Physician Recruitment

1. Physician Recruitment Mark Murray, MD

2. Recruitment • Currently based on an opinion about needs • Multiple opinions • Local “community” • Local medical community • “Government” • Recruiters • Needs are not subjective but objective, based on a formula

3. Considerations • One physician FTE does not equal another • Dependent upon an objective measurement of work capability or capacity • Physicians’ office time is “diluted” by other chosen activities and duties • Objective formula

4. Formula • 4 variables • Panel (unknown or known), times • Patient visits per year (can be determined) equals • Providers’ days worked per year, times • Visits delivered per day

5. Panel: Demand and Supply Equation Demand Supply 5

6. Influences on Equation • Each of the 4 variables is influenced by the other 3 • Any change in the other 3 variables can change the panel • Tool in excel

7. Influences on Equation • We can work either from the known panel/population or to the panel/population to drive an objective determination for physician recruitment • Work backwards from the population and provider behaviors toward panel or caseload • For example, if we know the population, we can determine physician recruitment needs; or if know the physician “population,” we can determine how much of a patient population they can manage

8. Caution! • Local urgent care, after-hours, Locums, etc, all constitute a form of hidden supply • That hidden supply is less effective than “regular” supply

9. How Do We InfluenceVisits Per Year? • Continuity • Return rates • Non-visit care • Telephone • Max packing • Group visits • Care team

10. How Do We InfluenceProvider Days Per Year? • Expectation • Other chosen duties • Current physician behaviors

11. How Do We InfluenceProvider Visits Per Day? • FTKA • Support • Space • Appointment length • Documentation templates • Bookable hours • Velocity

12. Caution! • By reducing the appointment length, we increase the provider visits per day; but since less is done, the number of visits per patient per year on the other side of the equation will increase • The current standard reimbursement system affects the willingness of providers to influence or change the variables • The “system” is blind to the incentives and behaviors

13. Why is Panel Important? • Patient satisfaction • Panel defines workload and limits to workload • Panel determines and helps predict demand • Allows a view or provider variability • Panel drives continuity; continuity drives cost, revenue and outcome

14. High-Level Effects on the Formula • Population changes • Rise in total population • Demographics of the population • Provider population • Aging and retirement • Burnout • Contraction

15. Demographic Issues • Knowing the population and the projections for that population, and given current performance, we can predict physician recruitment needs • “Current performance” is current population behavior • Per 100,000 population how many of…… do we need? • Population behavior is driven by system and provider behavior: habits, culture, expectations, reimbursement • Changing behaviors and expectations changes recruitment needs • If we cannot recruit, we may have to change the system behavior • Service Agreements define the work, packaging of the work

16. What is the Panel/Population Size? • Population measurement • Billing code • Unique, unduplicated patients seen over 12, 18, or 36 months • Start at practice or “department” and then use the 4-cut method to determine individual panels

17. 4-cut method • Unique, unduplicated patients seen by anybody • How many seen by one only • How many seen predominantly by one • Tie: sentinel exam • Tie and no sentinel exam: who saw the patient last

18. What it is – the Second Step • Determined total # of pts and clinical FTE • Divide pts by FTE to determine “share” • Compare current panel by 4-cut method to share and look at over and under

19. What Should the Panel Size Be? • Use the equation • Equation can be influenced • Isolate the variables

20. Acuity/Demographic Adjustments • Critical in salaried environments • Less critical in revenue environments • Triangle and corridor • Zero-sum game

21. Panel Size Limit • Set by the equation • If panel is greater than worker, there are consequences: increasing expanding wait time and then line-cutting to others

22. Consequences of Delay • More calls • More no-shows • More walk-ins • More overtime • More cost due to triage and rework • Reduced satisfaction • Poor outcome

23. Consequences of Overflow • Reduced satisfaction • Increased visit length • Reduction of productivity • Adverse outcomes • Increased return visit rate (demand)

24. Reality • If a provider is over-paneled, then that provider is saying “no” • “I don’t want to say no to any patient” is a myth and a dangerous one

25. Recruitment • Must be driven by objective, not subjective, criteria • There are variables, and they can be quantified and influenced • The formula applies to both Primary Care and Specialty Care • A population will create varying levels of need through Primary Care into specific Specialty Care practice types