Easing the Transition: Private Practice to Employment

Leslie Garson, MD Executive Director, Physician Practices

St. Vincent Regional Medical Center

Howard Gershon Principal,

New Heights Group

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Agenda •  Introductions • Why employment? • Who is being employed? • What are the key challenges? • How are these being addressed?

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St. Vincent Regional Medical Center

•  Est. 1865 •  New Mexico's oldest hospital •  Non-profit, non-affiliated •  Local board of directors •  Major medical center for

19,000 square-mile area

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•  268 licensed beds •  250 physicians •  22 medical specialties •  45 employed physicians •  Level III Trauma Center

(Only in northern New Mexico) •  More than 56,000 Emergency

patients treated annually

St. Vincent Regional Medical Center

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Threats to Private Practices •  Increasing Government regulation •  Growing capital requirements •  Declining reimbursement •  Shifting power toward payers •  Skyrocketing malpractice rates •  Growing consumer demands •  Move towards transparency •  Lifestyle concerns

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Why do Hospitals Employ Physicians? •  To fully integrate care across the continuum

–  Improve outcomes and patient safety –  Reduce resource utilization and duplication –  Align incentives

•  To place committed physicians in outlying markets •  To create or strengthen ties with specialists who

support the Hospital •  To address specific community/employer needs

•  To maximize use of Information Technology

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Physician Employment Trends

Source: SHSMD Survey 2006

30%

51%

72%

57%

Intensivists

Hospitalists

Primary Care

Physicians

Office-Based

Specialists

Em

plo

ym

en

t S

trate

gy

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Source of Employed MDs

•  Established Private Practices • Other employment situations • Newly graduated residents

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Cost to Recruit

Source: Merritt Hawkins & Associates

First year guarantee/ salary $250,000

Benefits 50,000

Recruiters fees 25,000

Candidate sourcing 8,000

Candidate/spouse interviews 5,000

Relocation expense 8,000

Practice marketing 3,000

TOTAL $349,000

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Cost to Replace •  Financial consequences

– Recruitment expenses – Lost revenue

•  Effects on patient satisfaction •  Effects on the organization •  Effects on public relations

Source: American Journal of Medical Quality, Vol. 19, No. 2, 56-66 (2004); A Review of Physician Turnover: Rates, Causes, and Consequences Anita D. Misra-Hebert, MD, et al.

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Why Physicians Move? • More money • Hours/ call schedule •  Focus on patients •  Lack of autonomy/appreciation •  Poor relationships with Hospital

Administration •  Poor relationships with Colleagues

Source: Pinnacle Health Group

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Revenue vs. Satisfaction

73.4

71.5

70.9

69

68.5

67.5

Family Practice

Gen Internal Med

OB/GYN

Gen Surgery

Orthopedics

Cardiology

Satisfaction

HIGH

$

LOW

Revenue Generation

Source: Press Ganey Associates, 2007

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Where’s the Risk?

Orientation, Integration

Negotiation, Closing

Strategy Development, Due Diligence

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You have to have a strategy, not something you hope for, but something you work for.

Floyd Loop, MD

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Key Components of a Strategy •  Expectations • Governance/Leadership • Compensation •  Practice Management

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Cultural Differences Drive Relationship Challenges

*Gill S. Can doctors and administrators work together? Physician Exec 1987;13(5):11-16.

Physician Management

Focus on patient and practice Focus on organizational survival

Rapid-fire decisions based on clinical judgment

Deliberative decisions based on consensus

Hour-day time horizon Week-month time horizon

Responsive to needs of patients, families, colleagues

Responsive to needs of patients, families, physicians, employees, community, Boar d

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Where’s the Risk?

Orientation, Integration

Negotiation, Closing

Strategy Development, Due Diligence

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The Devil is in the Details •  Term •  Duties &

Performance •  Licenses •  Salary •  Benefits •  Vacation & PTO •  Expense

Reimbursement

•  Malpractice Insurance

•  Acceptance of Patients

•  Ownership of Records

•  Non-compete •  Non-solicit •  Termination

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Where’s the Risk?

Orientation, Integration

Negotiation, Closing

Strategy Development, Due Diligence

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• Orienting • Mentoring • Monitoring

Physician Transition Guide

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First Impressions Count: Physician Priorities

1.   Response of hospital administration 2.   Administration deals with changes 3.   Confidence in hospital

administration 4.   Communication with hospital

administration

Source: Press Ganey Associates, 2007

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Orienting: Employee Checklist

•  ID Badge •  Parking Sticker •  TB Fit Testing •  TB Screening •  Mailbox location •  Medical Staff Library location •  Hospital policies & procedures

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Orienting: Hospital Leaders

•  Senior Management Team •  Executive Committee •  Section Chiefs • Medical Directors

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Orienting: Departmental Meetings

•  Emergency Department •  Information Systems •  Health Information Management •  Pharmacy •  Operating Room •  ICU •  Obstetrics •  Outpatient Clinic •  Radiology •  Hospitalist Program

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Orienting: Key Committees

•  Credentials Committee •  Quality Mgmt. Committee •  Pharmacy, Nutrition and Therapeutics (PNT)

Committee •  Infection Control Committee •  Transfusion Committee •  Radiation Safety Sub-Committee •  Medical Education Committee •  Critical Care Committee •  Bylaws Committee •  ER Trauma Committee •  Cancer Care Committee •  Physician Assistance Committee

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Orienting: Information Systems

•  Available Clinical & Specialty Applications

•  Access Codes and Passwords

•  Requesting Support & Services

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• Orienting • Mentoring • Monitoring

Physician Transition Guide

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Mentoring • The Merriam-Webster Dictionary

defines a mentor as "a trusted counselor or guide."

• The Anesthesiology Department of Cleveland’s MetroHealth System defines mentor as "a wise, loyal advisor or coach."

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Mentoring @John Muir

•  “Local” mentor •  “Leadership” mentor •  Social activities

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• Orienting • Mentoring • Monitoring

Physician Transition Guide

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Monitoring •  Productivity

– WRVUS – Clinic Revenue Growth

• Quality – Clinical Indicators (HEDIS, PQRI)

•  Patient satisfaction – Satisfaction Surveys

•  Professional growth. – CMEs

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Putting it all Together

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Focus on Patients “ After becoming an employed physician, I found the

key benefits tend to be fewer management

concerns and general peace of mind. As a result,

I’m able to concentrate on taking care of

patients.”

~ Dr. Gupta, Norton Healthcare

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”My excitement is to have found a place that works for me….It is absolutely acceptable to make choices between money and time, between work

and family. And the career growth I am experiencing is really interwoven with the

personal growth I'm feeling.”

~ Tanya Threewitt, MD, Family Practice

John Muir Medical Group

Quality of Life

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