN RECRUITING ICEBERG
GETS MOST OF THE ATTENTION
Success Follow-Up The Decision The Interview
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THIS IS THE PART THAT IS OFTEN OVERLOOKED
Candidate Screening Candidate Sourcing Establishin
g Parameters The Incentive Package/Contract Assemb
ling the Recruiting Team Ensuring Regulatory
Compliance Objective Opportunity
Analysis Strategic Staff Plan/Needs
Analysis Physician Search Cost/Benefits Ongoing
Physician Retention Plan Knowledge of the
Physician Market
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WHAT RECRUITERS HATE TO HEAR
Just get us a doctor to interview. Well know
what to do from there
IF ONLY IT WERE THAT EASY
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JUST GETTING A DOCTOR
TODAY, JUST GETTING A DOCTOR MAY BE THE
TOUGHEST CHALLENGE YOUR FACILITY WILL FACE.
TO UNDERSTAND THIS CHALLENGE REQUIRES
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MARKET KNOWLEDGE
THE FOUNDATION OF THE PHYSICIAN RECRUITING
ICEBERG
Who is looking (DEMAND)?
Who is available (SUPPLY)?
What does our level of commitment need to be
(resources responsiveness)?
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ANSWER THESE QUESTIONS
BEFORE you speak to a single candidate
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MARKET KNOWLEDGE
THE MOST POWERFUL TOOL IN HEALTHCARE

• The Physicians Pen

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MARKET KNOWLEDGE
ITS NO SECRET
Without doctors, hospitals are just empty hotels
with average food.
Doctors drive the majority of the 2 trillion
health care market
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MARKET KNOWLEDGE
WHOS LOOKING?
(and you)
(and you)
YOU ARE
Is Your Facility Currently Recruiting
Physicians?

Yes No 100 beds or
less 75
25 101 to 200 beds 95
5 201 beds or more
98 2
(and you)
(and you)
Source Merritt, Hawkins Associates 2005
Survey of Hospital Physician Recruiting Trends
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MARKET KNOWLEDGE
WHOS AVAILABLE?
90,000 to 200,000 fewer doctors than we need
AAMC PROJECTS...90,000 too few physicians by
2020 RICHARD COOPER, M.D200,000 too few
physicians by 2020
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MARKET KNOWLEDGE
THE UNITED STATES IS IN THE MIDST OF A NATIONAL
PHYSICIAN SHORTAGE
READ ALL ABOUT IT
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MARKET KNOWLEDGE
HOW DID WE GET INTO THIS MESS?
See
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MARKET KNOWLEDGE

• U.S. population increasing by about 50 million
  from 2000 to 2020
• Baby Boomers hitting 65
• Number of physicians being trained is static
• One new doctor does not replace one older doctor
• Resident Physician Shortage Reduction Act, S.588
  stalled

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MARKET KNOWLEDGE
Demand
The Coming Gap Between Physician Supply Demand
(2020)
1.2 Million
Supply
0.9 Million
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MARKET KNOWLEDGE
EVERY ELEMENT OF PHYSICIAN SEARCH
Candidate Parameters
Incentives
Resources Committed
THERE ARE NOT ENOUGH DOCTORS TO GO AROUND
Sense of Urgency
Sourcing Strategies
Proceeds from this Premise
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PHYSICIANS ARE A PARAMOUNT RESOURCE
HOLD ON TO THE ONES YOU HAVE!
Retention is at the base of the Recruiting
Iceberg
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RETENTION
HOW DO YOU RETAIN PHYSICIANS?
Make the practice environment as efficient, open,
remunerative and appealing as possible.
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RECRUITMENT
HOW DO YOU ATTRACT PHYSICIANS?
Make the practice environment as efficient, open,
remunerative and appealing as possible.
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RETENTION
RETENTION AND RECRUITMENT ARE TWO SIDES OF THE
SAME COIN
Basic Recruiter Truth 101
Physicians are not pulled from their
practices They are pushed.
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RETENTION
PUT A RETENTION PLAN IN PLACE THAT INCORPORATES

• Physician communication (formal and informal)
• Physician employment
• Pay for ED call
• Hospitalist program
• Gain Sharing/Joint Ventures
• Appropriate nurse staffing
• Timely test turnaround
• Access to patient data
• Consistent OR availability
• Enhanced ER triage
• Convenient parking
• Marketing/Contracting

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CAN YOU AFFORD TO DO ALL THIS?
CAN YOU AFFORD NOT TO?
Understanding physician recruiting cost/benefits
is part of the iceberg.
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COST/BENEFITS
POTENTIAL COST TO RECRUIT A CARDIOLOGIST
Physician salary/income guarantee
390,000 Benefits/perks
50,000 Recruiters fee
(in-house or agency) 30,000 Candidate
Sourcing
10,000 Candidate/spouse interview
3,000 Physician Relocation
10,000 Practice
marketing
3,000 Total
496,000
Source Merritt Hawkins Associates 2008
Recruiting Incentives Survey
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COST/BENEFITS
AVERAGE NET ANNUAL INCOME GENERATED BY PHYSICIANS
FOR AFFILIATED HOSPITALS
FOR EVERY YEAR YOU RETAIN THEM
Source Merritt Hawkins Associates 2007
Inpatient/Outpatient Revenue Survey
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COST/BENEFITS - Compliance
NOT INVESTING IN PHYSICIAN RECRUITING/RETENTION
CAN BE EXPENSIVE
So can proceeding without a compliance plan
Congressman Fortney Hillman "Pete" Stark Jr.
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COMPLIANCE
VIOLATING FEDERAL PHSYICIAN RECRUITING
REGULATIONS CAN LEAD TO

• Exclusion from Medicare/Medicaid
• Loss of Not-for-Profit Status
• Fines and civil and criminal penalties

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COMPLIANCE
KNOWING WHAT YOU CAN AND CANT DO IS PART OF THE
ICEBERG
New Stark II Phase 3 (or Stark III) Regulations
Groups CAN impose non-competes. Hospitals CAN
pay more than incremental expenses.
The Stark laws and related federal regulations
are complex nothing herein is intended as legal
advice and parties are advised to consult legal
counsel.
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STAFF PLAN
BASE COMPLIANCE EFFORTS ON A DEMONSTRATED NEED
FOR NEW PHYSICIANS IN YOUR COMMUNITY

• Complete a medical staff development plan
  including
• Physician counts (FTEs) in your service area
• Local physician demographics
• Physician input (Medical Staff Survey)
• Local patient demographics
• Local disease incidence
• Portrait of community need

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STAFF PLAN
THE ICEBERG INCLUDES A FORMAL MEDICAL STAFF
PLAN

• Provides a recruiting blueprint
• (avoids the Little Dutch Boy approach)
• Creates buy-in for recruiting among existing
  staff
• Offers recruits objective data proving a practice
  exists
• Proves recruitment is based on community need

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STAFF PLAN
SPECIFIC DATA/RECOMMENDATIONS
Internal Medicine
Sample
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STAFF PLAN
CLEARLY THERE IS A LOT AT STAKE IN PHYSICIAN
RECRUITING.
WHO ARE THE STAKEHOLDERS?
Assembling a recruiting team is part of the
iceberg.
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THE RECRUITING TEAM
FOCUS OF RECRUITING TEAM

• Works on retention/doctor satisfaction issues
• Oversees Medical Staff Plan
• Sets recruiting goals
• Establishes candidate parameters
• Approves incentives
• Participates in/organizes interviews
• Drives post-interview closing
• Oversees candidate relocation

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THE RECRUITING TEAM
THE TEAM INCLUDES

• Board members (emphasis on physicians)
• Staff Physicians
• Physician Recruiters
• Chief Medical Officer
• Hospital Department representatives
• Administrators of leading medical groups
• At large community members
• Limit the team to 9 stakeholders or less

THE KEY THE HOSPITAL CEO
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THE RECRUITING TEAM
ONLY THE CEO HAS THE POSITION TO

• Confirm goals
• Stick to candidate parameters
• Adjust incentives
• Drive negotiations

AND ENSURE RESPONSIVENESS
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PRACTICE/COMMUNITY ANALYSIS
YOU KNOW WHO IS ON THE TEAM
NOW, WHAT ARE YOU SELLING?
TAKE AN OBJECTIVE LOOK AT YOUR PRACTICE/COMMUNITY
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PRACTICE/COMMUNITY ANALYSIS
A GOOD SALESPERSON KNOWS THE PRODUCT. PRACTICE
ANALYSIS SHOULD INCLUDE

• Hours/coverage
• Incentives/contracts
• Non-competes
• Path-to-partner
• ER coverage
• Malpractice
• Hospital Support

• Patient volume
• Payer mix/reimbursement rate
• Collection rate
• Overhead
• Type number of procedures/surgeries
• Nursing/allied staff
• Referring physicians/colleagues
• Politics

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PRACTICE/COMMUNITY ANALYSIS
COMMUNITY ANALYSIS INCLUDES

• Current Physician Lifestyles
• Real estate
• Schools
• Recreational/cultural amenities

WHAT IS THE INTERNET (Chamber) SAYING ABOUT YOU?
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PRACTICE/COMMUNITY ANALYSIS
Im not satisfied now why will life be better
at YOUR opportunity?
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PRACTICE/COMMUNITY ANALYSIS
Weve got a great practice and a great
community! is not enough
Explain to me Whats under the hood?
TALK DOCTOR!!
TALK DOCTOR!!
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CANDIDATE PARAMETERS
WE THOROUGHLY UNDERSTAND OUR PRODUCT NOW, WHO
ARE WE TRYING TO ATTRACT?
APPROPRIATE AND REASONABLE CANDIDATE
PARAMETERS FORM AN IMPORTANT PART OF THE ICEBERG
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CANDIDATE PARAMETERS
WHO ARE DOCTORS TODAY?
Percent of Medical Residents Who are Female
Source AMA Masterfile, 2009
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CANDIDATE PARAMETERS
WHO ARE DOCTORS TODAY?
Medical Specialties by Age
Source AMA Masterfile, 2009
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CANDIDATE PARAMETERS
WHO ARE DOCTORS TODAY?
International Medical Graduates by Specialty
Nephrology
43 Internal medicine
39 Psychiatry
32 Neurology
32 Cardiology
31 Pulmonology
29 Gastroenterology 28
Anesthesiology 26
Source AMA Masterfile, 2009
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CANDIDATE PARAMETERS
WHO ARE DOCTORS TODAY?
How Many Orthopedic Surgeons Are Available?
Source AMA Masterfile, 2009
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CANDIDATE PARAMETERS
TWO WAYS TO IMMEDIATELY IMPROVE YOUR CHANCES OF
RECRUITING SUCCESS
1. Open the search to older physicians 2.
Seriously consider International Medical
Graduates
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CANDIDATE PARAMETERS
PUT YOUR PARAMETERS IN WRITING
OBTAIN SIGN-OFF FROM THE RECRUITING TEAM
STICK TO YOUR GUNS DO NOT COMPARISON SHOP!
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INCENTIVES/CONTRACTS
YOU KNOW WHO YOU WANT
NOW, WHAT DO YOU OFFER?
THAT, TOO, IS PART OF THE ICEBERG
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INCENTIVES/CONTRACTS
Family Practice Compensation Surveys
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INCENTIVES/CONTRACTS
For Physicians, Fear of Loss Outweighs Potential
For Gain THE INCOME OFFER IS ALL ABOUT
CREDIBILITY
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INCENTIVES/CONTRACTS
Dont Go Into the Market if You Dont Have a
Contract
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INCENTIVES/CONTRACTS
STANDARD RECRUITING CONTRACTS TODAY TYPICALLY
WILL COVER..

• Work statusIndependent? Employee? Shareholder?
  Partner?
• Salary and production bonusthe 50 model
• Income guaranteeforgiveness clause?
• Educational loan forgiveness
• Non competesprohibited by Stark?
• Hours/duties/call coverage/vacation
• Path to partner
• Benefits
• Termination

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SOURCING CANDIDATES
CONGRATULATIONS! You

• Understand the physician market
• Have a staff plan
• Are compliant with recruiting regulations
• Have a team in place
• Know what you are selling
• Have candidates parameters set in writing
• Have a competitive financial package
• Have a sample contract outlining terms

ITS TIME TO SOURCE CANDIDATES. WHERE DO YOU
LOOK?
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SOURCING CANDIDATES
LEAVE NO STONE UNTURNED
Networking with staff/community/residencies
The Internet (your site, employment sites, the
Chamber site)
Direct mail (for passive candidates)
Journal ads (focus on residents)
Physician conventions
High-need doctors (residents, military, J-1s)
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SOURCING CANDIDATES

• Number of physicians BTL in Texas (54,803) but
  now practicing in

NH 101
124
899
VT 58
159
69
442
515
817
611
345
515
RI 74
123
239
CT 230
87
782
254
287
744
239
DC 129
506
DE 45
759
308
380
92
1166
841
MD 612
430
414
916
3224
1233
1136
1030
519
812
888
545
1041
455
649
1129
AK 158 HI 185
25519
1785
Source AMA Masterfile
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SOURCING CANDIDATES
MEASURABLE ACTIVITY MEASURABLE RESULTS
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SCREENING
A CANDIDATE IS ON THE PHONE
NOW, WHAT DO YOU SAY?
THE SCREEN IS THE ART OF PHYSICIAN
RECRUITING, AND A KEY PART OF THE ICEBERG
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SCREENING
HOW DO YOU GO FROM STRANGER TO CONFIDANT?
Leave your practice, Doctor, take your kids out
of school, sell your home, and quit the country
club, because have I got the deal for you.
Trust me.
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SCREENING
THE ARC OF PERSUASION
14 Days
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THE INTERVIEW
NOW, THE STAGE IS SET
Youve got a lot of sweat equity in this search,
BUT

• You know your candidate (written profile,
  professional and personal)
• The candidate knows you (setting, hours,
  finances, payer mix, etc.)
• Your offer is ready
• Your team is ready
• The interview itinerary is ready

EXPECTATIONS ARE CLEAR on both sides.
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THE INTERVIEW
WHAT IS THE INTERVIEW FOR?
Confirmation not Exploration THE 70/30 RULE
ONE INTERVIEW ONLY, PHYSICIAN AND SPOUSE
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THE DECISION
THE PHYSICIAN AND SPOUSE HAVE LEFT THE COMMUNITY
NOW, ALL YOU CAN DO IS WAIT, RIGHT?
WRONG
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THE DECISION
THE PYRAMID OF INTEREST
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SUCCESS!
Now, it is time to incorporate the new physician
into the Retention Program while the Recruitment
Cycle begins again.
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THE PHYSICIAN RECRUITING ICEBERG
For more information about Stark II Phase 3
Regulations or to receive a copy Merritt Hawkins
Associates Survey of Physicians 50-65 contact
Kurt Mosley at kmosley_at_mhagroup.com.