1. THE PHYSICIAN RECRUITING MAKEOVER: HOW TO MAKE YOUR FACILITY A DOCTOR MAGNET Presented to: The GHA Center for Rural Health Annual Meeting

2. PHYSICIAN RECRUITING IN 2013 THERE’S GOOD NEWS AND BAD NEWS

3. FIRST, THE BAD NEWS THE PHYSICIAN SHORTAGE IS LIKELY TO GET WORSE BEFORE IT GETS BETTER

4. 50 million more people from 2000 to 2020 (we will be adding the population of England) RISING DEMAND

5. 150,000,000 Additional Physician Visits Per Year By 2020 Based On Population Growth Alone (3.0 visit per/pop X 50 million population growth) Does not factor in age demographic

6. 75 MILLION BABY BOOMERS BEGAN TURNING 65 IN 2011

7. PATIENT VISITS BY AGE Source: National Ambulatory Medical Care Survey; www.cdc.gov

8. FLORIDA IS OUR FUTURE By 2030, the entire country will be as old, on average, as Florida is now. Source: U.S. Census Bureau

9. PHYSICIAN SUPPLY HAS BEEN STATIC FOR ABOUT 20 YEARS 24,000 – 25,000 new doctors per year SUPPLY STATIC

10. A Voice for Physicians 10 THE PHYSICIANS FOUNDATION www.physiciansfoundation.org New Survey Available in September 2014

11. SHRINKING FTEs The Physicians Foundation reports physicians are working 6% fewer hours versus four years ago… A loss of 44,000 FTEs Source: The Physicians Foundation/ Merritt Hawkins 2012 Survey of America’s Physicians

12. CHANGING WORK PATTERNS Physicians are seeing 16.5% fewer patients per day than in 2008 They are working 6% fewer hours They spend 22% of their time on non-clinical paperwork Source: A Survey of America’s Physicians: Practice Patterns and Perspectives, The Physicians Foundation/Merritt Hawkins, 2012

13. RESULT: A “SILENT EXODUS” A 6% reduction in work hours = a loss of 44,250 FTEs 16.5% fewer patients seen per = over 100 million fewer patient encounters 22% of time spent on paperwork = a loss of over 165,000 FTE’s

14. HOW MANY MORE PCs? 30 million newly insured patients X 2 additional patients visits per year = 60 million patient visits divided by 4,000 = 15,000 additional primary care doctors Source: The Lewin Group

15. PROJECTED SHORTAGE OF PHYSICIANS BY SPECIALTY BY 2025 Doctor Deficits Primary care………46,000 (37% deficit) Surgery……………….41,000 (33% deficit) Other patient care…29,000 (23% deficit ) Medical specialties….8,000 (7% deficit ) Source: Association of American Medical Colleges/Modern Healthcare/December 1, 2008

16. GEORGIA PHYSICIAN WORKFORCE GeorgiaState MedianRank 214.7244.539 th GeorgiaState MedianRank 76.190.341 st Active Physicians per 100,000 Active Primary Care per 100,000 Source: 2013 State Physician Workforce Data Book

17. GeorgiaState MedianRank 31.4%30.8%22 nd GeorgiaState MedianRank 20.6%18.2%22 nd Percentage of Active Female Physicians Percentage of International Medical Graduates Percentage of Active Physicians Age 60 or Older GeorgiaState MedianRank 24.7%26.5%43 rd Source: 2013 State Physician Workforce Data Book GEORGIA PHYSICIAN WORKFORCE

18. NOW, THE GOOD NEWS Physicians are seeking alternatives… Is your grass greener?

19. Recruitment Process Opportunity Analysis –Objective review of the opportunity What are the strengths? What are the challenges? –Four Quadrants Quality of Life Quality of Practice Geographic Location Financial opportunity –Practice positioning No opportunity is all things to all people How do you stand out? How are you different? Footer Text: Detail/Disclaimer 01/07/10

20. How do we stand out in a crowded market? In rural America, 50-60% of the hospitals are actively recruiting primary care. What differentiates our opportunity from all of the hospitals in a 100 mile radius? –Work schedule (5 days, 4 days, extended hours) –Outpatient vs. Traditional –Daily hours –Be flexible Footer Text: Detail/Disclaimer 01/07/10

21. Inpatient care Hospitalist program –Neighboring community hospitalist group –Independent service provider –Have local physician provide hospitalist service Provide call coverage compensation –Impacts candidate profile –ED physician assistance –Pediatrics Footer Text: Detail/Disclaimer 01/07/10

22. How do we bring the physician into our community? Hospital employment model –New recruits looking for employed position –Local physicians looking to leave PP Private practice model –Partnering with practice groups Local Neighboring community –Community health center –Solo private practice Footer Text: Detail/Disclaimer 01/07/10

23. Sharing Common Vision Source: HealthLeaders Media | Intelligence Physician Alignment in an Era of Change September, 2010 23

24. Think outside the box Strategic community partners –Community Health Centers http://gaphc.org/ Primary Care Associationhttp://gaphc.org/ Duane Kavka, Executive Director NACHC –Physician employment organizations Footer Text: Detail/Disclaimer 01/07/10

25. Build a firm foundation Establish a recruitment process from the start to the arrival of the new physician –Finalized contract and Letter of Agreement (LOA)!!! –Defined roles on your team –Have a project orientation vs. an ongoing process All efforts toward concluding the search effort and don’t stop until the search is completed. Have a 120 day time frame for completion Footer Text: Detail/Disclaimer 01/07/10

26. Build a firm foundation Compensation/Benefits –How is salary determined? –Production bonus? –Benefits Vacation Sign on bonus (forgivable loan) Retirement Be aware of the value of your benefit package Footer Text: Detail/Disclaimer 01/07/10

27. Who are we looking for? Candidate profile Cast a wide net % of physicians are 46 and older International Medical graduates Candidates on visas (Shusterman.com) –Understand what is needed to recruit a physician on a visa –Treat them the same as all other physician recruits Specialty Advanced practitioners (NP/PA in our top 10) Primary Care (IM, FP, PED, HOSP) are 4 of the top most frequently requested specialties in our 2014 survey. Footer Text: Detail/Disclaimer 01/07/10

28. ARE PA’S AND NP’s THE ANSWER? 83,000 Physicians Assistants 2/3 in specialties 1/3 in primary care Median salary: $91,000 155,000 Nurse practitioners 75% in primary care 25% in specialties Mean salary: $93,310 A 20% deficit of by 2025 Source: American Academy of Physician Assistants, American Academy of Nurse Practitioners, “Physician shortage isn’t the only looming one,” Advance for Nurse Practitioners & Physician Assistants, July 28, 2011

29. BECOMING A DOCTOR MAGNET: A SOUND MODEL IS A GOOD BEGINNING A SENSE OF URGENCY Hospitals, medical groups, CHCs – all are looking for the same doctor you are

30. LEAVE NO STONE UNTURNED Physician conventions Networking with staff/community/residencies The Internet (your site, employment sites, the Chamber site) Direct mail (for “passive” candidates ) Journal ads (focus on residents) High-need doctors (residents, military, J-1s) SOURCING CANDIDATES

31. MEASURABLE ACTIVITY = MEASURABLE RESULTS SOURCING CANDIDATES

32. SOMEONE HAS TO GET ON THE PHONE Usually after hours or on weekends Suggested Telephone Metrics/In- House Recruiters 100 dials per week 10 physician contacts per week 3 Healthcare Center opportunity presentations 1-2 candidate referrals from physicians contacted 1 potential candidate sourced per week SOURCING CANDIDATES

33. SCREENING “Leave your practice, Doctor, take your kids out of school, sell your home, and quit the country club, because have I got the deal for you. Trust me.” HOW DO YOU GO FROM STRANGER TO CONFIDANT?

34. A CANDIDATE IS ON THE PHONE THE “SCREEN” IS THE “ART” OF PHYSICIAN RECRUITING, AND A KEY PART OF THE “ICEBERG” SCREENING NOW, WHAT DO YOU SAY?

35. Screening/Qualifying Physicians Motivation(s) for change –Why are they leaving their current position? Is it personal? Professional? Both? Candidate professional & personal goals –Spouse goals –Family goals What follows the physician screen? –Opportunity presentation Footer Text: Detail/Disclaimer 01/07/10

36. Objectives Of The Screen  Build relationship/rapport with candidate  Identify motivations (personal or professional)  Understand candidate’s priorities/goals  Consultatively address needs vs. wants  Determine whether candidate is a good long-term fit for you Screening, Know the Roles

37. WHO THEY ARE: Understanding each physician is the key to retention, and they won’t care how much you know, until they know how much you care: Family Considerations Hobbies & Non-Practice Activities Training & Previous Experience Research & Subspecialty Interests Work Ethic & Desired Schedule Patient Encounter & Volume Preferences Practice Management Involvement Income Expectations Professional Goals Personal Goals 37 Screening, Know the Roles

38. Family Considerations Where were they born and raised? Are their parents still living? Do they have any siblings? What are their siblings professions? Where do their extended family members live? How often do they travel to spend time with family? Are they married? Does their spouse work outside the home? Do they have any children? What are their children’s interests? 38 Screening, Know the Roles

39. Hobbies & Non-Practice Activities Do they exercise? Where do they vacation? Do they play a musical instrument? What do they do during evenings and weekends? What are their favorite television shows? Where do they live? How is that neighborhood? Is their commute reasonable? Are they a member of a local religious institution or social organization? Is the physician rooted in the community? 39 Screening, Know the Roles

40. Training & Previous Experience Where did they go to medical school? What program provided their Residency and/or Fellowship training? Are there other members of the medical staff that also attended these schools? What other positions have they previously held? Do they have skills developed in prior opportunities that could benefit this current role? Why did they relocate from any earlier practices? Is their present job fulfilling prior unmet needs? 40 Screening, Know the Roles

41. Research & Subspecialty Interests Do they have Fellowship training which is being under utilized? What research projects and/or clinical studies are listed on their CV? Have they expressed interest in developing programs or niche services (for which they’re qualified) within the local market? Is there an opportunity for them to provide these services or does supply/demand and demographics preclude success in this style of practice? 41 Screening, Know the Roles

42. Work Ethic & Desired Schedule Are they intent on building a practice or just in being paid for their time? Are their expectations reasonable? Have they requested scaling back to part-time? How many hours would they like to work? What are the needs of the community relative to the physician’s desired contributions? How can on-call responsibilities be structured in a tolerable manner? Do they tend to stay until the last patient is seen, or make sure to get home on time for personal reasons? Are they open to the recruitment of additional doctors? 42 Screening, Know the Roles

43. Patient Encounter & Volume Preferences What is the health system’s expectation for productivity, and does the physician believe this is both realistic and commensurate with the compensation model? How many patients would the physician like to see per (day, week, year, etc.) in clinic and/or the hospital? Would the physician like a slower patient flow and correspondingly lower income? Is there adequate consideration for patient appointment times relative to new patients vs. return visits? Are satellite locations, and trips back and forth from the office to the hospital causing logistical difficulties and decreasing available time to see patients? 43 Screening, Know the Roles

44. Practice Management Involvement How much involvement would the physician like in the day to day operations of the practice? Does the physician possess the necessary business acumen to run an office with staff, or lead a team with other doctors? Do they expect to show up at a designated location, at a set time, and simply see the patients that have been scheduled for them? If this physician has run a successful practice previously, are their ideas and suggestions being solicited, appreciated and implemented? 44 Screening, Know the Roles

45. Income Expectations Is the originally agreed upon base remuneration still in effect? Is the physician exceeding the guarantee? Does the physician feel the financial potential of the practice was honestly represented during recruitment? Is there adequate demand in the service area for the physician to earn the income they would like? Does the physician have an accurate sense of financial benchmarking data, and are they able to determine if their current productivity is being appropriately compensated relative to national norms? Is the demography and payer mix in the market able to accommodate a normal income range, and if not, are both the employer and physician open to exploring alternative compensation models? When assessing the impact of the practice, are both the physician and hospital cognizant of factors beyond the doctor’s Professional Charges (i.e. non-physician providers, ancillaries, inpatient revenue, etc.)? 45 Screening, Know the Roles

46. Professional Goals Does the doctor aspire to a Medical Director role or a “C” level position within the health system? Is the physician content with their current practice style and apprehensive about additional responsibilities? Do they want to continue working in the community but run their practice privately? Is it possible to build a hospital employed group around this physician leader? Will the physician likely need to pursue opportunities elsewhere to achieve this perceived advancement? Would the physician like to change their position, to slow down nearing retirement, or have more time for family? 46 Screening, Know the Roles

47. Personal Goals Would the physician like to move to be closer to family? Do they have significant student loans or other personal obligations motivating them to earn greater income? Are there changes in their marital status or children altering their professional focus and commitments? Does the physician need training or support in developing their interpersonal communication skills? Is there a negative relationship with a colleague, administrator or staff that needs to be addressed? What are the goals of the physician’s spouse and how are these impacting the families professional decisions? 47 Screening, Know the Roles

48. Opportunity Presentation –This is your one shot! –Comprehensive presentation Community –Broad to narrow focus on region Opportunity Hospital Financial package –Salary + realistic financial expectations –Email follow up that day with supporting documents/web links / presentation summary –Telephone follow up within 4-5 days with confirmed next steps Edit Footer Text 01/07/10 48

49. 14 Days THE ARC OF PERSUASION The Road to the Interview

50. Candidate Interview One interview process with Physician and spouse 70% Social Recruitment team to include community members of similar age and station in life Separate spouse interview Confirmation, not exploration Goal is to secure physician Footer Text: Detail/Disclaimer 01/07/10

51. NOW, THE STAGE IS SET You know your candidate (written profile, professional and personal) The candidate knows you (setting, hours, finances, mission, etc.) Your offer is ready Your team is ready The interview itinerary is ready THE INTERVIEW You’ve got a lot of sweat equity in this search, BUT… EXPECTATIONS ARE CLEAR on both sides.

52. THE PYRAMID OF INTEREST THE DECISION

53. Educational loan repayment http://nhsc.hrsa.gov/loanrepayment/ National Health Scholarship Program –Become an NHSC site –$30,000 - $50,000 loan repayment over a two year period Footer Text: Detail/Disclaimer 01/07/10

54. THE VALUE OF PHYSICIANS TO HOSPITALS 2014 Physician Inpatient/ Outpatient Revenue Survey

55. PHYSICIAN GENERATED REVENUE All Physicians………… $1,448,458 Primary Care………….$1,566,165 Specialists……………..$1,424,917 According to the Lewin Group, the economic value of a physician is $2.2 million

56. COST/BENEFITS

57. RETENTION RETENTION AND RECRUITMENT ARE TWO SIDES OF THE SAME COIN Basic Recruiter Truth 101 Physicians are not pulled from their practices… They are pushed.

58. Candidate Retention Two years is the magic number –If a physician remains for 2-3 years, he/she will establish roots in your community Established retention program –Spouse program –Formal process to monitor physician onboarding for the first two years Footer Text: Detail/Disclaimer 01/07/10

59. SUCCESS! Now, it is time to incorporate the new physician into the Retention Program while the Recruitment Cycle begins again.

60. If you have any questions, please contact Mark Conley at: Mark.conley@merritthawkins.com Follow Us:

61. THE PHYSICIAN RECRUITING MAKEOVER: HOW TO MAKE YOUR FACILITY A DOCTOR MAGNET Presented to: