Tag Archives: physician recruitment

Going out in style for 2017

It’s been another successful year at Advanced Inpatient Medicine in 2017. How do we define success? Making patient care better, faster, safer, & of overall higher quality at the hospitals where we provide hospitalist care. How do we measure that success? It’s all about system & process improvement; finding ways to create changes which result in improved outcomes for patients. We do this while maintaining volume control, work-life balance, and overall satisfaction of our providers. Whether it was moving to a geographic rounding model in Wilkes-Barre, which improves the multidisciplinary approach to care and subsequent improved outcomes, or creating telemetry guidelines to hasten patient flow from the ED in Scranton, our focus on continuous quality improvement remains very successful.
Another measure of success is in recruiting. We have many recruiting interviews scheduled for the month of December as we continue to expand. As more & more traditional outpatient providers transition out of the hospital in 2018, AIM will be poised for growth. When you have a rare group that actually cares about every individual provider and focuses on quality of care and work-life balance, it usually results in our group standing out to recruits. In fact, because of growth projections, AIM plans to add at least 7-8 physicians and 3-4 APCs next year.
Expansion of our Post-Acute division remains a major goal as well. Expanding to other skilled facilities and growing the census in those facilities that AIM already maintains a presence is a virtual certainty for 2018. We have demonstrated through hard data that our involvement in the post-acute market has resulted in improved cost utilization, improved outcomes, shorter lengths of stay, and improved star ratings for those facilities that we serve.
Where do we go from here? Look for a major announcement shortly as AIM positions itself for the long-term future with significant improvement in infrastructure to support growth and the addition of administrative staff to improve efficiency. AIM continues to move forward as the best hospitalist program in the Northeast. For now, that means NE PA. Soon, Northeast US? Big news coming soon…

Remaining Idealistic During growth

When AIM was founded over nine years ago, it was created with one purpose. Namely, to provide care of the hospitalized patient that was better, faster, safer, and more cost effective than before. The approach was and still is completely different than the vast majority of hospitalist programs out there that are profit driven. Keeping volumes down to improve quality by allowing staff the time they need to excel is still a novel approach. Taking care of our staff so they have a good work-life balance gives them the energy & motivation to strive for excellence. These concepts are so simple and so successful that you would think they would be widely adopted. Yet, here we are, one of those rare programs that actually cares about every employee and remains solely focused on quality.
A physician that interviewed recently described our approach, along with our excellent benefits package, as maybe ‘too good to be true’. She & her family are lovely people and hopefully will join AIM eventually, but I think it’s sad that this recruit was actually a little unsure because of our approach being so unusual as to make it almost hard to believe. Based on what’s out there, she has every right to be skeptical since 20-25 daily encounters and frequent burnout & staff turnover seems to be the current state of hospitalist affairs, to the point where it’s become accepted as ‘normal’. Are we really so disenfranchised and settled into these ritualized routines of 20+ encounters and punishing shifts daily that AIM keeping it to 15-18 encounters a day seems unbelievable? When the average hospitalist lasts only about four years in a program before moving on as is the case now, hospitalist medicine has a problem.
In the long run, I hope that everyone moves to the quality focused format that AIM has been so successful with. In the meantime, being surrounded by overworked, unappreciated, & burned out hospitalists at so many other programs sure helps with recruiting. Once an interview candidate visits and speaks with members of our team, we usually end up adding a new provider. That’s good for AIM, but not good for hospitalist medicine as a specialty. I think hospitalist medicine has ceded control of its own growth and identity to large hospitalist management groups focused on profits and expansion over quality. That’s going to come back to haunt our profession down the road. Well, AIM will continue to stand alone in our region as a group that understands that patient care is our focus, not dollars. That will never change.

2015 Review & looking ahead to 2016: A Time of Growth

In January of 2015, AIM was managing two hospital sites and had just started a fledgling nursing home division. As of January 1, 2016, AIM consists of seven separate divisions including four hospitals, 8 nursing homes, and Palliative Care & LTAC divisions. That’s over 300% growth in 2015! Success breeds success, and our approach of keeping patient volumes under control and allowing our hospitalists time to succeed leads to some pretty impressive metrics. These include lower lengths of stay, higher case-mix index, lower costs per case, and higher patient satisfaction. All of these numbers translate into improved quality of care at lower costs, and they have a significant and direct impact on the bottom line of the hospitals that AIM serves. This, in turn, makes our group very appealing, leading to further expansion. To put it another way, we don’t just think of ourselves as working to take care of patients. We work to take care of patients better, faster, safer, and with higher patient satisfaction. We ‘AIM’ to be the best at what we do, and we take that goal very seriously as a core principle.
As a consequence of controlling volumes and allowing our staff the time they need to do a great job, we have excellent staff retention and recruiting continues to go well. There are still so many surrounding programs that choose to go short staffed, either because of the inability to recruit, or simply to try to save money at the expense of the hospitalists, who get crushed with well over 20 encounters a day on a daily basis, which is not sustainable. This quickly leads to staff dissatisfaction, which leads these providers to seek out & join AIM. I’ll never understand that model of ‘work them until they leave’. AIM keeps its doctor’s happy and with a good work-life balance. In return, they do great work, which saves hospitals considerably more money than using less staff up front. Why so many programs fail to understand that happy & satisfied hospitalists leads to higher quality & more cost effective care in the long run is beyond me.
Bundled payments and other government sponsored initiatives to improve quality and decrease costs have led AIM and other organizations to expand into other arenas across the continuum of patient care. Expansion of our nursing home services this year, along with the addition of our Long-term Acute Care (LTAC) and Palliative Care divisions are logical extensions of our inpatient programs. A large percentage of waste in the system takes place in these transitions of care areas, particularly in Skilled Nursing facilities. By taking a management role in these facilities, AIM has positioned itself to provide even more efficient, high quality, and cost effective care.
As we look to 2016, there are many exciting things on the horizon. Continued growth into other hospitals, skilled nursing facilities and LTACs is a given. Continued system & process improvements such as our move to geographic rounding with interdisciplinary bedside rounds will be starting shortly. Streamlining care and patient flow from admission to discharge will continue to improve the patient experience, and should be reflected by even better HCHAPS scores for patient satisfaction. In short, AIM continues to work to find ways to make health care better, faster, and safer. If you are a hospitalist reading this, can you say that about your program, or are you just there to take care of as many patients as you can in a shift? Is your program able to say that you’ll NEVER see 20 patients in a day? If not, stop working in a patient ‘factory’ and meet our team and see just how rewarding it is to be a part of a team dedicated to the highest quality of care and patient satisfaction while maintaining equal satisfaction for our providers. 2016 will be quite a ride…time to jump on board!

Survey says….

When Advanced Inpatient Medicine started at our Wilkes-Barre site in October of 2013, I saw a very dysfunctional facility that was essentially run by specialists and the primary care docs that consulted them frequently. There was no thought to the changing landscape from a fee for service mentality to a pay for performance one. Right before we started there, I met with the CEO & warned that if we did our job right, he would have many consultants beating down his door to complain about us. In fact, that is exactly what happened. We didn’t consult a pulmonologist for every simple pneumonia or cardiologist for every chest pain, so, as our service grew, some specialists got upset and considered us a threat to their livelihood. One went so far as to try to get us thrown out with literally fabricated stories about our performance. On the 2014 physician satisfaction survey, my fellow medical staff, especially the medical specialists, crucified us. They were very critical and talked about a lack of communication and expressed concerns about clinical quality of care. After all, as one cardiologist put it, “You can’t possibly take care of CHF without a cardiologist.” Yes, it was that bad. We had to work with the CMO & other staff to create a dashboard to show that our quality was better than the general primary care doctors, with a markedly lower length of stay with no corresponding increase in admission rates.
Fast forward a year later to the newly released annual physician satisfaction survey this week. Our group has had a tremendously large increase in our scores across the board. No longer does the medical staff seem suspicious that everything we do is part of some conspiracy to affect their livelihood. (Yes, there is always one who just won’t give up that idea!) We received much higher marks in the perception of quality of care, communication, etc. The bottom line is that we have now generally become accepted as a part of the medical staff that provides a quality role at that hospital. That is a very gratifying survey to read because it means that things are progressing right on schedule. Taking care of hospitalized patients is the easy part, and not a whole lot different from place to place. Changing a culture requires patience & the ability to communicate openly & realize that this is a gradual process. Bad habits have been allowed to fester for a generation. Yet, we are slowly putting in system & process improvements that are starting to create fundamental change. The resistant few are beginning to realize that pay for performance is coming whether they like it or not. Those that refuse to embrace it will be left without a hospital to work at. Truthfully, that’s fine with me because I believe that our hospitalist team will be able to provide excellent care of those patients.
AIM continues to grow by hiring staff that embrace the two pronged challenge of patient care and improving the system. Are you one of those looking to truly make a difference? We have added several more sites and are looking for some talented providers that have that same mindset. Time to jump on board!

Raising the bar

Getting our new site in Wilkes-Barre off the ground has been a rewarding, but intense, experience. Getting a chance to attend the annual Society of Hospitalist Medicine meeting this past week in Las Vegas has been a great way to recharge the batteries after months of hard work. As usual, inspiration was everywhere, with plenty of innovative ideas around and great people to network with. One of the big topics was the recent release of the ‘Key Principles and Characteristics of an Effective Hospitalist Medicine Program’. They were created essentially as an assessment guide for hospitals & a framework for hospitalist groups to look at ways to improve their capabilities and performance. There are ten guiding principles and 47 characteristics listed, which serve as a benchmark to self assess our program to see where we stack up as compared to the gold standard. I am happy to say that AIM stands strong. Our group embodies these standards in almost every aspect. That’s not to say that some of these principles don’t need a little more refinement, but the core structure is there. Our focus on team based care that is patient centered and focused on aligning goals with those of the hospital fits this gold standard well. Working on improving care coordination across care settings by working closely with referring providers is another key principle that AIM has embraced. Playing a leadership role in the hospital in key areas such as patient safety and quality improvement is another core value of our group that is reflected nicely in the publication. In fact, given the similarities of our mission with the new Principles and Characteristics of an Effective Hospitalist Medicine Group, this is yet another testament that AIM remains at the forefront of hospitalist care. These principles and characteristics will no doubt be tweaked over time, but AIM will continue to remain one step ahead of the curve.

As this conference concludes, it’s time to get back to work and apply some fresh ideas to our program to keep AIM a step above the rest. It’s been a great conference for learning new aspects of care, networking for fresh perspectives on ideal hospitalist care, and to verify AIM’s standing as one of the top hospitalists programs in the country. We will be reviewing these principles as a group and looking for ways to raise the bar yet again.

Faith restored

My faith has been restored. If you read my last blog, (go ahead, it’s right below this one, I can wait) you will understand that I was very unhappy and disappointed with many of my hospitalist brethren for some of the more outrageous demands that they were making when considering a hospitalist position within our organization, and seemingly ignoring the important aspects of the job while focused only on compensation and minimizing workload. It seemed as if the high demand on hospitalists had brought out the worst that some people had to offer. Well, I had the pleasure of interviewing a couple this past week that actually came to me because of AIM’s ideals of excellent patient care and wanting an opportunity that afforded them the chance to do the best job that they could. They asked questions about the system, the amount of patients that they would expect to see, and spent a great deal of time trying to learn our system and how we planned to operate. While we discussed salary & benefits, it wasn’t the first question they asked, and they clearly had the attitude that I look for in our employed physicians. Namely, a desire to excel and to deliver the best care that they could, and a willingness to invest time into improving the overall patient care process. Our hospitalists are expected to provide more than just excellent patient care. We expect them to provide care that is faster, safer, of higher quality, and to deliver that care in a more efficient manner. I am thrilled to find hospitalists who still believe in those ideals. I have my fingers crossed that they will join our team, since you never know what other factors may affect their decision-making process. I do know that they would be a perfect fit for our team, though. So, if these two found AIM, I know that there have to be others out there who are motivated to try to improve the status quo and go beyond ‘ordinary’ hospitalist bedside care and join a team that wants to be extraordinary. Like I said, faith restored. Now, back to recruiting since we are about to announce out next expansion site shortly.

Something is rotten with recruiting!

While excited about our newest expansion into Wilkes-Barre General Hospital, the recruiting experience as I form my new staff has been eye opening. There is such a relative shortage of hospitalists that there is almost a feeding frenzy by hospitals to offer up just about anything to entice a hospitalist to sign on the bottom line. It’s been disturbing to see competitors that have lots bigger bank accounts than this growing organization of mine throwing out large signing bonuses, relocation expenses, vacation time, and more to get docs, and that’s essentially where the market is right now. Many of those docs looking to make a quick loan repayment, however, find out quickly how life works when their new hospital makes them see 20 patients a day or finds ways to make bonuses unreachable without any recourse. There’s no way that I can compete against these deep pocketed organizations except by making sure that my message of quality and job satisfaction cuts through the dollar signs, and that is the part that really rubs me the wrong way lately.
Many young hospitalists have already taken full advantage of the market to make increasingly greedy demands because they know full well that someone out there is going to be desperate enough to give them what they want. So, over the past few weeks, I have had hospitalist recruits start conversations with comments like: How much are the bonuses? How many vacation weeks? When do I get a raise? I want full tail coverage from day one and am not doing any night call…and on and on. What ever happened to these questions: What philosophy does your group have? How will you help me advance my career and gain leadership experience? How will we do CME? How does the team get along? What effect will this job have on my lifestyle and family life? There have been no questions about quality of care or how the hospital is approaching changes in health care. These are all important questions and, in my opinion, way more important than how much you get paid for your moving van. Have hospitalists become hired guns? Have we already started to lose our way because of greed? I won’t even talk about locums docs, because they take all this to the extreme …talk about hired guns!
So, as you think about the next phase of your career and consider various hospitalist programs, look at the program, not the benefit package, as first on the list. We all have school loans, but, you know what? You are all going to pay them off no matter where you work. Therefore, wouldn’t it make more sense to work where you would have the best satisfaction, safest workload, opportunities for personal and professional growth, and overall best lifestyle? Money can’t buy happiness. As long as a group like mine is competitive with its salary & benefits, and AIM certainly is, then all of the intangibles that AIM offers should be very enticing to any hospitalist. I just hope most docs can figure that out when they rub the dollar signs out of their eyes. It’s not your fault though! Hospitals all over are throwing those dollar signs at hospitalists & many docs just can’t help themselves. Be smarter than that and don’t be fooled. When you make your checklist of plusses and minuses when choosing a program, I submit that salary should be no higher than the middle of your list. If you want it first on the list, I guarantee that you will get paid exactly what you want by somebody. Whether you get anything else out of that job besides a paycheck (headaches, frustration, and fatigue, maybe?) is another story. As the knight said to Indiana Jones…choose wisely.