Coming Soon: 32M New Patients — Now is the Time to Assess Your Affordable Care Act Staffing Needs

In 2014, it is estimated that up to 32 million people will receive health insurance coverage through the Patient Protection Affordable Care Act, granting them greater access to the healthcare system and instantly creating an influx of new patients. This occurs at the same time that many baby boomers are turning 65 and becoming Medicare eligible, at a rate of 10,000 a day. No one knows for sure what the true patient volume increase will be, but everyone agrees that it will tax our current healthcare delivery system.

Facing a well-publicized physician shortage, our already overburdened healthcare system will have to evolve and innovate to meet everyone's needs without creating long wait times, stressed staff and unhappy and unhealthy patients. Being in the healthcare staffing industry, we hear often from our clients about how they are preparing. After all, physicians aren't made or recruited overnight.

Healthcare providers should keep the following statistics in mind while updating their physician recruiting and retention strategy:

• More healthcare providers are employing primary care physicians — the latest Association of Staff Physician Recruiters survey shows that more than 70 percent of searches conducted last year were for practices owned by hospitals or health systems. This aligns with the fact that many healthcare providers are transitioning to coordinated care models like patient centered medical homes and accountable care organizations.
• There is fierce competition for primary care providers  — the same ASPR survey showed the top five most heavily recruited specialties and positions were family medicine, hospitalist, nurse practitioner, physician assistant and internal medicine. Our LocumTenens.com annual compensation survey and report shows that demand is driving higher compensation for these physicians.
• It is taking longer to recruit physicians — the ASPR survey reports the median days to fill a vacancy was 155 across all physician specialties (222 days on average) compared to a median of 120 days (208 days on average) a year before. The median time to fill a primary care vacancy was 151 days (up from 125 days). For advanced practice providers, the average recruitment time remained 90 days.
• Retaining current physicians is becoming more challenging. Many physicians are contemplating retirement or giving up medicine — a 2012 survey by Jackson Healthcare, LocumTenens.com's parent company, found that 16 percent of physicians plan to retire, work part time or leave medicine by 2013. The main reasons cited: economic factors like declining reimbursement, the increasing regulatory burden, burn out and being retirement age.

The following questions can help you start discussions that will help you frame your new and improved strategy and develop the action plan you need to be prepared:

Determining need

• Have you determined the volume increase your facility or system may experience by looking at current rates of uninsured in your population?
• What are the demographics of your patient population? What percentage are over 65 or turning 65 in the next 10 years? Can you determine what your payor mix will look like after the PPACA is fully implemented?  
• Are you located in a healthcare shortage area?
• Have you analyzed the incentives within the PPACA to determine what can help you be better prepared for an increase in new patients?

Physician recruitment/retention

• On average, how long has it taken you to recruit full-time physicians over the past three years? Have you broken this down by specialty?
• What incentives, like loan paydown, housing allowances, etc., are you using to recruit physicians?
• Do you currently use advanced practice professionals in your staffing model? In what roles do they serve, and are you using them to the extent you can as governed by state laws? How long does it take you to recruit physician assistants or nurse practitioners?
• Do you know the short and long-term plans of your current physician staff? What percentage is planning to retire or cut back over the next five years? Can you incent them to stay?
• Are you using locum tenens providers to ensure your employed physicians are able to take time off to recharge and avoid burn out?
• Have you looked at your budgets for temporary staffing needs? Will it need to be expanded to ensure coverage? Have you done a cost benefit analysis of not seeing patients vs. paying for temporary physicians?
• Have you discussed partnerships with local physician groups or the possibility of acquiring local practices to supplement your primary care needs?
• Is your organization allowed to hire foreign medical graduates practicing on J1 Visas?

Maximizing efficiency

• Do you have a telemedicine program? How do you promote it with patients and physicians?
• Have you studied or attempted variable staffing models to maximize your efficiency during peak and non-peak hours?
• Are you using Lean healthcare concepts and staff feedback to re-engineer your current processes to increase efficiency?
• How are you marketing to and educating prospective new patients to attract them to your organization and funnel them to the appropriate areas (a primary care practice instead of the emergency room)? What are your competitors doing to attract these new patients?  

Tips for Preparing for the PPACA

• Have an offer letter ready during physician recruiting visits to close the sale. Don't forget to market your organization and your community to the physician's family. Work with your board of directors to have compensation packages pre-approved.
• Compare your compensation packages with annual physician surveys to make sure your offers are competitive.
• Physicians and their families are likely to research your organization online. Monitor and be a part of the conversation to help build a great reputation that physician recruits will see.
• Develop creative incentive programs to attract physicians to your organization
• Explore whether advanced practice professionals can help you offset a primary care shortage.
• Develop a plan to fight staff burnout before it happens to increase retention.
• Develop a community outreach plan to market your services to new patients.
• Leverage technology and use telemedicine programs to alleviate physician shortages.
• Go to your experts, your current staff, and engage them in identifying ways your organization can increase efficiency.

R. Shane Jackson is president of LocumTenens.com and executive vice president of Jackson Healthcare, the third largest healthcare staffing company in the U.S. In 2012, Jackson was named to Staffing Industry Analysts Staffing 100 List of the most influential people in the staffing industry.

More Articles on Physician Recruitment:

5 Components of Developing a Medical Staff Plan
5 Compensation Strategies to Help Retain Primary Care Physicians