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Beyond the Labels: Lessons for Physician Recruitment in Changing Times
SEP-08-2006
Carol Westfall, President
Cejka Search
John Powers, Attorney
Husch & Eppenberger, LL
St. Louis, September 18, 2006 - Bob Dylan turned 65 this year.a milestone that highlights the irony of his most famous lyrics:
Come mothers and fathers throughout the land
And don't criticize what you can't understand
Your sons and your daughters are beyond your command
...For the times they are a-changin'.
The medical profession continues to be dominated by physicians of Dylan’s generation. Labeled as the “Boomer” and “Mature” generational segments, these are the physicians who ushered in some of the greatest advances in medicine, earned the trust and loyalty of their patients, built successful practices and raised their own families -- amid a rapidly changing health care system.
These are the physicians who are looking to their “sons and daughters” to continue to replenish their profession, care for their patients and take over their practices. But today, many physicians are coming to realize that handing over the reins and riding into the sunset of retirement is a greater challenge than they anticipated.
Yes, the times are changing. Driven by new market realities, a dramatically different demographic physician profile is developing.
According to the American Medical Association:
- 18% of practicing physicians are at least 61 years old, and 49% are between 42 and 60. Combined, 67% of practicing physicians fall into the generational segments labeled as “Mature” and “Boomer,” respectively. And within this combined group, 88% are male.
- Roughly 33% of practicing physicians are 27 to 41 years old, representing the “GenX” segment. Within this generation of physicians, 58% are male and 42% are female.
- Millennials, born after 1980, are just now emerging from medical school. Although small in numbers at this point, 54% are women. This is the first segment in the history of modern medicine in which women will represent the majority of physicians.
These young physicians bring with them new values, needs and expectations that today’s healthcare leaders must thoroughly understand in order to effectively recruit and retain this future generation of physicians. After all, they will ultimately shoulder the responsibilities of delivering healthcare services and managing physician practices.
Demographics aside, the core issue is the physician shortage: there are simply too few physicians trained and ready to assume care for an aging, growing patient population. According to the Association of American Medical Colleges, in the last 25 years, the U.S. population has increased by 31%, while the number of newly trained medical doctor has remained constant at about 15,000 to 16,000 per year. Meanwhile, the number of physicians reaching retirement age accelerates. It’s a physician workforce collision in the making.
Young physicians have more options than ever, but they are entering practice with greater debt loads, the prospect of sky-high malpractice premiums, and uncertain reimbursement rates. They demand more, both because they can. That is why it is important to understand the prevailing cultural differences and market forces in order to adapt your recruitment and retention practices to meet today’s realities.
Crossing Cultural Divide to Employ the Candidate of Your Choice
Hundreds of gray heads nodded in recognition with the generational profiles offered in the general session of AMGA’s 2005 National Conference, presented by Cam Marston. He is author of the book, Motivating the “What’s in it for Me” Workforce (Marston Communications 2005).
Boomers and Matures remember entering the work force ready to “climb the ladder” and “pay their dues” within an organization. They view their time commitment as an investment in their careers that would yield future rewards. Today, these physicians expect that younger physicians will – or should – do the same.
Wrong! According to Marston, young GenXers and emerging Millennials carefully guard their time.While strongly loyal to their principles and their families, they are less loyal to their employers than their parents were to theirs. Rather than viewing the practice opportunity you offer them as the start of their lifetime career, your young recruit may see it as a means for building a personal – and portable – portfolio of career assets.
Volumes are being written about how veteran and new physicians can improve their communication styles to arrive at shared expectations and goals in the workplace. But it is also important to understand the practical aspects of recruiting to gain a competitive edge and improve your odds of attracting and keeping the candidate of your choice.
The first step is taking a comprehensive approach to recruitment and retention. This starts with new hires and requires nurturing physicians as they evolve throughout all phases of their careers. A best practice recruitment model aligns physician recruitment strategies with retention initiatives. It is designed to hire the “right” physician – one who fits well within your cultureon retention initiatives. This includes building relationships between the physicians, the practice and the community they serve to decrease the turnover.
The importance of alignment and cultural fit is underscored by the findings of the 2005 Cejka Search and AMGA Physician Retention Survey, in which “practice issues” were cited as the top reason physicians leave a practice, with “poor cultural fit” prime among these issues.
Setting Expectations Everyone Can Live With
Establishing clear expectations is paramount. Employers and new recruits will mutually benefit from aligning their expectations with the realities of the practice, including productivity goals, the compensation model, work environment and leadership expectations.
Healthcare leaders should be aware of generational “traits” that appear to be emerging as factors in candidate expectations. While it is dangerous to make broad generalizations, GenX and Millennial generations were raised to view their parents as friends and confidants. They use modern technology (think cell phones, email, handheld email devices, text messaging and instant messaging) to communicate with friends and family on a daily basis and to involve them in their decision making process. The consumer marketplace has catered to them since infancy (think child centric clothing stores, child-oriented TV stations and child specific publications). As a result, they have gained many of the perks of adulthood early in life. As corporate, governmental and institutional scandals made headlines, they were taught to question authority and learned to be suspicious of organizations.
These life experiences translate to a different tone and set of expectations in contract negotiations. For GenX and Millennial physicians, tomorrow is now. Twenty years ago, young physicians may have joined a practice on the strength of a handshake and the expectation of partnership and perks after “paying their dues.”
Today, a young physician may expect an accelerated partnership track, one that includes a reasonable buy-in and early sharing or equity participation in ancillary revenue sources. They want to see the specifics of “how much” and “when” spelled out clearly in their employment contract. That being said, partnership has become less of a carrot for some young physicians. Traditionally, partnership has been perceived as a strong incentive with upside potential. In today’s world of high starting salaries, bonuses and guarantees, partnership now may simply represent headaches and risk. Many physicians would rather have the security of employment than to increase their debt and limit career flexibility by being locked into one organization.
This does not mean that Millennials cannot be motivated, it just may mean they are motivated by “apples” instead of the traditional “carrots.” For instance, flexibility and control over time will be a strong, recurrent theme throughout all phases of the recruitment process. Before they will seriously consider joining a practice, physicians want to evaluate call coverage, clinical hours, the number of office and hospital sites, and anticipated patient volumes. Employers should anticipate these concerns and be ready to address them both during the interview process and in their employment agreement.
Be aware that younger physicians may balk if your practice is paperwork intensive and inefficient, or lacks the state-of-the-art medical technology that they were exposed to during their residency or fellowship.
Additionally, the mobility of GenX and Millennial physicians makes tail insurance a much greater source of concern during negotiations. If a physician is ready to settle into the practice with plans to work with you through retirement, the issue of tail insurance is less contentious. He or she realizes that a tail payment is not likely. For the recruit who is testing the waters or wants to minimize future restrictions, the tail insurance cost for a claims-made policy can make or break the decision to join your practice. If you are willing to work with candidates to find middle ground on these issues, it can increase your attractiveness as an employer.
It's A Package Deal
Younger physicians are much more likely to have a spouse or significant other whose career pressures and goals are on par with their own. That makes family time and family proximity paramount for some and creates an added dimension to the work/life balance equation.
Engage the spouse early in the recruitment to understand family ties, professional needs and other motivations. Realize that you are recruiting the “couple,” not just the physician. This strategy will help you determine early in the recruitment process whether your young physician candidate is a viable recruit and a likely long-term hire. It is important to determine those variables early to avoid hiring disappointments and unexpected turnover after you’ve invested significantly in your new physician.
If your practice opportunity is especially unique or in a remote location, consider offering a one-week locum tenens assignment with your practice, with family included in the trip. This experience can reveal a great deal about fit and possibly prevent both you and the candidate from making a costly and painful hiring mistake.
Buyer Beware
Employers should be aware of these expectations, but exercise caution. There is no need to go overboard by putting everything in writing or committing to significant expenditures to meet the candidate’s expectations, before they have some demonstrated success with the practice. This can cause problems later, due to changes in circumstances outside your control.
Nevertheless, you should be as open as possible about the realities of your practice. Describe how the most recent physician became a partner or under what circumstances another foundered. Be sure that the physician you are recruiting spends plenty of time observing the practice in action and offer access to those who will be his or her peers – without the practice leaders standing over their shoulders. By interacting with their prospective peers, your candidate may quickly learn – and more readily believe – what drives the business of your practice. This can make your candidate more willing to meet you in the middle on critical employment issues.
Most importantly, look for the qualities and strengths these young physicians will bring to the practice, and structure the opportunity to leverage these for the benefit of all. GenX and Millennial physicians offer medical practices a tremendous amount in terms of increasing practice efficiency through technology and their generally strong time management skills. They understand the value of team work. They are eager to have goals and expectations spelled out and can thrive in an environment where they receive frequent feedback and mentoring.
Importantly, healthcare leaders should remember that it will be far more productive to seek to “understand” rather than to “criticize” the characteristics and motivations of the GenX and Millennial physicians. After all – Boomers and Matures raised this generation.
John Powers II is a member of the Health Law Practice Group in the St. Louis, Missouri office of Husch & Eppenberger, LLC. John represents a variety of health care entities including hospitals, physicians, health insurance companies and various managed care organizations. He provides counsel on physician recruitment transactions, physician and provider compensation, contracting, Stark II and anti-kickback compliance, mergers and acquisitions, and other basic corporate issues.
Carol Westfall is President of Cejka Search, a nationally recognized physician and executive search organization providing services exclusively to the healthcare industry for more than 25 years. Carol engages in search management, from initial consulting and problem-solving to final contract negotiations, with a wide range of client organizations, including hospitals/systems, academic institutions, group practices and managed care organizations.