Jessica Barrick is a Senior Recruiter at Corazon, Inc., offering strategic program development for the heart, vascular, neuro, and orthopedic specialties. Corazon offers a full continuum of consulting, software solution, recruitment, and interim management services for hospitals, health systems and practices of all sizes across the country and in Canada. To learn more, visit www.corazoninc.com or call (412) 364-8200. To reach the author, email jbarrick@corazoninc.com.

The recruitment of expertly trained specialty physicians to a new or growing hospital-based program or practice is critical in order to compete in today’s healthcare marketplace. However, as the number of hospitals offering advanced services grows, the result is greater market demand for many specialists, which is complicated by a diminishing supply. The shortage will be further exacerbated as the expansion of insurance coverage and the aging of baby boomers likewise drive demand for care.

In cardiology in particular, shortages are projected to worsen into the future.  As reported in the Journal of the American College of Cardiology (JACC), there are currently at least 4,000 too-few cardiologists to fill open private-practice and academic positions, and this shortfall is predicted to rise to 16,000 by 2050. When these researchers further examined open positions to find how many employers were seeking cardiovascular specialists, they found the following shortages:¹

• 1,685 general cardiologists
• 660 electrophysiologists
• 1,941 interventional cardiologists (coronary and peripheral combined)
• 127 pediatric cardiologists

Several factors will continue to drive the demand for cardiologists, and one thing is certain: the cardiovascular disease burden in the United States is significant and growing. Each year, cardiovascular disease strikes 1 to 2% of the U.S. population and this trend will only continue over the next several decades. While clinicians have worked to reduce cardiovascular mortality, the ACC Board of Trustees Workforce Task Force has estimated that deaths from heart disease will increase 128.5% between 2000 and 2050², an increase that has already greatly impacted the healthcare industry as we move through the beginning of this period.

Unfortunately, not enough cardiologists are trained and/or available to serve these patients. Fifteen percent of C-suite and cardiovascular professionals surveyed by the ACC in March 2012 said that recruiting cardiologists was one of the biggest hurdles.² A 2010 survey² revealed that cardiologists saw an increase in the number of new patients. On average, cardiologists reported seeing 349 new patients in 2009 alone. By 2025, the shortage of general cardiologists could grow to 16,000, and by 2050, the number of practicing cardiologists will need to double.¹

U.S. hospitals have also begun responding to the implementation of healthcare reform by accelerating their hiring of physicians, many of whom are recent fellowship graduates or experienced physicians relocating from other areas. In fact, more than half of practicing cardiologists today are now employed by hospitals or integrated delivery systems. 

Typically, the hospital’s chief motivation for using a physician employment approach is to gain market share, which is typically done through service line strategies that are encouraged by a fee-for-service payment system that rewards volume. At the same time, stagnant reimbursement rates, coupled with rising costs of private practice and the desire for a better work/life balance, have contributed to physician interest in hospital employment. While physician employment or other forms of alignment may improve quality through better care coordination, hospital employment does not guarantee clinical integration. As hospitals hire more physicians, they must set clear expectations for productivity, and outline responsibilities for sharing the clinical workload and participating in program leadership.

An organization can implement several strategies in order to be better prepared for cardiologist recruitment. The passive approach of posting a position on the hospital’s website and waiting for the candidates to apply is no longer enough. Proactive search efforts for candidates are a must. There are too few qualified candidates to expect an influx of potential hires.  

Corazon recommends the following:

• Build relationships with residents and fellows of the organization, as well as with leaders representing other organizations’ training programs. Getting to know physicians who are at the front end of their career can lead to a long-term, loyal relationship should the physician choose to stay.  
• Encourage the medical staff to actively participate in professional associations related to their specialties. Memberships in these organizations often allow access to member mailing lists, which can be a tremendous resource in recruitment.  
• Develop a network of contacts using social media. According to a recent LinkedIn marketing solutions blog, LinkedIn reaches over 40% of physicians and surgeons in the country, with over 360,000 users who specialize in everything from cardiology to radiology and anesthesiology.³

Even if a current need doesn’t exist, a hospital should always be building an internal database of prospective candidates for the future. This background work will provide a springboard for success when the time comes for hiring. In fact, building a pool of potential candidates and vetting their qualifications is often the most time-consuming step of the recruitment process; thus, ongoing work on a database will pay off in the long-term.    

Organizations that are poised to have the greatest success with physician staffing will devote as much attention as possible to proactive recruitment and also, retention. Hospital employers must recruit carefully, clearly articulate expectations, and enlist the help of strong leaders to minimize turnover and conflict among physicians. To ensure a search effort is effective, organizations first need to assess their needs as well as situations that could affect the success of recruitment. 

1. Can the hospital support another cardiologist financially? In terms of volume?
2. Does the hospital/physician practice offer interesting procedures, collegial colleagues, and a positive culture in order to entice candidates to apply? Are there significant internal or external issues that need to be explained, such as financial difficulties, strong competition, etc.?
3. Is the need for someone driven to become highly productive in terms of patient throughput? Or someone to serve more as a leader?  
4. Is the hospital looking to advance cardiology services?
5. Is the organization actually prepared to extend an offer? 

A committee of physician stakeholders, recruiters, and hospital administrators should be assembled prior to starting the search so that decisions can be made quickly. Doing so will also ensure consensus of all individuals with key roles in integrating new hires. 

The above suggestions for questions to consider will help define the ideal candidate. Indeed, knowing first what type of hire is necessary alleviates delays that may occur if such questions arise during the interview/selection process. A candidate may have all the qualifications, but if his or her personality isn’t a fit with the organization overall, it’s best to move on. Conversely, the candidate may be a cultural fit, while missing experience or qualifications key to the role. In either case, the big picture must be considered if a ‘good hire’ is to be made.

When struggling to retain physicians, it is worth trying to figure out why they are leaving. Some of the most common reasons a physician voluntarily resigns from a practice or hospital are depicted in Figure 1.⁴

When looking at the reasons why physicians leave, consider what can be controlled, because those factors, such as compensation and scheduling, can be manipulated to offset what can’t.

The ultimate success of a placement depends heavily on the hospital’s commitment to recruitment and retention; however, organizations continue to make common mistakes. Corazon believes even just minor adjustments to the recruitment process can shift focus and have a positive impact on the results.  

1. Some organizations wait to make contact with the candidate until everyone in the organization has reviewed the applicant’s information. But this process usually creates a long timeline due to workloads, schedules, etc. An unfavorable first impression may result, and the physician candidate may feel he or she is not important. The more time passes, the greater the risk of losing the physician from the candidate pool. Corazon advises clients that physicians, especially preferred ones practicing in an in-demand specialty, are not just looking at one facility, but many others in parallel.
2. Often, hospitals end the phone interview call with “we will be in touch soon to have you speak with…” This not only lengthens the recruitment process, but the physician may become disengaged after multiple calls over several weeks or even months. Instead, we recommend closing the initial call by scheduling a site visit for the candidate. If it becomes necessary to have a candidate speak with someone else, then scheduling a site visit in parallel to the additional call can optimize timing as well. 
3. Creating a standard on-site visit schedule for all candidates serves as an important step in the process, though a one-size-fits-all approach may not be the ideal way. We believe that tailoring the visit around the physician’s character and personal/professional interests is a much better option for a site visit. Indeed, there will be standard elements of all visits, but including personalized components will make the candidate feel welcomed, and will give the impression of the organization going above and beyond. Each candidate is different, and will want to meet certain people and see certain things while on-site. Being flexible and catering to requests as best as possible will do much to entice the candidate to choose your organization.

When becoming employed, most physicians expect a combination of a salary guarantee and an incentive-based bonus. The guarantee provides an appropriate financial foundation while he/she becomes established in the area. Certainly, these numbers will vary according to region, responsibilities, and requirements of the position. Hospitals and practices located in less desirable areas often must pay higher salaries than those in more desirable locations (though one physician’s ‘desirable’ area may be the opposite for another!). Cost of living affects competitive offers as well, so organizations can’t just rely on Medical Group Management Association (MGMA) guidelines — understanding the dynamics of the local market is key to presenting an offer that is likely to be accepted.

Onboarding is a multi-faceted process that begins during recruitment. If done well, the new physician will be off to a strong start in the practice and community.  Likewise, a successful onboarding process aids significantly in physician alignment and retention efforts. Often overlooked is having a thoughtful and well-orchestrated orientation plan in place for newly hired physicians. Savvy hospitals understand the power of first impressions and use the onboarding process to help physicians feel connected to the organization from their first day on the job.

Recruiting and retaining the right physician begins with understanding your organization’s needs and matching them with what your organization can offer. Recruit high-quality candidates and interview them carefully to find the right fit, then negotiate an employment agreement that is fair to both parties. But the process never ends there! Organizations must motivate a new physician off to a fast start, even before his or her first day. Monitoring performance and holding the physician accountable to program goals, organizational vision, and also national benchmarks will create aligned interest for the ultimate benefit of the patient. We believe building a productive and committed medical staff is a realistic and attainable goal…one physician at a time. 

References

1. Rodgers GP, Conti JB, Feinstein JA, Griffin BP, Kennett JD, Shah S, Walsh MN, Williams ES, Williams JL. ACC 2009 survey results and recommendations: Addressing the cardiology workforce crisis. A report of the ACC board of trustees workforce task force. J Am Coll Cardiol. 2009 Sep 22; 54(13): 1195-1208. doi: 10.1016/j.jacc.2009.08.001.
2. Dmyterko K. Where have all the cardiologists gone? Cardiovascular Business. Mar 13, 2012. Available online at https://www.cardiovascularbusiness.com/topics/practice-management/where-have-all-cardiologists-gone. Accessed November 20, 2014.
3. Dunlap M. Leave Gray’s Anatomy on the bookshelf: how modern healthcare professionals engage with social media. LinkedIn Marketing Solutions Blog. Available online at https://marketing.linkedin.com/blog/leave-grays-anatomy-on-the-bookshelf-how-modern-healthcare-professionals-engage-with-social-media/. Accessed May 6, 2014.
4. American Medical Group Association. 2006 Physician Retention Survey. Available through https://www.cejkasearch.com/resources/surveys/. Accessed November 20, 2014.