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Surgery centers need to consider generational differences when they develop ways to recruit and retain new physicians.
When ASC leaders wish to hire or contract with new physicians, there are two issues that arise. First, ASCs and other healthcare settings are facing a nationwide physician shortage that crosses all specialties. Second, there are generational differences in what will motivate a physician to work with an ASC.
“There are a lot of different generations of physicians out there. They all view things from a different perspective,” says Nick Hernandez, MBA, FACHE, founder and CEO of ABISA, an independent healthcare consultancy in Valrico, FL. “Baby boomers view things differently from Generation X, including in how they view life-work balance.”
Another issue concerns team building. “Physicians are not, despite what academic institutions like to claim, taught how to work as members of a team,” Hernandez notes. “That’s a big issue. Think about doctors going through medical school programs, residency, anatomy, and it’s all about who has the best answers.”
Doctors learn to compete, not team up. From an ASC administrator’s perspective, it is important to learn how to engage, motivate, and retain physicians with a variety of experiences, interests, and priorities. “For example — and this is not just an age thing, it’s a generational thing — the older physicians tend to not worry about putting in long hours and doing what it takes to get the job done,” Hernandez says. He notes that younger doctors might finish procedures at 4 p.m. and call it a day. Further, he observes younger medical professionals may not work on administrative tasks late into the evening.
One way to view this is that the work ethic varies between generations. Another viewpoint is that older physicians are less efficient with their documentation and administrative work, which means they have to work longer to complete their tasks.
“Younger physicians are actually wickedly productive,” Hernandez says. “To stereotype older doctors, they will dictate notes with an old cassette player if you allow them to, and they’ll wait and do it at night from their house.”
Younger doctors are more technology savvy, which means working with electronic health records is not so problematic for them because they grew up with that kind of technology, Hernandez offers. From an administrator’s perspective, younger, more efficient physicians could help save costs.
“If administrators are smart about it, they can run their operations much more efficiently with younger doctors because those are the type of doctors that get in there, get their work done, and go home,” Hernandez says.
Also, Hernandez observes that younger physicians tend to depend less on staff.
“Recognizing that from an operational standpoint, the younger generation might be more productive and efficient means that you can tailor your operations and operational expenses accordingly,” he says. “And you’re likely to have a more profitable surgery center as a result of it.”
Beyond generational factors, Hernandez offers other considerations when trying to boost physician engagement:
“Generally speaking, doctors look at things on a more case-by-case basis,” Hernandez says. “They look at one patient at a time, and they’re dealing with this patient, policies, and procedures.”
Administrators are the polar opposite, Hernandez notes. “They’re not allowed to look at things case by case, patient by patient,” he explains. “They have to look at it from a system perspective and the point of interest of all patients their center sees.”
Leaders need to plan for the long horizon, looking at what will be beneficial in five years. They are focused on the financial picture, overarching policies, and patient satisfaction results, Hernandez says. Also, physicians are experts of their own specialty, while administrators have to care about all specialties. Studying operations from the center’s perspective means a focus on productivity and weighing the considerations of all specialties, not just a focus on one specialty.
“If you understand the perspective of the other person, it’s much easier to work with them on projects, policies and procedures, and operating expenses,” Hernandez offers. “You understand how the other person looks at things.”
When there is a clash between doctors and administrators, bring everyone together to talk. “If there is a clash, it has to do with some kind of fundamental negotiation skills, knowing you won’t get everything you need on both sides,” Hernandez says.
Administrators must remember that physicians have the say in clinical care. Their role is governance and following policies and procedures.
“You use governance documents and negotiation skills to deal with a clash,” Hernandez says. “My hope is that if people on both sides can understand the perspective of where everyone is coming from, then we can minimize the number of clashes and minimize the intensity of the clash.”
“Recruitment is important, whether or not an operator employs physicians,” Hernandez says. “I would argue it’s applicable no matter how you’re structured.”
With a shortage of physicians, recruitment is crucial. Still, the issue is more complicated than just offering more money.
“You need to know what kind of doctors you are hiring,” Hernandez says. “For some physicians, the pay is important; for others, it’s about how much time off they’ll have.”
When ASCs are involved in physician recruitment, Hernandez says they need to know each candidate’s clinical skills.
“At the end of the day, after evaluating clinical skills, this is a business decision. Who is better apt at that than a business person?”
The physician partnership could involve ownership, if that is an option, Hernandez says. Whatever the ASC’s arrangements are with doctors, it is important to articulate those expectations up front.
“I recommend that as part of the interview process so the doctor understands where this is going,” Hernandez offers. “This is more important now than before.”
The prospect of a partnership track could be a point of contention if it is not addressed in the beginning.
“Sometimes, the partnership track could be five years, 10 years, or a longer period of time for a new physician to become a full partner,” he says. “But if the new recruit expects to be a partner in two to three years, that’s a problem.”
ASC leadership can prevent down-the-road issues by addressing exactly what they are looking for and how it will work out in the beginning and later. Failing to make intentions clear could result in a disgruntled a physician who decides to leave the practice soon after the ASC has invested considerable time and money in hiring the new employee, Hernandez warns.
“This happens all the time,” he laments. “You have to start all over with recruiting a new physician. It’s your fault because you didn’t properly screen the type of candidate you wanted and didn’t tell him how it would work over time with all of the details.”
Along with the partner track discussion, voting rights could be an issue. Succession planning is an especially sticky point in physician retention, one Hernandez has seen cause many problems.
For example, an older physician will tell a newly hired physician that he plans to retire, but then the older physician discovers that the new hire helps lighten the workload. This leads the older physician to think he may continue working for another five or 10 years.
The new physician discovers that the succession is not going to happen as quickly as expected and decides to leave. If older physicians believe they will want to step aside and allow a new physician to take over, they should put the plans in writing so everyone knows the plan, agrees to all the stipulations, and sticks with it, Hernandez advises.
“They need a simple, nonbinding letter of intent for succession planning,” he says, noting that administrators and/or business professionals should be involved in these agreements. “It also helps if they have a partnership structure.”
Financial Disclosure: Consulting Editor Mark Mayo, CASC, MS, reports he is a consultant for ASD Management. Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Editor Jonathan Springston, Editor Jill Drachenberg, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Author Stephen W. Earnhart, RN, CRNA, MA, Accreditations Manager Amy M. Johnson, MSN, RN, CPN, and Editorial Group Manager Terrey L. Hatcher report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.