Healthcare Recruiting and the Affordable Care Act

On March 23, 2010, President Obama signed the Affordable Care Act. The law mandates comprehensive health insurance reforms that have been slowly rolled out over the last four years and will continue to be revealed and implemented. An abbreviated timeline: in 2010, a patient’s bill of rights went into effect; in 2011, people with Medicare began receiving key preventative services for free; in 2012, Accountable Care Organizations and other programs helped healthcare providers work together in a more integrated way to deliver better care; and, this year, all Americans were able to access affordable health insurance options and to compare health plans on a level playing field.

All together, these reforms mean that millions of people who were previously uninsured will now have coverage and enter the healthcare system, some for the first time in their lives. So, what does this mean for the healthcare recruiting industry and the business of healthcare? Below we explore some key ramifications.

· Shortage of/need for physicians, specifically primary care physicians (family physicians and internists), pediatricians, cardiologists, oncologists, neurologists, orthopedists and psychiatrists. As more patients enter the system, the demand for frontline physicians is increasing significantly. In addition, the demand for specialists is also increasing because a majority of those entering the system are older and/or sicker due to having not had access to healthcare before. Compounding the problem is the economy. Thousands of physicians were forced to delay their retirement dates as the economy suffered. Now, as economic conditions improve, we are seeing an increase in physicians retiring.

· Shortage of/need for advanced practitioners. As demand for physicians increases, so, too, does the demand for advanced practitioners, including nurse practitioners and physician assistants. We are seeing an increase in candidate searches for these positions. In order to increase patient care standards and productivity, healthcare organizations must supplement physician practices with APPs. 2015 will see a surge in recruitment activities for these providers, as well as the need for increased specialization of these healthcare professionals. Much like physicians choose a specialty, advanced practitioners with specific surgical or subspecialty expertise will be highly sought after-and will be able to command a higher salary.

· Increase in/expansion of primary care training programs. Because the demand for frontline physicians is increasing exponentially, academic and training hospitals are expanding, resurrecting or developing primary care training programs – and just in time. Researchers have estimated that America’s current primary care workforce would need to expand by 3 percent between 2010 and 2025 to keep up with the country’s healthcare demands.

· Shortage of/need for teaching physicians. As the primary care programs expand, the need for teaching physicians increases. The healthcare search industry is experiencing requests not only for more physicians and advanced practitioners, but also for more physician faculty members and residency program directors to train these professionals.

· Integrated healthcare model; broader physician skillset. Many large (and small) healthcare organizations are moving to an integrated care model that features a multi-disciplinary care team for patients who get sick most frequently. This coordination and cooperation among different physicians, healthcare providers, hospitals and health plans moves away from conventional “fee-for-service” medicine that encourages volume rather than quality-of-care – and can save organizations millions of dollars. As such, recruiters are being asked to find candidates with a cooperative spirit, a team mentality, excellent interpersonal skills and experience working with an electronic health record (EHR) system.

· Increase in frontline healthcare facilities-and staff. Many healthcare organizations are opening up additional frontline facilities like urgent care centers to reduce the number of uninsured people reporting to emergency rooms. Before, these people could only receive care by going to an ER. Now, with healthcare coverage, they have options. This, too, is a move toward preventative care that saves healthcare dollars. It is more cost effective to treat a runny nose than it is to hospitalize a patient with pneumonia. As these ancillary facilities open their doors, they need to be staffed. The recruitment industry is seeing an increase in requests for administrators, physicians, nurses and support staff for these centers.

· Increase in demand for physician leaders. Recruiters are increasingly being asked to screen physician candidates based on additional factors. Not only do physicians need to be clinically sound, but they also need to possess leadership and management skills. They must be able to work as a member of an interdisciplinary group, lead and support a team and have an overall understanding of how quality of care and financial metrics intersect. Since demand for these physician leaders is increasing, educational institutions nationwide are creating programs to adequately prepare physicians. Additionally, as the requirements for these specific types of candidates increase, so, too, does the time it takes to screen and source these candidates. Many healthcare organizations are finding it more cost effective to outsource this function to search firms, particularly those with comprehensive candidate databases.

· More competition requires package flexibility. Competition for physicians used to be local; now, it is national. There are more open spots and fewer physicians, so the recruitment process needs to be strategic, streamlined and customizable. For example, one candidate might want a larger signing bonus, while another may prefer student loan repayment. Healthcare organizations need the flexibility to customize these packages in order to get the candidates they want-and they need to be able to do so in a timely manner.

· Physicians Will Continue Seeking Employment within a Healthcare System. The Physicians Foundation survey found that the hospital employment model is making large and swift inroads into private practice. In 2008, 62 percent of respondents were private practice owners. This year, only 35 percent of the respondents remained independent practice owners. In addition, according to The American Hospital Association, the number of doctors on hospital payrolls has increased one third since 2000. Being employed by a hospital provides a certain level of protection-and a significant decrease in overhead costs. Currently, hospital/health system employment is the number one career choice among medical residents in their final year of training. Hospitals will continue to acquire primary care practices and specialist groups as it makes sense for implementing integrated care models and achieving their business goals in 2015.

· Data-driven Decisions. In January, 2013, McKinsey & Company, in association with the U.S. Health System Business Technology Office, published a report titled “The Big Data Revolution in Healthcare: Accelerating Value and Innovation.” In it, they discuss how big data will rule all healthcare metrics. 2015 will be the year this comprehensively comes to pass. Escalating costs and shifting trends in provider reimbursement will combine with regulations that affect healthcare organizations’ bottom lines (such as the American Recovery and Reinvestment Act’s (ARRA) meaningful use measures), to drive this demand for specific metrics.

At a recent meeting of the Independent Physician Association of America (TIPAAA), IPAs reported their physicians in Accountable Care Organization models are beginning to acknowledge practicing better medicine based on data availability and comprehensive patient follow-up. In 2015, healthcare systems will need to record and retrieve data that accurately tell the story not only of physician productivity, but also of patient health outcomes and satisfaction; data will be the basis for all care management and business decisions.

· Compensation Increases Depend on Patient Outcomes. With this insatiable desire for data comes new ways in which to use it. Data revealing physician productivity, patient health status and patient satisfaction will be inextricably tied to provider compensation. The “fee-for-service” model will be replaced with the “fee for providing value and improving population health” model. In fact, in 2013, the Medical Group Management Association (MGMA) included patient satisfaction scores as part of their annual compensation report for the first time. In 2015, healthcare providers will be incentivized for positive patient outcomes, as opposed to the quantity of the patients they see.

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