Retaining Providers in Rural Kentucky
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Transcript of Retaining Providers in Rural Kentucky
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RetainingProviders in Rural KentuckyKRHA Annual ConferenceAugust 16-17, 2012 - Bowling Green, KYJan Hurst, National Rural Recruitment and Retention Network3rnet.org
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• This presentation is sponsored by the Commonwealth of Kentucky Health Care Access Branch/ Primary Care Office (PCO) using federal funds provided by Health Resources and Services Administration/ U.S. Department of Health and Human Services.
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objectives
• Profile trends regarding provider mobility • Note barriers to longevity in practice• List effective methods to enhance retention• Identify rural specific solutions• Develop action plan
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economic climate
Cause• Unemployment and
restricted capital
• Drop in stock market
• Declining housing values and reduced employment
Effect• Delayed expansion
• Revenue shortfalls
• Retirement postponed
• Relocation unattractive
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recovering economy
pent-up demand
improving
conditions
Increased Turnover
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since 2008
5 - 6% turnover
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pre-recession
598,000 physician jobs in US, 20% experienced turnover in 2004
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cost$ of losing physician
• Recruiting replacement expenses• Cost of starting new practice• Loss of down-stream revenue
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over $1 million per FTE
$50-75,000 recruiting costs
Downstream revenue loss
$900,000
New practice startup
$211,000
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‘soft costs’
employee morale
more training
recruiting effort
rush & hire bad fit
practice reputation
workflow disruptions
patients defect
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community dollars
Community benefit of adding
ONE family medicine physician
in Kentucky: $878,642
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shortages drive competition
• AAMC predicts shortage of 159,300 by 2025
• 30,000 more primary care physicians needed in next three years for health reform
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practice determinants
Geograph
ic loc
ation
81%
Call / person
al tim
e
68%
Lifest
yle
64%
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seek hospital jobs
2001 • 3%
2011 • 32%
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job satisfaction
• 43.5% employed
• Only employed group were significantly happier with practice than 3 years before
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kentucky
primary care to population
49% below US average
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28%doctors
43% population
RURAL
KY
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metro not spared
2012• Primary care physician shortage looms even in Louisville
2020• Must replicate entire
current cadre just to replace those retiring
• Study did not include extra needed if health reform enacted in 2014
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expansion plans 2012
83% plan hiring more PCPs
78% will hire more specialists
78% hiring NPs & PAs
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2 demographics display highest turnover
Males close to retiring Young female doctors
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Part time workforce 62% since 2005
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1 in 4 doctors part-time
12% of
males
26% of females
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offer options
• 4 day work week• Job sharing
• Floating schedule• Extended days
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groups vs. hospitals 2011
75% groups offer 4-day workweek and 30% allow job sharing
5% of males & 7% females in hospital based practices worked part-time
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retention strategy
Medical group plans:
76% developing hospitalist programs
65% actively hiring NPs & PAs
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nurse practitioners and physician assistants
13% turnover or double current physician rate
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nursing workforce
•Median age 46
•Over half ready to retire
•Recent growth in•23-26 year-olds
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nurse turnover
Over $50,000
Recruit & train new nurse
To replace Critical Care nurse
Can cost as much as $120,000
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greatest turnover occursin first 3 years
12.9% in second year
34% leave within 3 years
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in better economic times
left in first 5 years
60%
left in first 3 years
47%
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rural maybe more
rural Michigan 50%new
residentsleft first job in 3 years
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causes of turnover
Practice different than expected
• Lack of feedback during first months
Poor cultural fit
• Never joined the community
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practice different than expected
Longer hoursWeekend hours
Evening hoursIn-patient duties
Patient overloadScheduling
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poor cultural fit
Physician or spouse never became part of community
Desire to be closer to family Respect, appreciation missing
Little two-way communicationAbsence feedback honeymoon
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strong rural predictors
Hire rural raised
Or community- minded
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top talent leaves
when they are badly managed
& the organization is confusing & uninspiring
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those in charge
Manage
Hire ability then support
Hold accountable
Reward
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leadership
•First rule of leadership: everything is your fault. -from A Bug’s Life
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drive
• Control over their work
autonomy
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recruit •source•hire
onboard •orientate•integrate
retain •manage •engage
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optimize onboarding
Integrates new staff
Prepares them to succeed-
orientation and
includes
first year
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action plan
Time line
First day, first week
At 30, 60, 90 days
Dissatifiers
Address each issue
Report on progress
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Mentor / buddyProvider
Clinical mentor
Social buddy
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“mentees”
More mobile workers
Social networking
Build corporate loyalty
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socialization
Introduce key stakeholders (let both know in advance)
Assign cross-functional projects (helps prevent silo behavior)
Host events to connect provider & family to other physicians & community
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when do you interview?
before hire
??????
exit as leaving
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structure monthly
be great listener
neutral setting
take notes probe
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ask
stay leave
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stay interviews
What do you like about working here?
Do you feel can advance career here?
Anything I can do more of to keep you?
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create culture of retention
Value employees as people• respect• support
Build strong teams• sense of
community• have fun
Empower employees• involve in
decisions• adequate
resources
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be visible
accessible
openly &
honestly
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practice thankfulness
crave
praise
recognition
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seek out positives
chaos
sincere
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encourage exercise
wellness
half said more productive
40% said more likely to stay
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dealing with adversity
kindness
inner peace
resiliency
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little steps mean a lot
FloorUnitOne
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happiness is contagious
you
to
them
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“Our greatest assets walk out the door every night, and the company desperately hopes that they return the next morning.” - Google
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presenter
• Jan Hurst, MSPH, RN, FMSD, CMSR National Recruitment & Retention Network 3rnet.org Director University of Louisville Physician Placement phone 270.821.4516 fax 270.821.3647 [email protected]
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thank you for all you do