The Future of Primary Care Recruitment WORKFORCE PROJECTIONS Supply and Demand.

The Future of Primary Care Recruitment

WORKFORCE PROJECTIONSSupply and Demand

Physician Workforce

Active Workforce

• Approximately 767,100 physicians <75 in active practice that have completed Graduate Medical Education

• Women comprise 31% of the workforce

• Physicians ages 65-75 comprise 10% of the active workforce

• Physicians ages 55-64 comprise 26% of the active workforce

• 36% of all physicians will likely retire in the next decade Association of American Medical Colleges

Physician WorkforceActive Workforce

• 240,800 (32%) in primary care • 125,600 (16%) in medical specialties• 155,300 (20%) in surgical specialties• 245,400 (32%) in the remaining specialties

240,800

125,600 155,300245,400

Association of American Medical Colleges

Physician WorkforceNew Entrants

Using Status Quo Supply Scenario approximately 29,000 Annually

• 8,500 (29%) PC Physicians • 5,200 (18%) Medical Subspecialties• 5,200 (18%) Surgical Specialties• 10,100 (35%) Other Specialties

Primary

Care

Medica

l Sub

s

Surge

ry

Other

8,500 5,200 5,200

10,100


Physician WorkforceSupply vs. Demand

• Demand continues to grow faster than supply, leading to a projected shortfall of up to 94,800 by 2025

• Projected shortfalls in primary care 31,100

• Demand for non-primary care physicians will exceed supply by up to 63,700 physicians

66,700

133,200

2025


Supply Scenarios All Specialties


2015 2018 2020 2022 2025 765,000

775,000

785,000

795,000

805,000

815,000

825,000

835,000

845,000

855,000

865,000 861,800

848,800

833,900

810,500

767,200

800,900

Retire 2 Yrs Later

GME Growth

Status Quo

Millennial Hours

Reitre 2 yrs Ear-lier

Supply / Demand ScenariosAll Specialties

2015 2018 2020 2022 2025 750,000

775,000

800,000

825,000

850,000

875,000

900,000

925,000 911,400 906,700

890,300

864,900 861,800

848,800 833,900

809,100

800,900

D - Demo/ACA/MCD - Demo/ACAD -DemoD -APRN HighS - Ret. 2 yrs laterS -GME GrowthS - Status QuoS - MillennialS - Ret. 2 yrs Earlier


Supply / Demand ScenariosPrimary Care

2015 2018 2020 2022 2025 240,000

250,000

260,000

270,000

280,000

290,000

300,000 301,600

292,300

287,100

266,700

275,600 271,200

259,500

256,700

D - ACA / MC

D - ACA

D -Demo

D- APRN High

S - Status Quo

S - Ret 2 yrs Later

S - GME Growth

S- Millennial

S - Ret. 2 yrs Earlier


Physician WorkforceOther Stats

• 1987-2010 population grew 24%, number of physicians trained only grew by 8%

• 20% of Americans live in rural areas, only 9% of physicians practice in rural areas.

• Fewer than 1% of final-year residents prefer to practice in communities of 10,000 or less

• Female physicians practice an average of 8 hours less per week than male counterparts

• Physicians under 40 practice an average of 5.7 hours less than those over 40


WORKFORCE IN GEORGIASupply and Demand

Physician Workforce“Georgia’s drought of physicians will become a

crisis”

• 52% of graduates stay in GA to practice

• 17% practice in a wheel state (112 additional FTEs)

• 10% desire to practice in a HPSA, yet only 5.8% have an obligation or visa to do so

• 36% going into practice in ‘14 are PCP (238 FTEs)

• 42% of graduates have $200k+ in debt, up from 13.4% in ‘08

• 39th for physicians per 100,000“Without changes in state’s GME, Georgia will rank last in in

physicians/capita by 2020” GEORGIA BOARD FOR PHYSICIAN WORKFORCE

Potential Solutions toBolster the PC Pipeline

• Physician Reimbursement Reform

• Dedicated funding for PCP GME

• Increased funding for PC training (title VII, Section 747)

• Medical school debt relief

Additional PCP’s Required by 20302099

Or, 38% of current workforce, due to an aging, growing and increasingly

insured population

Current PCP Workforce7,378

Highlights: GA’s Projected PCP Demand

State’s PCP ratioof 1744:1 is

greater than the national average

of 1436:1

A LOOK INTO THE CRYSTAL BALLWhat Does the Future Hold for Recruitment?

Addressing PC Workforce NeedsWhat’s Uncle Sam Doing to Help?

Proposed ‘16 budget invests $14.6 billion through 3 Key Initiatives:

• $5.2b invested in new PC Training Programs• $4.0b invested for expansion of the NHSC• $5.4b invested for expanded Medicaid reimbursement

IS THIS ENOUGH?

Growth in PC Specialties

IM FP OBG PSYC-1.00%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00% 4.50% 4.70%

2.80%

-0.40%

Growth '08 - '14

Fighting for Smaller Piece of the Pie

Non-Clinical RolesRe-search

Big Box

Commercial Payers

Contact Provider Groups

In-Home PC

Concierge Medicine

Traditional Practice

CONTROL WHAT YOU CAN CONTROLSo What Can We Do About It?

Control

Employment Brand

Job Design/ Comp. & Rewards

Process

Onboarding

Retention

WorkforcePlanning

Control

Employment Brand


Process

Onboarding

Retention

WorkforcePlanning

Employment BrandsThe Power of a Brand

These may be a little more difficult

Good Luck!Can you Guess the Company?

Sutter HealthCommunity Health SystemMayo HealthEmoryAscension

Health

Employment Brand2014 Fortune Top 100 Employment Brands

Top 5 HealthcareWho’s on the List?

1. Google Rank

2. GE Humana 51

3. Qualcomm United 81

4. Walt Disney WellPoint 89

5. Goldman Sachs Cigna 91All C

ommer

cial

Payo

rs

Employment Brand • Career Pages

Are jobs updated? Is there multimedia content?

• Job Board Presence Positions listed on general boards as well as niche sites?

• Candidate ExperienceWhat’s Glassdoor say about your brand?What’s your goodwill in the market?

• AccoladesDo you make list(s) for “Best Companies?”

• Social media Does your company blog about its culture?

• Social responsibilityHow does the company rank on veteran, diversity, and “green” lists?

“83% of workers are wary of working with a company

that has a negative reputation”

Fortune Magazine – 2014 Top 100 Employment Brands

Employment BrandFour questions leaders need to know the

answer to1. Why would someone want to work for you?

2. What percentage of your managers have received training on how to deliver the brand experience? Employer Brand International research found only 26% have

3. What is the perception employees and candidates have about your employment brand?

4. How many of your employees would recommend your company as a great place to work?

Employment BrandGlassdoor.com

Facility Rating

Hamilton Medical Center 4WellStar Health System 3.2Archbold Medical Center 3.1Southeast GA Health 2.7Tift Regional 3.1Houston Healthcare 3.4Floyd Medical Center 3.0St. Mary’s Healthcare 2.7

Control

Employment Brand


Process

Onboarding /

Retention

WorkforcePlanning

Primary Care Job Design / Comp & Rewards

Support their Interest • Research• Academics• Missionary Work

Employment is the New Standard

In or OutNot Both

One Size Doesn’t Fit All• Flex-Schedules• Job Sharing• Part Time


$ shown in Thousands 2014 2015 Increase

FP Traditional $211 $221 4.6%

FP Outpatient Only $195 $215 9. 6%

Hospitalist (FP trained) $245 $279 12.1%

Hospitalist (IM trained) $254 $264 3.6%

Psychiatry $227 $246 7.6%

MGMA


How do you Compare?

Update your agreement

Student loan assistance is a

crucial KiSS

Control

Employment Brand


Process

Onboarding

Retention

WorkforcePlanning

ProcessProcurementPartnershipsJob BoardsMobile PresenceVisibility / ReachLose the Taboos

Screening / BackgroundMotivationsCultural fitSpouse / KidsGet’em on a plane

Interview ManagementMilitary PrecisionInterview TeamWOW the Spouse70% Social

ContractingLOI 48 hoursContract 7 days• w/ deadlinePrep for contract

MeasureCxPChannel SuccessCritical GapsKPIs

#1 Client Issue We See

Control

Employment Brand


Process

Onboarding

Retention

WorkforcePlanning

OnboardingThree critical periods

Signature to Start Date

• Practice Startup Planning• Communication Strategy

• Family Involvement

Start Date thru 90 days

• Welcome Sessions• Facility Acclimation

• Practice Developing Planning• Mentor Assignments

• Peer Support

90-days onward

• Practice Health / Wellness Reports• Practice Acceleration Team• Hardwired CxO Touches

• Anniversary / Milestone Check-Ins

OnboardingNeed more ammunition?

Onboarding and Mentoring Improves Retention

A significant majority (85%) have an onboarding process for physicians, yet only 33% of these groups stated their process is formalized through an onboarding committee or task force Groups who assign a mentor during onboarding reported a lower overall turnover rate of 5.8% compared with the 7.2% average turnover for all groups. Extended onboarding correlates to higher retention of physicians in the early years. Groups that provide a year-long onboarding process reported a turnover rate of 9% compared with the average 12.5% for physicians between two and three years with the practice, when turnover peaks.

Retention Facts• National average for physician turnover 7.2%

• Turnover for new grads is 12.4% by year 3

• The average physician generates $1.4 million for their organization

• For every one-point improvement in leadership score, there was a 3.3% decrease in likelihood of physician burnout and a 9% increase in physician satisfaction. - HealthLeaders

• Turn over cost estimates could average between $250,000 to well over $1.0 million depending on calculations used

• Primary care physicians receive 40+ solicitations per week

RetentionUnderstand the Psychology Behind Decisions

to Leave• Burnout• Practice is different than expected or explained• Lack of or poor feedback during first months• Desire to be closer to family• Lack of connection with community• Lack of control over practice• Lack of communication / appreciation from CxO

FP

IM

OBG

PSYC

Ped

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

RetentionPCP Burnout

MedScape

RetentionBurnout Factors

Bureaucratic TaskWork Hours

Impact of ACACog in a WheelLack of Income

Lack of Professional FulfillmentInadequate patient care

Too many difficult patientsComputerization of Practice

Difficult ColleaguesCompassion Fatigue

Difficult Employer

- 1.0 2.0 3.0 4.0 5.0 6.0

The Physicians Foundation

Key findings of the survey include:• 77.4% are somewhat pessimistic or very pessimistic about the future of the medical

profession. • 84% of physicians agree that the medical profession is in decline. • 57.9% would not recommend medicine as a career to their children or other young

people. • 35% would not choose medicine if they had their careers to do over. • Physicians are working 5.9% fewer hours/week than in 2008, resulting in a loss of 44,250

FTEs from the workforce.• They see 16.6% fewer patients per day than they did in 2008, a decline that could lead to

tens of millions of fewer patients seen per year.• 22% of their time spent on non-clinical paperwork, resulting in a loss of some 165,000

FTEs.• 60% of physicians would retire today if they had the means.• Younger physicians, female physicians, employed physicians and primary care physicians

are generally more positive about their profession than older physicians, male physicians, practice owners and specialists.

• In the next one to three years, over 50 percent of physicians plan to cut back on patients, work part-time, switch to concierge medicine, retire or take other steps that would reduce patient access to their services.

• 82% of physicians believe doctors have little ability to change the healthcare system.• 92% of physicians are unsure where the health system will be or how they will fit into it

three to five years from now.

Retention

Control

Employment Brand


Process

Onboarding

Retention

WorkforcePlanning

Workforce PlanningIf 36% of physicians are over the age of 55, and 60% would retire today if they could, we must have a plan in place to replace them

• What skills do you require today vs. what you will need for the future> Different care models, team-based approach, ACO’s, PCMH

• What does the community need show for 3 and 5 years out

• Who on your staff falls into the nearing retirement category> Have you had candid conversations about retirement plans

• How can you retain those planning to retire

Recruit | Engage | RetainBreak Through the

Clutter!

Let’s face it, we all think we live in utopia.

You have to stand out from the crowd.

It is our job to sell candidates on why we are different.

This is a fight and your competition is sitting right next

to you!

Questions

The Future of Primary Care Recruitment WORKFORCE PROJECTIONS Supply and Demand.

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