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Conley’s Corner February 2024

Post author By thinkitdesign
Post date February 12, 2024

I was recently speaking with a prospect and he said: “We have a great practice concept and offices in Fairhope and Huntsville which are great locations…why can’t we find someone?”

We get this question a lot and I generally have the same answer: It’s not you. It’s the market…don’t beat yourself up. After 25 years of physician search, I don’t know that there has ever been a more difficult market to recruit physicians.

Here’s why:

The demand for physicians has never been higher.
- As physicians age, they are retiring out of medicine and need to be replaced. A generally good stock market has kept retirement savings safe allowing the baby boomer generation of physicians to retire (or slow down and work part-time or do locums).
- Private equity is flowing into healthcare presently creating new models of delivery, especially in primary care. These organizations are looking for physicians who do procedures, make referrals and see patients. These start ups are actively recruiting physicians.
- The baby boomer generation, the largest population mass in the US, is roughly 80 years old to 60 years old. These patients access healthcare more than any other grouping.
Covid has had lasting effect on the physician search market.
- Interest rates have increased to levels not seen in years. This makes selling a higher priced home more expensive as well as buying a home more expensive.

So, what do we do about it? As I also tell our clients, unfortunately this is the world that we live in and you can’t do anything about it. What you can impact is how you respond to this market. Having the correct approach to recruiting and getting it right has never been more important. Here are some things to consider as you are recruiting:

Start with the mindset that I get one shot at it so when you identify an interested candidate, you have to get everything right. I spoke with a candidate today about an opportunity with a client which he expressed interest in. He quickly reminded me that “I have other offers that I am considering as well as this.” They won’t always offer this information to you, but trust that they have other options on the table.
- Have a plan after the interview to follow up with candidates to gain feedback and make an offer as appropriate. Respond when the memory of your opportunity is fresh in their mind rather than allow the candidate to continue interviewing.
Focus on candidates that are within your region. In the last few years, candidates have reconsidered their professional goals and their current role may not fit as well as it did a few years ago. Those candidates may not wish to relocate but are interested in a new opportunity.
- If you have changed something in your opportunity (better compensation, better call, etc.) advertise that to local candidates. This may be a way to catch the interest of a local candidate.
Think about resident and fellowship candidates who will complete their training in 2025 or 2026. With our aging physician workforce, those physicians may not meet your current need but they can address your future needs. If you have the ability to provide a stipend, you may be able to secure one of these candidates. You may find candidate who is planning to return to your region and you can get a jump on the competition.
Lastly, remember that your physicians and providers are your competitors’ targets. With the new year, take the time to ensure your current team is happy and satisfied and work to address as needed.
- Too often, we get the call when three OBGYN s or GIs have left due to an issue rather than when the issue was first identified. Replacing one physician is far simpler and less expensive than replacing multiple physicians so address those concerns early on.

I hope this information is helpful to you and your team and we are always available to discuss by phone specific questions or issues that you may have. Good luck!

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Conley’s Corner July 2023

Post author By thinkitdesign
Post date July 30, 2023

The end of June signals the halfway point in 2023 and is great time to look back on the first half of the year and the trends that we saw in physician recruiting. Here are some of our takeaways:

Primary care is still highly pursued as health systems are actively recruiting primary care physicians to ultimately replace those retiring. Almost half of the family medicine physician population are 55 and older.
- Hospitals and health systems are recruiting primary care physicians to partner with existing Advanced Practice Providers (APP). All States have unique rules regarding supervision of an APP and organizations are maximizing their primary care physicians. Specialties like psychiatry are also actively using APPS to provide care,
We have seen hospital clients implement new care models using advanced practice providers to cover inpatient and/or emergency department to relieve primary care physicians from these responsibilities.
In Q2, we saw two providers of physician services, envision and American Physician Partners, face financial challenges. These organizations provide hospitalist and ED staffing in hospitals and health systems. It will be interesting to see how these services will be replaced, either by hospitals employing these physicians, a private group or taking over at these facilities, or another national organization stepping into these facilities.
Ob/Gyn continues to be a highly demanded specialty and a surprisingly difficult recruitment. 48% of Ob/Gyns are 55 or older and Ob/Gyns tend to gravitate away from obstetrics and focus on gynecology as they age. This puts the onus on practice groups and hospital groups to recruit Ob/Gyns to replace those retiring or stepping away from obstetrics. Ob/Gyn recruitment is also affected by the demand for laborists which are drawn from the overall Ob/Gyn population.
Psychiatry remains a highly demanded specialty with the emphasis on outpatient care and less so inpatient care.
In the world of medical subspecialties, gastroenterology is a frequently requested specialty for recruitment. Cardiology, primarily non-invasive cardiology, seems to also be highly demanded.
Surgical specialties have not been requested at the same level as the aforementioned specialties. Urology continues to be one of the more sought-after surgical specialties as well as vascular surgery.
Radiology is the hospital-based specialty most frequently requested by our clients.
Lastly, the remaining effects of COVID and the rising interest rates have had a big impact on the physician recruitment market. Physicians are less likely to relocate than in past years, which has impacted recruiting.

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Competing Financially With A Candidate – Part 2

Post author By thinkitdesign
Post date April 13, 2023

Part 2 –

Continued…

So, how do you compete in this environment if your salary is not as attractive as other offers? Well, here are a few pointers that I have seen work over the years.

Once you have a good objective evaluation of your practice, identify the components of your opportunity that you can enhance. Look for areas of your opportunity where you can truly stand out and be best of class. It’s hard to be all things for all people but identify an area where your offering can stand out and market that to potential candidates.
If your practice can’t offer the best financial opportunity, focus on offering a great quality of life. Many physicians are attracted to this and a 4-day work week, minimal call, etc. are attractive to candidates and can be a difference maker for candidates seeking a better quality of life.
Understand the true cost of a physician opening – If you have a physician opening, what are you doing fill that role in the interim? What are the potential costs (financial and otherwise) of not filling a position? We recently spoke with a client about the dollars they are spending on locums’ coverage and realized they could pay more salary than they originally planned. Often the cost savings will cover the increase in salary
Candidate pool – Look for opportunities to expand your candidate pool, potentially with experienced candidates or part-time candidates. Many psychiatrists are looking for 2 to 3 days of work to supplement a private practice and a couple of part time candidates may replace a full-time candidate.
A Physician once shared with me that his career could be divided into three phases – Your learning years where you learn the practice of medicine and ramp up; your earning years where a physician can maximize his/her income; and your legacy years where a physician focuses on giving back, possibly in a health clinic or an academic setting. Be sure to look out for the candidates who are in the legacy phase of their career.
Be committed to recruiting and outwork the competition – This means when engaging with prospective candidates, move with purpose and efficiency including following up with candidates, setting interviews and most importantly extending offers. If you give candidates time to find a higher salaried offer, they will likely find one so be timely with your offers.
Candidates will be able to identify the shortcomings of your opportunity on their own so don’t belabor these points with candidates. Know your strengths and let candidates know what makes you strong. Emphasize the positive!

Lastly, I always remind candidates who wants them to take more money…the Government. If a candidate makes more money, they pay more in taxes. Always remember that the difference in compensation between positions is taxed and not fully realized by the candidate.

I hope these points are helpful to you and we are always available to discuss in detail your current situation.

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Competing Financially With A Candidate – Part 1

Post author By thinkitdesign
Post date March 21, 2023

Part 1 –

I have had the opportunity to work with FQHC clients over the years and have always enjoyed helping those clients. A common hurdle that they face, as do many academic and other practices, is competing financially when making an offer to a candidate. Sure, there are those candidates who are mission-minded or looking to give back (more on this later) or enjoy teaching, but more and more physicians are looking for the best salary that they can find.

So, how do you compete in this environment if your salary is not as attractive as other offers? Well, here are a few pointers that I have seen work over the years.

Start with a good objective evaluation of your opportunity. Understand your strengths as well as the areas that you may lag vs. competitors in the marketplace. Sure, this will likely include compensation but may include other areas as well. Some categories to consider include:
- Benefit package – CME, PTO or vacation, malpractice insurance, retirement
  - I have a client that offers a 6% retirement match which can equate to $18k per year which is tax deferred…do you have an offering like this?
- Salary – Is it guaranteed? For how long? Many salaries today are for 1-2 years and then wRVU compensation plan takes over.
- Additional compensation – Is a productivity bonus available? Quality bonus? Supervision bonus? When is this bonus available to a new hire? Many times these bonuses aren’t available for 2 or more years so the impact to candidates is diluted.
- Sign on/Commencement bonus? Retention bonus? Training stipend?
  - If you are a private physician group, these types of bonuses are where local hospitals often contribute to a group’s recruiting efforts. If you haven’t had those discussions with your local hospital, you should consider.
- Educational loan repayment – Do you offer this? Are you eligible for NHSC program? Have you registered? Many practices that are eligible for NHSC loan program have not applied.
- Community- What does your community offer? Get input from people on your team who are not originally from the area. Why did they move here? What do they like about living here?
- Region – Understand your overall region (roughly a 1-to-2-hour radius). Your community may be a small rural location, but access to
- Patient/procedure volume expected – This impacts quality of life.
- Call and coverage – Physicians look at call and coverage in terms of frequency as well as severity. How does your position compare?
- Support – RN? NP/PA?

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Challenging Times with Physician Recruitment

Post author By thinkitdesign
Post date February 10, 2023

Multiethnic team of doctors and nurses working together, network of concepts on the top: healthcare and medicine

The physician recruitment market continues to be challenging, with specialties like urology, ob/gyn and psychiatry being particularly difficult. Because groups and health centers are actively recruiting to fill these types of searches, I encourage all of you to continue to focus on the retention of your current medical staff/team. Remember, your medical staff is the target of communities actively seeking those specialties.

In those hard-to-find specialties, your physicians and providers are being bombarded by opportunities every day. I spoke with a urologist yesterday who told me he receives 10 job solicitations daily which I am sure is not uncommon. Additionally, if you are actively recruiting for a specialty, then your current physicians are likely being stressed by additional call in the absence of a physician. Before losing one of your physicians, take steps to ensure better retention of your medical staff.

Retention has never been more important for physician groups and medical staffs due to this environment. Here are some things I have learned over the years regarding retention:

Physicians are most vulnerable to departing your community in the first two years. After two years, physicians and their spouses (and their kids) have established roots in the community and are much more likely to remain in your community through the everyday ups and downs of the practice of medicine. Therefore, the focus on retention needs to start from day 1 the physician is in your community and really before they ever arrive.
When devising compensation, try to keep this two-year window in mind. The sooner physicians are maximizing their compensation, the more likely they are to settle in.
Empathy is critical to identifying physicians who are susceptible to leaving your community. When we talk to physicians who are relocating, it is often brought on by some form of change. When change occurs, identify those vulnerable physicians, and have a talk with them.
Retention bonuses are a good way to have physicians remain to earn/receive bonuses after the end of year 1 and 2.
The average age of physicians has never been higher with physicians actively working in their 50s and 60s. Physicians of this age group are often empty nesters and therefore are not susceptible to some of the children issues that cause physicians to relocate like quality of schools. Broaden your target market to include these physicians when recruiting.
Physicians relocate for personal as well as professional reasons, maybe more for personal reasons. The personal component means the entire family including spouse and children. It is often easier for the physician to settle into your community because they have a work family from Day 1 but with so many people working remotely, the spouse may be working from home without a social network. Look for ways to get the spouse and children involved in the community. Many organizations have groups in place to help spouses transition to a community and this can be a great resource if you don’t already have this in place.

I hope these points are helpful to you and we are always available to discuss in detail your current situation.

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Recruitment is a commitment

Post author By thinkitdesign
Post date January 6, 2023

Recruitment is rarely, if ever convenient. That’s just the way it is. You are going to have to make phone calls at night, go to dinner events on Thursday or Friday night, and spend your Friday afternoon touring a candidate through the hospital. It takes time and the results will not always be what you hope they will be. But, if you are committed to the search and work efficiently and expeditiously, you are much more likely to have a successful outcome sooner and begin to enjoy the benefit of adding a new colleague to the team.

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Healthcare Staffing Shortage

Post author By thinkitdesign
Post date December 1, 2022

Definitive Healthcare recently produced a report on addressing the healthcare staffing shortage. It is a sweeping report that touches on all aspects of healthcare staffing and the drivers of today’s shortages including aging patient population and burnout experienced by providers. While the impact of staffing shortages on healthcare is significant, I do want to address the factor that will further affect healthcare organizations in the near future: our aging physician population.

In the physician space, many specialties including psychiatry, surgery and internal medicine, have an average age of 50 years old or higher. Therefore, many medical staffs have active member practicing well into their 60s. A practice administrator once told me, “Physicians don’t plan their retirement. They just show up one day and say they are going to stop practicing at the end of the month.” I’m sure many of you have experienced this and it is important to not be caught by unexpected retirements in key physician specialties such as primary care or surgery. In many small to mid-sized hospitals, a couple of unexpected retirements could result in a domino effect of additional departures which would take years to correct.

As I tell many clients, when you begin a search, plan for the first day for that new physician to be a year from now and you probably have a pretty good estimate. Also, COVID has accelerated the use of telehealth which is great, but it limits the population of potential physician candidates to see patients in your community. My recommendation is to begin recruiting for those specialties well before you think you need to. We have clients actively interviewing and making offers to 2024 candidates so it is not too soon to start the process.

Also, I suggest changing your definition of a retention time frame for physicians. We harken back to the days when a physician would hang his shingle and practice in one community for 30 years, that’s not the norm anymore. In a pursuit to find those candidates, people focus on younger candidates. I say consider all qualified candidates. Many of of our experienced candidates want to practice for 3-5 more years while serving as mentors for your younger medical staff.

Better to have a few too many physicians in the short term then caught with too few for the long term.

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Conley’s Corner First Post

Over the course of my career, I have had an opportunity to talk with over a thousand physicians regarding career choices. One bit of wisdom I tend to share with all candidates is set the contract aside for a moment and think about where you want to live, where you want to work and who do you want to work with. Generally, if you start with these elements, you are much more likely to have a long-term fit which is probably what you are looking for.