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Physician-Hospital Relationships & ACOs 33 How Has the Rise of Physician Employment Changed Hospitals' Recruitment Strategies? By Molly Gamble T he appeal of hospital employment to physicians is no secret. Upon completion of their training, more physicians are looking to work in either larger, independent group or hospital-owned practices, whether for financial reasons, lifestyle preferences or a combination of the two. The number of independent physicians, or providers with a financial stake in their practice, shrunk from 57 percent in 2000 to 39 percent in 2012 and a projected 36 percent in 2013, according to data from Accenture. In the latest annual Residents and Fellows Survey conducted by Cejka Search, 46 percent of respondents from medical schools' 2012 graduating classes said group practices were the ideal choices, while 29 percent said hospital-affiliated practices were most preferred. And interest in employment is not restricted to fresh-faced residency graduates, either. Many established physicians in private practice are losing interest in entrepreneurship and the risks associated with it. "The fact that established physicians also want to become employed has changed hospitals' attitudes toward recruitment," says Max Reiboldt, CPA, president and CEO of healthcare consulting firm Coker Group. These findings suggest a natural and progressive physician exodus from private practice into group practices and health systems, begging the question of whether physician recruitment is still imperative to hospitals these days. The answer? Very much so. "Recruitment efforts are still very much an issue for hospitals," says Marc Halley, president and CEO of Westerville, Ohio-based Halley Consulting Group, a physician practice management and consulting firm. "Regardless of the model used, whether employment or an income guarantee, hospitals still have to recruit. In fact, for some specialties like primary care, recruiting is a lot tougher today." Phoenix-based Banner Health's goal for 2011 was to hire 220 physicians. "We successfully met that goal," says Anne Folger, senior director of physician recruitment for Banner. One of Banner's strategies is to build Banner Medical Group, which is about three years old and has just over 800 employed physicians. "That number will continue to grow," says Ms. Folger. "The trend we're seeing nationally is that both new graduates as well as seasoned practitioners are more interested in employment model." Certain demographic conditions and emerging models of care delivery are calling for hospitals to revisit their recruitment strategies to not only attract the number of providers they need, but specific qualifications as well. Here, experts weigh in on new trends in recruitment strategies, the responsibilities of hospital CEOs in the process, challenges facing rural hospitals and how accountable care organizations are changing traditional employment requirements. Role of the hospital CEO in physician recruitment "Is the hospital physician-friendly, or not so much?" That's a crucial question physicians want answered when considering a hospital's employment opportunities. The answer depends on whether physicians are appointed to leadership positions, whether incentives are aligned and other determinants. But the hospital and/or health system CEO plays a huge role in physicians' perception of the organization. The physician culture will become evident during the recruitment period, meaning CEOs best be mindful of how they interact with medical staff. Word travels fast. "Physicians will be exposed to other members of the medical staff, and medical staff will be very honest about what the institution and the CEO are like," says Aimee Greeter, senior manager at Coker Group. "I can name certain CEOs who have pro-physician reputations. They're communicative with medical staff, and even when making unpopular decisions, they are not hiding back in their office. They tend to be held in higher regard by the medical staff as a result." Aside from developing and maintaining a pro-physician hospital culture, CEOs can reinforce recruitment by acting as market managers. In this role, the CEO looks at the physician workforce holistically and continuously identifies opportunities for hospital-provider alignment. "Instead of CEOs being concerned about new pieces of diagnostic equipment, they're very much concerned about having primary care physicians in the right neighborhoods to feed subspecialists affiliated with their hospitals," says Mr. Halley. "Those market managers are, by nature, good physician partners. They understand the world does not revolve around the hospital — it revolves around an integrated system of care delivery." The curveball of accountable care organizations With their emphasis on care coordination, team-based care delivery and evidence-based medicine, ACOs are demanding new qualities from physicians. According to a recent survey from the Mediscus Firm, 73 percent of healthcare executives involved in ACOs said the delivery model will change their physician recruitment goals or processes. Specifically, the majority of executives said they expect to increase recruitment efforts for non-physician providers, such as nurse practitioners and physicians assistants, to build up their provider ranks for ACOs. ACOs are not only influencing the type of providers recruited by hospitals, but also the professional qualities and attitudes those providers hold. There is a delicate balance between attracting a large number of physicians to develop an integrated team, and recruiting physicians who have demonstrated potential throughout their residency. It's not always easy to differentiate subpar from high-quality physicians, especially if the individual has just left residency. But hospitals still keep an eye out for time-tested predictors among candidates, such as productivity. Hospitals want physicians who are quick to accommodate larger patient volumes. "When we start looking at potential folks coming out of training, we want to know how busy their residency was," says Mr. Halley. "If they had a busy residency, they may have seen half a day's work by their third year and be comfortable with that volume. If they saw eight to 10 patients in half of a day by their third year, and you say, 'You need to get to 25, 28 patients a day,' the doctors can say, 'OK, I was almost there in my residency program.'" Hospitals are also seeking nimble physicians who are open to team-based care, which is especially critical since advanced practitioners will play an expanded role in care delivery. In the Mediscus Firm survey, 78 percent of healthcare executives said a team-oriented outlook is necessary for physicians participating in an ACO. Ms. Folger says this trait is in high-demand at Banner, as well. "We are very much looking for folks that work well on teams. We look for someone who is very collaborative and has a high tolerance to changing environments, because we know we have to evolve," says Ms. Folger.