Episode Transcript
Speaker 1 00:00:05 This is the casus Podcast Network where your trusted advisors are at your fingertips, are in your earbuds At Casus, we are an accounting and advisory firm with a team of specialists in a variety of industries. Everything from cybersecurity to healthcare consulting, to everything in between. I'm Tara Arrington, and I'm your host. As an ex journalist turned marketing professional, I'm the non-expert who will be chatting with our experts, giving you all the tips and tricks you need to help your business succeed. Today we are joined by principal and healthcare advisor, Joni Wyatt. Uh, Joani has over 20 years of experience in healthcare advisory and she is a certified professional in health information management system. So welcome to the podcast,
Speaker 2 00:00:49 Joanie. Thank you. Thank
Speaker 1 00:00:51 You. Um, so obviously it's, it's hard not to know that recruitment and retention across all industries is a little bit crazy right now. Mm-hmm. <affirmative>, but Joanie, with her expertise, we are going to chat about physician recruitment and retention and how that plays in this landscape we're currently in.
Speaker 2 00:01:08 Yeah, yeah. It's, uh, it's kind of an interesting time and like you said, it's, it's across all industries, it's across, you know, very professional, like physicians all the way down to staff members with our physicians. I think we've had a couple of things. One, um, you know, we've been talking about a physician shortage for years. Mm-hmm. <affirmative>, so we kind of know there's this higher number of physicians retiring than we had coming out of medical school. Mm-hmm. <affirmative> C did not help because I think that drove a lot of physicians wanting to burn out if they weren't already in burnout. Mm-hmm. <affirmative> into burnout. And then, um, a lot of 'em just took early retirement. Mm-hmm. <affirmative>, we, you know, we look at, you know, different areas. Obviously urban physicians are the most plentiful ones who wanna practice in a city. Suburban would be next. And then our rural physicians are the most difficult to recruit.
Speaker 2 00:02:05 We were looking at rural, um, physicians recently. There was a study done, I can't think of the name of the study, but a study done recently, like in January of this year. And it said like it was almost half of all of the rural physicians were within 10 years of retirement. Mm-hmm. <affirmative>. And 43% of those were contemplating early retirement. Mm-hmm. <affirmative>, and that the percent of, um, uh, physicians who, and again, this is for a rural environment, which is the hardest place to recruit the, uh, percent of physicians who were coming from rural areas into medical school, which is usually the most likely to go back to rural areas. That's decreased from, I think that's decreased down below 5% and has continued decreased since 2017. Mm-hmm. <affirmative>. So I think across the board we're seeing, you know, this shortage of physicians, shortage of providers. Geographically, you're gonna see a bigger shortage in places like rural health, which has always been the case.
Speaker 2 00:03:10 It's just really an issue right now. Um, I also think we're gonna, we're seeing a not, we're going to, we're already seeing obviously a shortage of more primary care. Mm-hmm. <affirmative>, you know, if you've ever tried to be a patient these days and it takes three months to get in with your doctor mm-hmm. <affirmative>, uh, it might just be, cuz there's not enough, there's not enough doctors mm-hmm. <affirmative>, um, and it's not really, it's, it's interesting cuz it's not that there's not enough doctors per se, it's that the distribution is off. Mm-hmm. <affirmative>, lots and lots of physicians may be here, but then none in a three county area. Right. You know, in rural Alabama mm-hmm. <affirmative>. And so a lot of what we talk about with the practices is, you know, how do we, how do we make sure that we are staffing appropriately, really thinking about growth in the practices, just getting doctors where we need them to be. Mm-hmm. <affirmative>. And then how do you, um, how do you make that an enticing place for someone who is right outta medical school to go mm-hmm. <affirmative>, that's a hard thing to do.
Speaker 1 00:04:09 Mm-hmm. <affirmative>, and I mean, I know, and I'm sure other states do this too, but I know, you know, here in Alabama we have the Alabama Rural Medical Scholars program mm-hmm. <affirmative>, um, as an incentive where their med school basically gets paid for if I, it's what they think they have to work in a rural area maybe for 10 years. Right. Um, so I know that, you know, there's that kind of thing, but you've gotta, you know, you've still gotta find students. Some students might rather just take the debt instead of working in a rural area for 10
Speaker 2 00:04:36 Years. Yeah. Uh, blue Cross Blue Shield of Alabama instituted a program too for rural health. I think they have to stay in a rural envir, a rural location for six years mm-hmm. <affirmative> and they will pay up to a percent of their student loans for primary care. Mm-hmm. <affirmative> if you're a primary care physician. Mm-hmm. <affirmative>, so even the payers, um, because clearly if you don't have a physician in an area or don't have enough mm-hmm. <affirmative> and I, I was talking about rural areas, but it doesn't have to be a rural area, suburban area could not have enough physicians. Mm-hmm. <affirmative>, particularly primary care, you end up with patients who aren't attached and so they don't show up to see a doctor until something's really wrong. Mm-hmm. <affirmative>. And at that point, the care is probably a lot more difficult. ACU is higher and you know, probably more expensive from the perspective of the payer. Mm-hmm. <affirmative>. And so a blue Cross or a, you know, a big payer in our state, it's Blue Cross, um, really has, you know, skin in the game to make sure that they have physicians, enough physicians to take care of patients before they get that sick. Right. You know, intervention early mm-hmm. <affirmative>, um, as opposed to people showing up in dire condition in the emergency room.
Speaker 1 00:05:44 So with thinking about like how you mentioned making, trying to show these, um, you know, either they're coming in a residency with you or those finishing with residency coming on as an attending with you. Um, trying to show them wherever the, wherever you are hiring is enticing. Um, you know, with any clients you've worked with or any of your colleagues, how early are they trying to entice uh, these doctors?
Speaker 2 00:06:10 Usually? It's usually a couple years. Mm-hmm. <affirmative>, I mean often, you know, and this is also an issue too. Health systems will offer stipends early mm-hmm. <affirmative>, if you're in independent practice, you're having to compete with the health system who's also wanting to bring those doctors in cuz they need 'em too. Everyone needs doctors. Um, so enticing them into places, I think I think the biggest overall, uh, it's com compensation obviously is gonna be a part of it. Mm-hmm. <affirmative> quality of life. You know, we can usually get people into some of these, um, less urban environments when they really see their quality of life could be much higher. You know, even if it's just kind of on the outer suburbs. Outer suburbs can often, um, offer a higher quality of living mm-hmm. <affirmative> than living in a, you know, in a big city in the middle of a
Speaker 1 00:07:00 City, not gonna have as much trauma call out in the
Speaker 2 00:07:02 Suburbs. Yeah. I mean Yeah, exactly. But you, I mean, and also, you know, cost of housing mm-hmm. <affirmative> and, you know, um, schools might be better. Right. You know, out in the suburbs you may not need to have a private school situation mm-hmm. <affirmative>. Um, so there's just lots of benefits and I think what we were trying to do is basically identify what those are. Mm-hmm. <affirmative> where we have trouble is we do have small, I mean there are small communities when we had the housing shortage, um, although I'm not sure how much were coming out of that, but I think, you know, for a period of time there was no housing mm-hmm. <affirmative> anywhere. And so places even that we could show a better quality of life, they didn't have homes mm-hmm. <affirmative>. So we couldn't recruit a physician cause there was nowhere for that physician to live mm-hmm. <affirmative>.
Speaker 2 00:07:46 And that was kind of a, uh, oh, what do we do now? Kind of moment because you can't build a house fast enough Right. To, um, bring a physician in. And so there was a lot of kind of, um, um, you know, worry about how you get past that you can get, you can work around things like compensation. There are benefits, there are other quality of life things that you can offer. I mean, we obviously have to be within fair market value when we pay a provider for an area, you can't pay them, you know, an inappropriate amount. But, you know, you still have community. There's so many things in a community that are positive you can't really get past, we don't have a place for you to
Speaker 1 00:08:28 Live. Yeah.
Speaker 2 00:08:30 So that, that was kind of a, that was tough.
Speaker 1 00:08:32 Mm-hmm. <affirmative>. So you talked a little about ways to entice way to get talent there. What are, um, some things that you've talked about with, with clients or with colleagues about retention and keeping the doctors
Speaker 2 00:08:45 There? Yeah. In that same survey that we were looking at, um, it was interesting. It depended on, um, like generation, well, sort of a combination of generation as well as geography. So, um, your urban doctors tended to be your millennials. Mm-hmm. <affirmative>, you know, they were 15 years plus away from, um, uh, retirement. Mm-hmm. <affirmative>, they could actually be enticed to go to a rural area or a, or a less populated area, um, with specific things. So for them it was things like, um, an increase in compensation and maybe potential for a, like a more of a leadership role mm-hmm. <affirmative>, which they probably wouldn't get in a big city because there's lots of competition. Right. And lots of physicians who have tenure above them. Um, in the suburban area, those tended to be your Gen Xers. Um, they tended to be more, uh, independent. They, they were not, you know, employed by a hospital or a big health system, whereas your, your, uh, millennials were typically employed.
Speaker 2 00:09:51 They actually, uh, talked about retention in areas that were a little more remote if they had the ability to do telehealth. Okay. And so that was one of the things that said, you know, it would, it would inspire me to, um, accept a job in a more, you know, a more rural or less populated area, places where they need the doctors the most. And then the retention would be around the ability to do telehealth. I think the, uh, the, if I remember correctly, I'm trying to remember off the top of my head, but the Gen Xs were also a lot about transparency and kind of, um, uh, open, uh, dialogue and relationships with the people who had hired them. Mm-hmm. <affirmative>. So wanting to be kind of part of the, you know, part of the, uh, development of the health system or the clinic or wherever they were going as opposed to just showing up for work and doing whatever they were told to do.
Speaker 2 00:10:48 Mm-hmm. <affirmative>. Uh, and then, and then the rural physicians actually had, uh, most of them are older. They're typically our baby boomers, the ones unfortunately that are retiring in less than, um, 10 years, most of them three to five years. Which is a little scary, which means we should be recruiting to those areas now. But the retention for them was different. For them. It was a lot about incentive bonuses and I couldn't, I was thinking about why that would be so important. I was like, cause they're about to retire. Right? They're saving money. Mm-hmm. <affirmative>, one thing we did not, and we've talked about this but we're not sure is if it is a component of the generation or a component of the age. So for example, um, are the things that are um, are, you know, beneficial or the things that a Gen X physician in the suburbs does, the things that are, um, that they really look for and would like to have.
Speaker 2 00:11:45 Is it because they're Gen X or is it because they're at the Gen X is at an age right now mm-hmm. <affirmative> that that's, um, something that, you know, makes it popular for them. So, um, when the millennials age in to where Gen X is now, are they gonna no longer wanna work in an urban environment? Are they gonna wanna work in the suburbs? Right. And so that's something that we've talked about quite a bit cuz it's, it's hard to tell if it's really related to general characteristics of the people of that generation or the physicians in that generation as opposed to, well, I'm 30 versus, I'm 50 or I'm closer to retirement. Mm-hmm. <affirmative> and kinda how your needs change over the course of your life as opposed to, you know, general characteristics of a, of a generation.
Speaker 1 00:12:32 Yeah. That's interesting to think about for
Speaker 2 00:12:34 Sure. Yeah. I wish we could figure that out. It might help us recruit more physicians. Yeah. Certainly retain them. Maybe
Speaker 1 00:12:39 <laugh>. Um, now are y'all doing, or have you seen anyone doing, trying to maybe pull, um, maybe a millennial or it could not be a millennial, maybe someone who's been in academics and is tired of that. Maybe they're tired of like the research component. Maybe they're tired of like the presenting or working with students. Have you, have you seen anyone successfully like pull someone from academics into a rural area into more private practice?
Speaker 2 00:13:05 Um, what's interesting about that is we typically don't, and I, I think it has to do with the type of work. So, um, you know, when you work in an academic environment, like you said, there's research, there's usually teaching, there's all these different components, um, of being part of an academic environment. It's very structured. Um, someone takes care of basically all the rules. You know, if you work for an academic environment here, like a uab, I mean there's, there's really not a whole lot you decide mm-hmm. <affirmative>, it's sort of provided for you what system you use. You know, the hours, the, you know, what, what specific areas of your specialty they're gonna help you develop or research more on. Whereas when you, and I could see how some people would think, well maybe that would be exciting to be able to go in an area where I could be an independent physician and do whatever I wanted.
Speaker 2 00:13:59 Mm-hmm. <affirmative>, I think that the anxiety of having to set that up or be responsible for some of those things mm-hmm. <affirmative> might outweigh the ability to do it. Occasionally we do see people who are, you know, who wanted to kind of make that transition into a, a independent practice or in a different area where there might be more independent practices, uh, but it often doesn't work well. Mm-hmm. <affirmative> because what they're used to is so vastly different than practicing medicine in an independent environment away from the structure and support. I mean, I talk about structure, but it's really about overall support to resources and you know, there's someone to do whatever you need them to do when you're in an academic environment or any, any large health system for that matter. Right. Um, when you start moving out into a more rural area, um, you're the guy.
Speaker 1 00:14:51 Yeah. It's, um, kind of hard to consult as easily if you're in a rural area. Yeah. Um, they're not on a different floor from you, they're two hours from you. So Yeah. That
Speaker 2 00:15:01 Makes sense. Tell, and telehealth has helped some with that. I do think that, um, there was an article in the business journal, I think it was the Birmingham Medical News. Mm-hmm. <affirmative> actually, and they were talking about, um, some of the hospitals here, rural hospitals. UAB sort of had this aha moment during Covid that had they not had some of these rural hospitals, it would've been bad because they did not have the capacity. Mm-hmm. <affirmative>, they didn't have the beds, um, to take care of all these patients. So a lot of those COVID patients were, um, retained in their local small hospitals. Had we not had them then, I mean, we would've, we could've potentially had many more fatalities because we wouldn't have been able to take care of everybody we need to take care of. I say that because now what UAB has done is I think they've actually partnered with some of these hospitals mm-hmm. <affirmative>
Speaker 2 00:15:51 To help kind of shore them up. Rural hospitals have been struggling for a long time. Um, but to help shore them up, bring some more services back, encourage the community to stay in your community. You know, come see us when you need certain things. Mm-hmm. <affirmative>, um, but you got a good hospital here and I, I think that partnership helps UAB and in that the name recognition's there. Um, and if there's bigger services, you know, that are needed, um, they can come here. But at the same time, it's huge for those rural hospitals, um, and the providers because that helps recruit physicians who'll stay. UAB is helping provide, uh, physicians and other a or mid-level to those locations and that allows those locations to be open and provide more comprehensive care to the patients, which they couldn't before. It's kind of like a, a self fulfilling prophecy where there's no doctors, so there's no patients, so there's no doctors, so there's no patients. Mm-hmm. <affirmative>, you know, so you gotta, you gotta start somewhere. Chicken or egg, it doesn't matter. But, you know, I think with covid there were patients, right. So the need to have physicians was really highlighted and then the need to have physicians outside of the one area was, was really, um, important. You really could see how important that was. Yeah.
Speaker 1 00:17:12 Um, cuz I mean it can be really easy, especially for someone who's maybe always grown up in a major city, has always had maybe three or four hospitals to choose from. Maybe they had really good insurance, they could go to any of 'em. It's kind of hard. I think for those people it's easy to be close-minded and forget that not everybody can get in a car. Like maybe they don't have reliable transportation, maybe they don't, you know, can't afford, you know, the ambulance bill can get in a car, drive an hour drive 90 minutes to get to a health system to see them and maybe they don't have that much time with what's going on with them. Right. Especially with covid. Right.
Speaker 2 00:17:47 We do work a lot lot with some of the smaller rural hospitals. Recruitment and retention is a big, is a big issue for them. They recognize the needs of those smaller communities. Mm-hmm. <affirmative>. Um, but like you said, I don't know that that's really, unless you've been exposed to that, I don't know that there's something you really realize the mm-hmm <affirmative>, um, the variability and the level of care or the ability to have access to care that um, some of our patients just don't have. Mm-hmm. <affirmative> and we sort of take it for granted, I'm from a small town so my family has to get in the car and drive an hour and a half to New Orleans anytime they wanna go to a real, like I say a real hospital. That's not true. They have smaller rural hospitals. Mm-hmm. <affirmative>. Um, and actually a lot of those have, uh, had some development because they've been bought by um, Ashner or something like that. Mm-hmm. <affirmative>. But when I grew up you really had to drive mm-hmm. <affirmative>, you know, the smaller community hospitals were there for stabilization critical access. Right. Um, and that was just kind of normal. Mm-hmm. <affirmative>. But it would be nice to see people be able to stay in their communities and get that same level of care. Mm-hmm. <affirmative>. Um, we gotta have physicians though, and I say physicians, we gotta have providers. Right. Nurse
Speaker 1 00:18:58 Practitioners,
Speaker 2 00:18:59 PAs. Yeah. Yeah. Alabama's a little bit limited. You know, we've tend to put a, a bit of a limit on the scope. Mm-hmm. <affirmative> we allow for, um, and especially for reimbursement purposes. Mm-hmm. <affirmative>, I think some of that might have to change. I mean if there's not a provider mm-hmm <affirmative>, I mean there's not a physician then I know some fantastic nurse practitioners and PAs. Fantastic. So, um, we might, we might see some of that switch a little bit. Mm-hmm. <affirmative> hopefully. Hopefully.
Speaker 1 00:19:31 Yeah. And then, um, also, uh, just a, still a physician but a different kind. Um, you know with the, cuz there's a DO school now in Alabama mm-hmm. <affirmative>. Um, how about like recruiting from that pool? Is that, is that also on like something people are talking about?
Speaker 2 00:19:47 Yeah, I mean I think, I think that um, it's fairly interchangeable. Mm-hmm. <affirmative>, I mean obviously we have more MDs than dos mm-hmm <affirmative>. Um, but we have lots of fantastic dos. I've worked with a lot of them and so I don't really see, not personally anyway, I don't really see huge difference Right. Between the two mm-hmm. <affirmative>, um, there could be maybe areas that there would be some mm-hmm. <affirmative> differential. But I, I don't think I've spent enough time in any of those areas to really see the difference. Mm-hmm. <affirmative>. So someone may disagree with me, but for me I think that, you know, you've got some really, um, good trained physicians and whether it's MD or do it's really often doesn't make a difference. Right. Yeah. And you know, general pop and if you need a physician, you need a physician.
Speaker 1 00:20:34 Right. Exactly. Yeah. Especially
Speaker 2 00:20:36 If, cause I can't take care of patients and you can't take care of patients. No. You gotta have those specialized people.
Speaker 1 00:20:40 That's exactly right. Um, I guess anything else you can think of? Um, as far as, cuz I feel like we've talked a a lot about recruitment and we talked about, we've talked some about retention, but anything else you can think of as far as retention? I know y'all do a lot of like value based like y'all, y'all will do a lot of value based stuff for incentives, that kind of thing.
Speaker 2 00:20:59 Yeah, we've been looking a lot at, um, different compensation models. Mm-hmm. <affirmative>, um, things that would, you know, entice someone. Um, there are lots of ways that a physician practice can actually make revenue outside of just the fee for servicing the patients. You know, for visit, there's all these incentive programs and these incentive programs if they participate with them, can be lucrative, but it means that they have to meet certain measures. It means that they have to, you know, complete their annual wellness visits. It depends what program you're in, but there are certain things they have to do. Um, if we're able to assist some of these areas with creating models where they're incentivizing or helping the provider meet some of these metrics and then, uh, likewise bring in more revenue, then you have that ability for increased compensation. Um, you have the ability to maybe, uh, offer a little bit better benefit package.
Speaker 2 00:22:01 Mm-hmm. <affirmative>. Um, because, because it's actually being supported by the services and the, the fee for service world is not gone, it's not going, I don't think it's gonna go away completely, but most of our, most of our, um, you know, ability to grow is gonna start coming from this other places of revenue just because the fee for service world is drinking. I mean, we're not, we're not getting the same amount of money that we used to to see a patient. Um, but if I can get a bonus for seeing that patient having a really good outcome and being very efficient on the back end, then I might have actually just gotten paid more to provide really good care. But the metrics can have to prove that. Right. And the metrics is what you incentivize through those compensation models. Mm-hmm. <affirmative> and you can do that anywhere. Mm-hmm.
Speaker 1 00:22:50 <affirmative>. Yeah. I guess anything else that I haven't asked you about that you think is important?
Speaker 2 00:23:00 I can't think of anything else.
Speaker 1 00:23:01 Yeah. Well in short we need physicians.
Speaker 2 00:23:05 Yeah. Yeah. We really do. I mean we really do. And uh, I do think there was a larger number of, of, uh, medical students entering medical schools actually since Covid, which is fantastic. So we have had an increase. Mm-hmm. <affirmative> problem is that they're not gonna be done for a few years. Right. So we're gonna have a hole for a little while. Yeah. Um, by the time you and I agents are really needing them, we might be okay.
Speaker 1 00:23:31 Here's hoping. Right.
Speaker 2 00:23:32 That's right.
Speaker 1 00:23:33 Absolutely. Well, thank you so much Joni. I appreciate it.
Speaker 2 00:23:37 Absolutely. Thank you for having me.
Speaker 1 00:23:41 Thank you for tuning in to the casus podcast Network. Resources for today's episode are linked in the episode nodes. Thank you to our producer Russ Dorsey and for Caso for powering this podcast. Be sure to stay up to date on new episodes and more information about today's episode by following at caso Co. Until next time, thanks for tuning in.
