Hospitalist Recruitment and Retention: Building a Hospital Medicine Program »

KENNETH G. SIMONE, DO, FHM, is a board-certified family physician, Fellow of Hospital Medicine, and the founder and President of Hospitalist and Practice Solutions, a consulting company that develops, restructures, and redesigns hospitalist programs. Dr. Simone founded the first hospitalist program in Maine and served as its administrative director for ten years. In addition, he has developed and rebuilt numerous hospitalist programs nationwide. He is currently Chair of the Society of Hospital Medicine's Chapter Support Committee and a board member of the University of New England.

The Right Way to Build and Sustain a Successful Hospital Medicine Program

This first complete treatment of hospitalist recruitment and retention gives you all the tools and guidance needed to build a new hospital medicine program for your hospital. Moreover, it shows you how to reinvigorate and maintain an established hospitalist program, enabling your hospital to fully benefit from the improved clinical outcomes that a hospitalist approach can offer. All the key elements for building and maintaining an effective hospitalist program are covered, including:

• Developing a recruitment plan that attracts the right people and clearly sets forth expectations
• Hiring the best people to meet organizational objectives
• Implementing an effective retention plan that keeps high-quality staff motivated and committed to excellence

Based on the author's extensive experience in both clinical practice and professional consultation with new and established hospital medicine programs, the book covers such critical topics as:

• Significance of current trends in hospital medicine
• Key factors in successful hospitalist recruitment and retention
• Role of the hospitalist in recruitment, retention, and stabilization of physicians in their communities

Recruitment and retention of physicians in all specialties is a national challenge, and it is expected to become even more difficult due to an impending physician shortage. As more and more healthcare organizations come to understand and embrace the hospitalist movement, this book will prove essential in recruiting and retaining the staff they need to implement and sustain an effective hospitalist program.

Preface xi

1 Physician Supply and Demand 1

1.1 The Aging Medical Workforce 1

1.2 The Growing and Aging Population 2

1.3 Decreased Medical School Matriculation 4

1.4 The Changing Demographics of Medicine 4

1.5 The Cost of Medical School and the Graduate Debt Burden 6

1.6 The Changing Role of the Specialist 8

1.7 The Changing Scope of Primary Care 9

1.8 The Availability and Accessibility of Training Programs 11

1.9 Technological Advances 11

1.10 The Increasing Regulatory Responsibilities Placed on Physicians 12

1.11 Rising Practice Expenses and Diminishing Returns from the Insurance Industry 14

1.12 Utilization of Nonphysician Clinicians 15

1.13 Government Policy 16

1.14 Generational Expectations 18

2 The Hospitalist Marketplace 23

2.1 Age, Gender, and Years Employed as a Hospitalist 23

2.2 Hospitalist Education 26

2.3 Hospitalist Practice Location 27

2.4 Hospitalist Employment Model and Hospital Teaching Status 29

2.5 Control/Hospital Governance of Affiliated Hospital 31

2.6 Hospital Size 31

2.7 Hospitalist Staffing 33

2.8 Coverage Schedule and Night Call Responsibility 34

2.9 Hospitalist Program Growth and Turnover 36

3 The Role of the Hospitalist 37

3.1 Hospitalist Program Patient Type and Encounter Type 38

3.2 Hospitalist Time Spent on Nonclinical Activities 40

3.3 Leader Time Spent on Administrative Activities 41

3.4 Hospitalist Activities Based on Location 42

4 The Hospitalist Recruitment Pool 45

4.1 Building Your Recruitment Network 45

4.2 Identifying Your Candidate Pool 50

5 Challenges Recruiting Hospitalists 57

5.1 Physician Compensation 57

5.2 Practice Model 61

5.3 Work and Call Schedule 64

5.4 Daily Workload 65

5.5 Added-Value Benefits 66

5.6 Medical Staff Support 66

5.7 Hospital Culture and Systems 66

5.8 Technology 67

5.9 Specialty Providers 67

5.10 Referral Network 68

5.11 Hospital Administrative Support 69

5.12 Staff Stability 69

5.13 Community and Practice Culture 70

6 Incentive Plans 73

6.1 Incentive Plan Objectives 73

6.2 Data Systems 74

6.3 Metrics 74

6.4 Benchmarking 79

6.5 Incentive Payout 79

7 National Recruitment Initiatives 83

7.1 Trend in Hospitalist Salary 84

7.2 Type of Incentives Offered for All Specialties 84

7.3 Relocation Pay, and Amount, for All Specialties 85

7.4 Signing Bonus, and Amount, for All Specialties 86

7.5 Amount of CME for All Specialties 86

7.6 Additional Benefits 87

7.7 Hospital-Employed Job Opportunities 87

7.8 Assessment of Fair Market Value and Physician Compensation 89

8 Retention Initiatives 91

8.1 Defining Expectations and Finding the Appropriate Fit 93

8.2 Work-Life Balance 94

8.3 Integration of the Hospitalist Program and Hospitalist Physicians 94

8.4 Support from the Clinical Director and Sponsoring Hospital 94

8.5 Clinical and Operational Support 95

8.6 Opportunities for Career Growth and Advancement 95

8.7 Financial Opportunities 96

8.8 Spousal/Significant Other and Family Integration Within the Community 96

8.9 The Orientation Program 97

8.10 The Exit Interview 100

9 Putting It All Together: The Site Visit and Interview 103

9.1 The Contact 104

9.2 The Site Visit 107

9.3 The Recruitment Team 114

9.4 Discussion Topics 119

9.5 The Interview 121

9.6 The Postvisit Phase 133

9.7 Hiring Protocol 134

10 The Contract 137

10.1 Employment Arrangement 137

10.2 Qualifications 137

10.3 Standards of Service 138

10.4 Physician Services 139

10.5 Duties and Responsibilities of the Employer 139

10.6 The Term of Employment 139

10.7 Hours of Employment 139

10.8 Compensation 140

10.9 Professional Liability 140

10.10 Employment Activities Outside the Practice 141

10.11 Restrictive Covenants 141

10.12 Termination of Employment 142

10.13 Patient Record Ownership 143

10.14 Confidentiality 143

10.15 Financial Relationship Between Employer and Physician 143

11 Practice Management Strategies 145

11.1 The Hospitalist Budget 145

11.2 Hospitalist Staffing 146

11.3 Program Policies and Procedures 153

11.4 Practice Support 154

11.5 Strategic Planning 155

11.6 Collaborative Systems of Care 157

11.7 Marketing the Program 165

12 Targeting Program Leadership 167

12.1 Attributes of Effective Program Leadership 167

12.2 Mentoring Potential Leaders 171

12.3 Leadership Versus Management 173

12.4 Identifying and Recruiting an Effective Leader 176

12.5 Practice Culture and Career Satisfaction 186

13 Concluding Thoughts 193

References 197

Index 201