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This episode of the MGMA Business Solutions podcast features Dr. Pamela Ograbisz DNP, FNP-BC and Scott Selby of LocumTenens.com. Dr. Ograbisz is vice president of clinical operations while Scott Selby is senior vice president in enterprise solutions.
LocumTenens.com specializes in the temporary placement of physicians, CRNAs, physician assistants, nurse practitioners and psychologists at healthcare facilities across the U.S.
Dr. Ograbisz joined LocumTenens.com in 2018 and is responsible for the oversight and direction of all telehealth initiatives and Advanced Practice Provider workforce solutions. Since joining LocumTenens.com in 2010, Selby has led eight different divisions and is now a partner in the organization. He currently oversees all enterprise client solutions which includes all account management divisions, the national recruitment team and the national business development team.
Both have been involved with a research paper titled The Innovation Imperative for Physician Retention. They sat down with MGMA Sr. Editor Daniel Williams, MBA, MSEM to discuss the importance of using innovative solutions to retain physicians in today’s ever-evolving healthcare landscape.
Q. Scott, what motivated you to undertake this research on motivating clinicians to stay at their current practice?
A (Scott). I think the obvious answer is that this is just something that plagues every healthcare organization out there. A few different observations we've seen over the last couple of years led us to really want to go into researching this further. We wanted to dig in and really try to at least be a small part of what the solution is and how we get there.
One of the things that kind of shocked me was that recent MGMA Stat poll [stating] 77% of medical groups reported that there was no formal strategy whatsoever on retaining physicians and retaining their staff. Physician shortage is something that plagues every part of our country as well as every healthcare organization. Retaining the clinicians you have on staff today is something that's relatively easy, but extremely impactful and an initiative that every organization has got to be more proactive about. Turnover impacts the bottom line. It impacts patient care, employee morale, team morale and the overall culture within your organization. Speaking with healthcare leaders, it's been clear that in order to address turnover, they've got to do a better job of digging in and really communicating with their physicians and their clinicians in general.
Q. Pam, what were some of the key findings from the research?
A (Pam). I think that one of the biggest things was that healthcare organizations are measuring performance, but not a lot of them are making it their business to measure employee engagement and individual development. When you look at your permanent staff — being a clinician myself and having worked inside of a lot of hospitals across the country — you know what it takes for someone to want to stay, to keep your permanent staff motivated and wanting to be a part of that team. When I first got out of school, I would say that locums didn't have the greatest perception. Now that narrative has truly shifted — locums are now necessary.
I think folks that are working locums work are happier. They have more control over their schedules and what they're doing. So a lot of this is looking at, “How do we offer additional relief to support existing staff?” Only 2% of respondents say that they saw locums as a factor for influencing physician retention. But I think that, in all honesty, if you were to look at locums as a solution to keeping permanent staff able to get vacations and moving through the process, I think that would really be excellent.
The other piece of this is that higher compensation bonuses and benefits for physicians are viewed as the top factor for retaining them. I think 71% of our respondents said that was really crucial. Even though physicians are looking for higher compensation and benefits, they're also seeking out flexibility. So I think that if you can't give both – if you say, “Well, I'll pay you but you can't take your vacation this year” or “I’ll pay you, but by the way, you have to work every other call weekends,” — those of us that have been in the industry a really long time, they're throwing their hands up and they're saying, “You know what I've been doing this 25-30 years, and I'm done. I'm going to go ahead and retire early.” That we can't have. We've got to keep our workforce going. And so I think that if we can appropriately utilize staffing modules, then we really can preserve the medical model.
Q. Scott, how are patient satisfaction scores and engagement measured? What are the KPIs to see if they're on the right track and are there any adjustments to be made?
A (Scott). One of the easiest ways is performance evaluations. Within those evaluations, we need to be looking at more than just how well our clinicians are executing their duties by also talking to them about their career goals and their aspirations for advancement. Ask what motivates them and are we as your employer meeting that?
Another easy way to measure satisfaction and engagement is just regular satisfaction surveys. One of the things that we found that was surprising was that large healthcare organizations do a pretty good job of this. I think it was 71% of those respondents in large organizations are regularly surveying their associates/clinicians and getting this intel, but for smaller organizations, only 37% we're sending out regular satisfaction surveys. There's a lot of resources out there now to help you get started with that if you don't have something in place today. Once those surveys are implemented, it's really important to look closely at those responses. Look for trends, look for changes you can make within the organization and then also monitor over time.
Another thing that we found that was really surprising was I believe it was just under 10% of the respondents had absolutely zero formal measures of workforce engagement whatsoever. So that tells me that there's a lot of room for improvement in the industry. Another thing that we learned is that monitoring physicians’ progress against their career goals really makes them feel that their self-actualization matters. So goal setting, helping them with individual development plans and what promotions and advancements are they looking for… all of these things help make careers way more meaningful, especially when you're doing it together with your employer.
The other thing that can move the needle a great deal is mentorship. We were surprised to see that for mentorship in medical workforces, generally less than half of the organizations out there are putting any sort of coaching or formal mentoring process in place. By providing a coaching or mentorship program to clinicians, everybody wins in that setup. So the mentee can be more productive and can gain a lot of valuable intel they wouldn't just from normal experience. For the mentors, it can potentially help them become future leaders and help build other skill sets that can help in many areas of the organization. Overall, the mentorship and coaching programs really have a big impact on retention.
Q. What have you found are the best delivery methods?
A (Scott). We all feel surveyed to death these days. I think it's like Christmas shopping right now, you can't even buy something without getting three surveys from the organization. There are a number of tools out there right now that will help you kind of wrap your arms around this and help you know what types of questions to ask. They are generally emailed out to the organization, but the key factor is communication. All of this is making sure that all of the associates know throughout the organization that this is coming. This is a survey we're taking and this is what we're going to do with the information — we're going to use this to help make your lives easier, improve the culture and all the things that are important to employees.
Q. Pam, what are the main challenges that healthcare organizations face in retaining those physicians?
A (Pam). It's burnout, but I think that in all honesty, it's not the burnout that we think it is. Yes people were tired and yes they felt overworked, but when we looked at the survey data, I think it was 31% actually said that they felt undervalued or underappreciated in the job that they were performing. They were used to long hours and used to the excessive workload, but essentially it was that no one said thanks. Nobody said you're doing a great job or we're so glad that you're a part of the team. I know that sounds silly, but even doctors need to hear that.
I think that we need to look more closely at how we're formulating healthcare teams while becoming more creative about how we're utilizing our medical workforce. And we know that APPs, which includes nurse practitioners, physician assistants, certified nurse midwives, as well as our CRNA colleagues who are providing anesthesia, are all a critical portion of what we are building and coming for in the future.
As institutions look at how they're going to staff, if they're not considering those folks — how they're going to plug them in and how they can bolster physician teams — then I think that they'd be missing a piece of this. The other piece of it is that it's a competitive market. If you want to stay on the leading edge of benefits and compensation and work life balance, what is it that you're going to do to provide your physicians with long term solutions? I think that in the survey, most clinicians said that they were tapping out because they just had hit their limit. But it wasn't just because they were overworked. It was truly because they no longer felt that same love and passion that they had for medicine and that's something that we definitely want to prevent.
Q. Pam, could you please share some insights from the research on the role of innovation in motivating clinicians to stay within their current organizations?
A (Pam). I often go and visit our clients. I'll sit down with them and they'll say, “We're struggling in this area and we just don't know what to do.” We start flipping through staffing models and actually start listening to what those physician providers have to say, and most of it is that they just need new options. We need to look outside of the box for how we are going about it. It's no longer just, “let me staff a 12-hour shift and let me make sure it's covered.” It's the fact that everybody is so much more complicated.
The ICU turnaround now often takes so much longer than it used to. How can we be more efficient? How do we streamline? Where do we use underutilized opportunities to keep the workforce engaged, provide guidance and establish open-minded listening channels with our provider teams so that we're really engaging with them on their feedback? I think that's a big piece of it. Giving the physicians and your APPs a voice is crucial.
I think the other piece is that by listening and starting a dialogue, we want to empower folks to impact the patient experience. If we have engaged providers across the board, then I think that they also take on a bigger sense of ownership and leadership inside of organizations, which we want. When we talk about innovation, it's not just business. And let's be very fair – medicine has become a business. Hospitals have to keep their doors open, they have to get compensated, and they have to be paid in order for all of us to do the great work that we do, but there has to be a balance. So make sure that your providers have a voice at the table when you are making those key decisions, because the people that will be impacted – if you have their support before you start, you'll be successful. If you go top down and not involving the folks that are actually doing the work, that's when we tend to see the most pushback.
I think that the word of the future, in my opinion, is “collaboration” across medical teams, which is making sure that our doctors and our APPs [enjoy] collaborative environments. We know that those teams work well together, we know that excellent care is produced by both sets of providers.
Q. Scott, in the factors that motivate younger physicians versus more experienced physicians to stay within those organizations, what did you find out?
A (Scott). I'm always fascinated personally by generations and how they're motivated differently, and some of the surveys and things that we looked at this year didn't disappoint that area. We have a commissioned survey coming out in January that you'll see published that really points to a lot of generational differences. One thing that we noticed was the baby boomer generation is less likely to report burnout, more likely to say they're highly engaged and that they're making progress toward their career goals. But millennials are more likely to cite high stress and lack of work life balance as part of their contributors to burnout. And they are much more likely than baby boomers to feel undervalued and underappreciated in their daily lives and in their work.
Gen Xers are much more likely to be motivated by higher compensation, bonuses, better benefits, those kinds of things. But Gen X also seemed to have retirement in mind and are more likely than boomers to be motivated by a lucrative retirement plan. Then the baby boomers that are encroaching on that retirement age (or semi-retirement) are the ones that are really motivated more by the ability to work part time and want those flexible hours.
The other thing that we focus a lot on here at LocumTenens.com is speaking to residents. We've gleaned a lot of interesting intel from them this year. Ten to 20 years ago, residents and new physicians into the market were not looking at locums. The locums lifestyle is really becoming more and more appealing to this generation that's coming out of medical school residency now. They can pick and choose their assignments – they can see different parts of the country and they can see different clinical environments as well. I think that's becoming more and more attractive to them. But one thing that has certainly become evident from talking to physicians this year (and residents this year) is that young physicians are looking to practice medicine in an employee centric culture, which is very different than a lot of other generations. They appreciate practicing medicine, but they want to do it in a way that does not cost them their lives. They prefer a place that focuses on professional needs over just the company driving revenue and overall output.
Q. Pam, what would you like our listeners to take away from here that can better motivate and retain those clinicians in their healthcare practice?
A (Pam). One of the biggest things would be: in order to win retention, don't be a part of the medical group who doesn't listen – who's not looking towards the future and not planning. You have to live in the present and you have to plan for the future. So I think that a big piece of this is, “how do we continue to measure workforce engagement?” Are you looking at creating KPIs around monitoring the health of your workforce and really making that a planning item in your meetings every month, not just a reactionary status? I think that we want to encourage people to stop being reactionary and start really planning for what staffing looks like and making locums a part of your solution as a partner. The medicals workforce is changing. Their expectations of how they work are changing and if systems don't catch up with that, there's going to be a big disconnect and so we want to help them plan.
Q. Scott, any final takeaways from you?
A (Scott). I think one simple way that organizations can make a big impact on retention is forming a retention committee. There's a lot of promising statistics out there around what this can do for your organization. Taking a small subset of your clinicians and the person that's driving physician recruitment within your organization and forming a retention committee … just the concept of having that within your organization is going to have a big impact on the clinicians throughout. This will also allow a voice from the clinicians to ask what they want, say what's not working, what's missing…those types of things. That can really help develop new programs and changes within the organization. It's coming from the clinicians. It's not coming from the executives that are handing it down from the top. I think that's one thing that will immediately make an impact. Then just growing that over time and fostering that kind of environment can have a big impact as well.
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The physician business training course is for early-career physicians or physicians who need a comprehensive understanding of the business of medical practices. The course is 7 hours long and broken into 9 modules. It was developed by Medical Group Management Association (MGMA) and leaders from Johns Hopkins University School of Medicine. This course awards 7 hours of CME credit.
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