Whitney Palmer

Healthcare. Politics. Family.

Survey: Residents Hold the Cards in Job Search

Published in the December 2011 Hospitals & Health Networks Magazine

By Whitney L.J. Howell

With doc shortage looming, final-year medical students are in high demand

In today’s physician job hunt, it’s a buyer’s market. More than ever, hospitals need qualified doctors, and potential hires, particularly residents, are calling the shots.

Physicians in the younger generation differ significantly from their predecessors in what they want in a job. Location, lifestyle and work-life balance are bigger priorities now than they were 30 years ago, but the shift has become more pronounced in the last decade.

Since 2001, the number of residents interested in hospital-based employment has spiked from 3 to 32 percent, according to the Merritt Hawkins 2011 Final-Year Medical Resident Survey.

“It’s about economic security. Residents like the safety of hospital salaries, and they appreciate someone else covering malpractice insurance,” says Kurt Mosley, Merritt Hawkins vice president of strategic alliances.

As employees, physicians don’t have direct responsibilities for practice management, including many of the regulatory burdens that pose significant financial constraints. Some residents also choose specialties with little on-call time, such as radiology, ophthalmology and dermatology, Mosley says.

Regardless of specialty, the survey demonstrates that health care is already feeling a crunch from a physician shortage that’s expected to hit 160,000 by 2025. Looming vacancies have employers recruiting aggressively — more than half of survey respondents said they’d received more than 100 recruitment contacts during their training.

Most employers recruit via email, says Katie Imborek, M.D., an assistant professor at the University of Iowa who finished her family medicine residency in April. Others are more aggressive.

“Not a day went by that we didn’t receive emails about jobs,” she says. “Some recruiters were more persistent — they wanted to meet with us in smaller groups. Others asked to take us to dinner one-on-one.”

A growing number of hospitals and practice groups have Twitter feeds and LinkedIn groups as ways to court residents.

“Like most places, our biggest need is primary care,” says Kevin Robinson, Southwestern Vermont Health Care communications director. “At the core, we need physicians to serve the entire community and increase access.”

But it’s more than the steady salary and low on-call time pulling residents away from private practice toward hospitals. Many institutions offer loan repayment assistance, says Joanne Conroy, chief health care officer for the Association of American Medical Colleges.

“For residents who graduate with an average of $180,000 in debt, these programs are like music to their ears,” Conroy says.

Hiring a Doc? Maybe It’s Time to Tweet

The rise of social media has forced job recruiters to rethink how they attract the best and the brightest. LinkedIn, Facebook and even Twitter are becoming integral parts of recruitment strategies at many hospitals.

A 2010 New England Journal of Medicine study found more than 40 percent of physicians would job-hunt through social media. The number of employers following suit is small, but the ranks are growing.

“Social media strategies won’t replace traditional efforts, but as add-ons they can enhance recruitment,” says Chris Boyer, digital marketing and communications director for Inova Health System in Fairfax, Va. “The key is that you have social media users among your doctors, your medical staff and your nurses.”

According to experts at Georgia-based physician recruitment firm Jackson & Coker, including social media in recruiting efforts can produce a multipronged, cost-effective strategy. But they caution that each job posting be identical across platforms, and employers must take steps to eliminate any possibility for discrimination.

Inova launched its social media recruiting with a LinkedIn group that posts all jobs, and it can broaden or target searches as necessary. When recruiting specialists, however, Inova contacts individuals directly to discuss potential employment, Boyer says. To reach Twitter users, Inova will go live in December with its own Twitter feed of all open positions. Boyer recommends hospitals create RSS feeds internally for Twitter and route each job to their human resource departments. Inova also has dedicated social networking for residents. Through the free service SocialGo, residents can access resources during training, and the site transitions to help them find employment.

There are other successful online methods. In 2007, Southwestern Vermont Health Care created a microsite dedicated to finding physicians. “We had 22 openings for a staff of 140,” says Kevin Robinson, communications director. “Within two months of going live, we had more than 100 applicants. We filled nearly all vacancies by fiscal year-end.”

SVHC used direct mailing and contextual advertising to announce its microsite. With final-year residents as targets, Robinson says, the site lists all open jobs, offers available housing information, details popular leisure spots and restaurants, and includes information about activities.

“We included information about things residents said were important to them,” Robinson adds. “And it’s working. Doctors come to us because they find the quality colleagues, lifestyle, and work-life balance here.”

To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/12DEC2011/1211HHN_Inbox_physicians&domain=HHNMAG


December 14, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Academic Medicine Explores ACO Model

Published in the December 2011 AAMC Reporter

By Whitney L.J. Howell

The release of the Centers for Medicaid and Medicare Services (CMS) final rule on accountable care organizations (ACOs) in October is helping some AAMC members take a second look at ACOs. Experts are debating whether the final rule, which excludes indirect medical education payments from the shared-savings mix, will help academic medical centers embrace the ACO model.

In an ACO, a network of doctors and hospitals will share responsibility for providing patient care to a minimum of 5,000 Medicare beneficiaries for at least three years. CMS begins accepting applications for the Medicare Shared Savings program in January.

If the U.S. Supreme Court rules that the health reform law is unconstitutional, ACOs and shared savings could become irrelevant. However, many in academic medicine are proactively aligning resources to provide services in quality-focused, collaborative ways to control costs. For some, that means launching multi-disciplinary, patient-centered care centers. For others, changes include integrating health information technology or adding “total health” courses into curricula.

There is no cookie-cutter approach to adopting the ACO model. Academic medical centers must identify strategies that work best for them, but it will be challenging, said Scott Berkowitz, M.D., M.B.A., Johns Hopkins Medicine’s accountable care medical director.

“There will be cultural and financial obstacles,” he said. “But academic medical centers have a golden opportunity to create value in the post-reform era through providing exceptional patient-centered care, engaging in the science of care delivery to supplement more traditional research, and by educating the next generation of health care leaders.”

Johns Hopkins is still reviewing the Shared Savings program but has improved care quality in recent years through several initiatives. The institution expanded its community physician group to more than 250 doctors, including many to augment patient access to both preventive and follow-up care, Berkowitz said.

There are, however, academic leaders who doubt their centers can achieve the ACO model, said John Kastor, M.D., a professor at the University of Maryland School of Medicine. In a February New England Journal of Medicine perspective, Kastor reported that of 37 senior faculty he surveyed nationwide, most believe the ACO structure will prevent care coordination and cost savings.

“Of the people I interviewed, none has figured out how to make this concept work at their center,” Kastor said. “Medical school deans and hospital CEOs often report to different people. Clinical departments tend to be in silos, and training students takes time. These issues will hamper an institution’s ability to form a successful ACO.”

Changing characteristics of teaching hospitals, including paring down didactic resources, to cut costs requires a significant culture shift, he said. But not all would be beneficial. According to AAMC, siphoning money from educational efforts to achieve savings—such as indirect medical education payments—undermines academic medicine’s tripartite mission.

“In our philosophy, these payments are for education and care of the uninsured,” said AAMC Chief Health Care Officer Joanne M. Conroy, M.D. “Excluding them from savings calculations prevents negative impacts on patients, and it stops any gutting of our care system or educational programs.”

However, the onus now weighs heavily on teaching hospitals and health systems to identify cost-saving strategies and demonstrate that they work.

“It’s still a tough road,” Conroy said. “It’s a complex rubric. Academic medical centers must drill down quickly to see what will be successful.”

For Greenville Hospital System University Medical Center in South Carolina, success is already here. According to chief medical officer Angelo Sinopoli, M.D., Greenville began working toward collaborative care nearly seven years ago and first tested the ACO model on its 17,000 employees. Using a $2.7 million Duke Endowment grant, the institution increased preventive care for employees and provided case managers for the sickest patients. The result was a 26 percent drop in emergency department visits and a 55 percent decrease in hospital stays.

The true key to success, Sinopoli said, was when hospital administrators offered on-site health care services to area businesses.

“It was part of our system change. We took our wellness programs to them,” he said. “Depending on the organization’s size, there is a nurse practitioner or physician there to provide a continuum of care, give high-risk patients health education, and eliminate social barriers to care.”

Having a Greenville-affiliated provider in the workplace gives patients more than the typical 20-minute doctor’s visit. They also have access to social workers, case managers, and practitioners who address their needs between appointments.

Achieving this goal was difficult. According to Sinopoli, Greenville faced two challenges when creating its collaborative-care environment. It took 10 years for physicians to embrace the model. The concept is foreign, he said, because physicians train as individuals and are not accustomed to working in teams.

The medical center also purchased health information technology to track accurate patient data, integrate it between sites, and make it readily available to providers. Along with an electronic health record system, the medical center installed a data warehouse so practitioners can mine existing data.

The institution is a newcomer to academic medicine, having joined South Carolina’s University HealthSystem Consortium in 2006, but it pivoted easily to train students about team-based care.

“Our curriculum and students are oriented to total health,” Sinopoli said. “Instead of teaching just the biochemistry of heart failure and what drugs treat it, our curriculum teaches how to coordinate care for a congestive heart failure patient and what resources and evidence-based practices can keep that patient from being readmitted.”

Greenville is still considering whether to apply for the Medicare Shared Savings program, he said. Regardless of the institution’s eventual route, Sinopoli said one thing is certain: Leaders in academic medicine must continuously promote culture change to create a true shift toward patient-centered care.

To read the article at its original location: https://www.aamc.org/newsroom/reporter/december2011/268852/aco.html


December 12, 2011 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment


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