Interview with ASPR Annual Conference keynote presenter Shane Foreman
Physician recruitment in a post-reform era
By Laurie Pumper, ASPR Communication Director
Will the Affordable Care Act help with the shortage of physicians across the country?
The looming shortage and mal-distribution of physicians in the US is well documented. The overall projected shortage of physicians across the US is expected to be 91,500 physicians (45,400 in primary care and 46,100 subspecialists) by 2020, growing to 130,600 by 2025. In addition, the number of physicians per 100,000 of population varies greatly by market, and it remains difficult to attract physicians to rural and payer-challenged urban markets, exacerbating shortages in those areas.
As if the macro shortage of physicians is not daunting enough, attracting physicians that can thrive in the post-reform environment is critical for hospitals and health systems. CMS (The Center for Medicare Services) has been clear on its three-part aim of “better care for individuals, better health for populations, and lower growth in expenditures.” In short, attracting the “right” physicians will become more difficult.
How does the Affordable Care Act impact the delivery of care?
Virtually all of the business models being discussed assume a dramatic change in the way healthcare is delivered — increased quality through evidence-based medicine at a lower or slower-rising cost. Beyond an attempt to slow the medical inflation rate, why focus on changing the traditional healthcare delivery model? Because the majority of the opportunities lie in improving the overall effectiveness of the traditional delivery model:
- Prior to healthcare reform, there were 49.9 million uninsured Americans — 16.3% of the population.
- A 2009 Harvard study estimated that 44,800 excess deaths occur annually in the US due to lack of health insurance.
- We spend more per capita on healthcare than any other nation in the world.
- Yet, our life expectancy of 78.49 is 50th in the world, below most developed nations and some developing nations — Monaco is first at 89.68 years and Angola is last at 31.88 years.
- Our infant mortality rate is higher than most of the industrialized nations — 42nd overall.
- According to the World Health Organization, the US ranked 37th in overall performance and 72nd by overall level of health (out of 191 nations included).
What will be the primary mechanism for changing the delivery of care?
Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of the evidence of risks and benefits of treatments (including lack of treatment) and diagnostic tests. If evidence-based medicine is the key in the transformation of today’s delivery system, what percentage of your medical staff believes in EBM? Practice EBM? Are willing to practice EBM?
What are the shortcomings in today’s approach to physician recruitment?
It is certainly understandable that the shortage of and difficulty in recruiting physicians influences how hospitals and health systems think about attracting physicians. The historic physician recruitment approach and criteria tend to be “soft” and geared toward the traditional model of care. Physicians are evaluated mostly on high-level background and overall fit:
- Why are you looking for a new practice opportunity?
- What is your training and background?
- What is your current practice like?
- What are you seeking in a new practice opportunity?
- How will this move affect your spouse and family?
- Post-reform, this is a very risky approach and strategy. Shared savings models do not work very well when there is no savings, and meeting the value-based purchasing and quality outcomes criteria will be next to impossible.
Does the definition of the perfect physician candidate change post-reform?
The ideal physician candidate profile, post-healthcare reform, is very different than in the past. Physicians will need to be asked more pointed questions about their clinical philosophy and acumen:
- Do you understand and believe in evidence-based medicine?
- What type of clinical outcomes do you expect of yourself?
- What is your experience in managing patient populations?
- What size patient panel is most comfortable for you?
- What are your top criteria in evaluating practice opportunities?
As a result, the potential pool of attractive physician candidates is even smaller than projected.
So, how do you attract the right physicians?
First, superior physicians are attracted to organizations with a clear commitment to quality. Embrace evidence-based medicine, set outcome goals, pursue them, and do not compromise. A “warm body” will not help you meet your goals and a collection of warm bodies can set your organization back for a generation.
Second, be willing to invest. You might have to pay more for better performing physicians. Finally, differentiate around the patient experience. Create a positive, different, and memorable experience for patients and the best physicians will get excited about working with you.