What Do Hospice and Palliative Medicine (HPM) Physicians Look For in a New Opportunity

I'm often asked what has made us (DAI Palliative Care Group) successful  in recruiting palliative medicine physicians. There are, of course, a number of reasons. Experience is one. Our experience "informs" our recruitng efforts. We've made a study out of understanding what physicians look for. We've come to appreciate "What's Important in a Practice Opportunity to Palliative Medicine Physicians".

 

We 've learned from our experiences in HPM physician recruiting that most prospects evaluate practice opportunities through four filters. Let's refer to these filters as:

 

• Rewards (monetary) 
• Community/environment (supportive culture of teamwork and recognition of contribution by HPM physicians) 
• Workload schedule (manageable workload and sustainable schedule) 
• Autonomy/control (ability to impact key factors that affect job performance).

Of course, each physician will place his or her own value upon each of these criteria in career decision-making.  The key to recruiting physicians (particularly in a market  where demand far exceeds supply) is to create a practice opportunity that recognizes and addresses all four filters in a balanced way.

Future posts will offer more detail into each of these filters and recommendations on how to create the "balanced" HPM practice opportunity.

 

 

 

Recruiting in Markets Where Demand Exceeds Supply

From time to time, clients inquire how they might best recruit a talented palliative care specialist. I've found success by utilizing recruitment approaches that have produced results in other markets where demand for talent exceeds its supply. In such markets, the scales are tipped in favor of the professional, in this case, the palliative medicine specialist.

How to best restore a balance? By understanding how specialists in short supply make career decisions, and then using methods that can best reach those "passive" candidates. The most commonly used method - job board postings - are most effective in reaching "actively-looking" candidates, usually in markets where supply exceeds demand. Such postings will typically not work in reaching "passive" candidates, since these individuals know well that, because of their relative scarcity, securing a new position is relatively easy.

Candidates in short supply need to be "approached and asked" and then "sparked and nurtured". This process is very demanding of time on the part of the hiring company /manager, and so frequently the "inside" recruitment team will be strengthened on an adhoc basis by bringing on a recruitment specialist with insider knowledge of the particular market.

When to Add a Hospice and Palliative Medicine (HPM) Physician to your Practice

Most hospice and palliative medicine (HPM) programs and practices are experiencing growing demand for their physician services. These growing pains, obviously, can put a strain on current staff and the practice's infrastructure. A physician practice that is stretched beyond capacity because of an unfilled position cannot carry the patient and on-call load of a larger group for an extended period of time. The overtaxed and overwhelmed physicians are prime candidates to leave the practice, seeking opportunities where they can find better control over their workload. In other words, unfilled positions beget unfilled positions. That is why turnover is often referred to as the "silent killer" of a practice.


One of the most challenging tasks for a HPM medical director or practice manager is determining how many physicians are needed to staff the program. Since most HPM practices do not generate revenue greater than their compensation, knowing when to add a full-time physician is not an easy decision to make. But it is important to consider the costs and lost revenue associated with an unfilled position as well as the salary it takes to fill it. Take a hospital inpatient palliative care consult service, for example. A 2008 study by the National Palliative Care Research Center found that savings from palliative care consults for hospital inpatients ranged from $1,500 to $5,000 per admission. A palliative medicine physician who performs 40 such consults per month will produce savings of at least $60,000 per month for the hospital. Or take a hospice program with a palliative care consultation service and a physician making home visits to palliative care patients. One-third of those patients can be expected to transition to the hospice benefit, generating, on average, $1,500 in hospice revenue per patient. An HPM physician visiting 30 patients per month on the palliative service will produce $15,000 in patient service revenue for the associated hospice.

While these guidelines are handy in building a case, alone they do not make a clear case for when a physician should be added. Nor will the conceptual approach, projecting the work for a time period (e.g., 5,000 home visits/year) and dividing that projection by the amount of work performed by one FTE HPM physician (e.g., 920 home visits/year). Careful consideration of several other factors will also enhance the decision-making process: use of non-physician providers, such as nurse practitioners; variation in workload (need to staff higher than the average to address spikes in service demand); expectations around nonclinical commitments that may include administration, teaching and research; and the need for off-hours coverage, vacations and the like. The right timing in adding a physician to a HPM practice will likely accelerate success. Mistiming will stymie program (and practice) growth. In future posts we will look more closely into effective ways to attract the right candidates to your practice.

Hospice Medical Staff Development Plans

Trained as a hospital administrator, and having worked in hospital executive positions, I've seen the power of careful and timely hospital medical staff planning in furthering a hospital's commitment to its community's health. Effective medical staff development offers other benefits to the hospital, not the least of which, I've found, is that a link will be created between the physician recruitment campaign and the hospital's strategic plan and its growth objectives.

So, I've wondered frequently since my career headed into the palliative care field, would medical staff development plans (MSDPs)for hospices produce similar benefits? My experience suggests that they would. As hospices move beyond their traditional role of serving terminally ill patients who have elected to use the hospice benefit, and toward a leadership role in shaping end-of-life care throughout their communities, the role of the hospice’s physician staff is being redefined. Hospices are evolving into advanced palliative care organizations in which care spans organizational and professional boundaries, while integrating physician services into a traditional nurse-centric organization, and simultaneously adopting a collaborative model. Such a convergence will, unsurprisingly, strain an organization’s resources and its roles.

At their best, MSDPs are an objective quantification of community need on a palliative care basis. The challenge, we've learned, is identifying a standard for staffing of programs. In developing a plan, we consider the following:
-Variability in clinical commitment of current staff
-Presence and clinical role of providers such as NPs and PAs
-Presence of academic practices that may include teaching and research
-Productivity data to analyze MD capacity to absorb additional volumes

So what can a Hospice MSDP offer to the executive leadership of a hospice?
An assessment of community practice around end-of-life care to identify improvement opportunity, and to translate community needs into physician staffing requirements and associated financial commitments. An assessment of the hospice's current capacity, the identification of competencies that are likely to accelerate growth, and the creation of practice opportunities that attract talent and fill competency gaps. Armed with this information, hospice executives are solidly positioned to make a difference in the palliative care practices within their community.

I'm confident that other hospice execs have had related experiences. I'm curious to learn your feedback.