BY: CHRISTOPHER M. DADLEZ
Mr. Dadlez is president and CEO, Saint Francis Hospital and Medical Center, Hartford, Conn.
A committed and fully engaged medical staff is the lifeblood of any hospital. Yet, in today's stressful health care climate, no hospital can take its medical staff for granted. Significant time and effort are needed to forge a culture that fosters strong partnerships between the medical staff and the hospital's administration.
At Saint Francis Hospital and Medical Center in Hartford, Conn., doctors and administrators strive to collaborate to achieve common goals, the result of a joint effort begun four years ago when a survey of the medical staff revealed an aging physician population at the hospital. In addition, national data indicated few medical school graduates are choosing primary care medicine. Hospital leaders realized they needed to strengthen the infrastructure to support recruiting efforts. This necessitated adding physician recruitment and physician liaison personnel and integrating them with human resources and medical staff leadership. A program involving income guarantees was developed to motivate new physicians to join existing practices and affiliate with Saint Francis.
Whereas, previously, contact between hospital administrators and physicians had been limited, the new efforts resulted in a stronger partnership. As new people were added to the hospital's staff, they met with private physicians in their offices to address their needs. Individual strategies were developed.
The new processes and programs gave doctors at Saint Francis a sense of empowerment and strengthened their commitment to work with administrators to meet the hospital's mission, which declares its commitment "to health and healing through excellence, compassionate care and reverence for the spirituality of each person." Among the hospital's core values is a commitment on the part of leadership to encourage "initiative, creativity, learning and research" within the culture of the clinical community. Meeting this commitment requires ongoing elevation of standards in recruitment, training and education of the medical staff.
Once largely relegated to spectator roles, physicians now sit on the board of directors, holding three of 33 board seats, and participate in key board committees in robust and diverse ways. A revision of the board's bylaws allows the president of the medical staff to be a voting member of the board. Previously, the president had served ex-officio.
Notable among committees with active physician participation is quality/medical affairs, which includes the president of the medical staff among its members. This committee deals with quality and patient safety issues, credentialing of physicians, and revision of the medical staff's bylaws. This revision, now underway, involves 30 physicians serving on three task forces and working with a consultant.
The president of the medical staff, an orthopedic surgeon, and a cardiovascular surgeon have participated in plotting the vision and strategic direction of the hospital as members of the strategic planning committee. An orthopedic surgeon serves on the finance committee, joining in deliberations related to the institution's financial health.
The president and CEO at Saint Francis (the author) encourages an open-door policy with physicians to foster upfront, candid discussions about improving the institution. These conversations are not always smooth or easy. Physicians, after all, represent diverse and often competing approaches to addressing the hospital's needs. Despite inevitable differences of opinions, both parties work to ensure that these conversations are productive.
For example, discussions between administrators and physicians recently led to the recruitment of four local orthopedic surgeons whose vision was central to establishment of the Connecticut Joint Replacement Institute at Saint Francis, which includes 11 physicians. Physicians were actively involved in the creation and design of this "hospital within a hospital," which now has dedicated operating rooms and nursing units for joint replacement patients. The physicians have performed about 2,500 joint replacement procedures in 11 months.
This initiative garnered significant resources at its introduction, such as operating room block times, patient floor redesigns and dedicated recruitments. Although it was a challenge to effectively communicate the benefits of this effort to the entire hospital community, the administration at Saint Francis strives to be accessible to all viewpoints and open to recommended alterations.
Recruiting and Marketing Physicians
Physician recruitment is continuous and extensive at Saint Francis. Led by the chief medical officer, a recruitment committee evaluates the hospital's needs for specialists and primary care practitioners (both hospital-employed and private practice) and matches them with available applicants. The hospital employs a full-time physician recruiter. This recruiter and her support staff direct all important searches, and rarely engage an outside search firm.
The recruiter serves on the recruitment committee, which also includes the chief medical officer and the hospital's vice president for network management. As a result of ongoing advertisements in professional journals, the recruiter receives numerous curriculum vitae from physicians seeking to relocate to the area. These are distributed to those private practitioners and office managers seeking to add staff.
These recruitment efforts have been quite successful. Since beginning the physician recruitment program in the 2006 fiscal year, 140 new and replacement physicians have been added to the staff: 51 primary care practitioners (internal medicine, family medicine, pediatrics, obstetrics/gynecology); 32 medical specialists; 27 surgical specialists; and 30 in such ancillary specialties as emergency medicine, anesthesiology, radiology and pathology.
When new physicians come on board, a multifaceted introduction program begins. This program, administered by the physician liaison, ensures that incoming doctors are broadly introduced to peers and community residents. These efforts inform the medical staff of new members, encourage the building of relationships and development of referral patterns, and also introduce the expertise of incoming physicians to the community at large.
Some of the highlights of the hospital's 13-point marketing program for each physician include:
- A news release for newspapers with an accompanying color photograph, and an advertisement in The Hartford Courant and select community newspapers.
- Announcements in the hospital's consumer magazine, employee newsletter, and medical staff newsletter
- Announcements on the hospital's "music on hold" telephone system
- Postcards to the 600 members of the medical staff and bulletin board announcements
- A new physician profile page and news release on the hospital's website, www.stfranciscare.com
- Optional participation and promotion of physician involvement in the "Dessert with the Doctors" program or public speaking opportunities
Creating a Physician-Hospital Organization
Another important component of the relationship between physicians and hospital administration is the Saint Francis Physician Hospital Organization. Founded in 1993, this is one of roughly 750 such organizations in the country, a relatively small number in the context of hospitals and health systems nationwide. Saint Francis owns 50 percent of its physician hospital organization; the other half is owned by member physicians. A physician hospital organization includes hospitals and physicians contracting with one or more HMOs, insurance plans, or directly with employers to provide health care services.
When initially formed, the Saint Francis Physician Hospital Organization focused on managed care contracting and shared financial risk. During its 15-year history, however, the organization has extended its focus to include improved quality and efficiency of health care services provided by its members.
Ten physicians and five administrators sit on the physician hospital organization's board of directors. Under their leadership, the organization's mission is to maintain a cohesive network of providers with a common goal of aligning the clinical and economic interests of its customers (physicians, hospital, patients, payers and employers) with a focus on continuous quality improvement, improved patient outcomes and the efficient management of resources. The physician hospital organization has implemented programs, systems, policies and procedures that increase the provision of cost-effective, quality care. This arrangement offers members a full complement of value-added services, including medical management, network management and information technology.
As a result of changes in the Stark Law and Internal Revenue Service regulations, Saint Francis was an early investor in electronic medical record system and practice management software that individual physician offices may acquire at reduced cost. The goal is to offer its physicians a common practice management system, which is integrated and interfaced with a common electronic medical record system. Shared patient data is a critical component of providing quality care, improving patient outcomes and efficiently managing resources.
Investing in Access Centers
In the past year, two new access centers have opened in key suburban markets, adding to 14 Saint Francis centers throughout the service area that have been developed during the past decade. These 16 medical office centers provide an opportunity for hospital physicians to establish satellite offices in these communities and allow hospital officials to meet the ambulatory service needs of our patients in outlying communities in a more accessible and convenient fashion. They also help the hospital promote patient-provider relationships in these communities.
Another example of the high level of cooperation that exists between the medical staff and the hospital is the Saint Francis GI Endoscopy, L.L.C., which is scheduled to open in November. This joint venture developed in partnership with 12 physicians, who own 51 percent of the practice. It will offer colonoscopy and endoscopy procedures in a convenient suburban location. The partnership will result in a high-quality ambulatory care center that leverages both the expertise of the physicians and hospital administrators in creating a patient-centered environment.
The sense of empowerment that administrators at Saint Francis seek to give to physicians is critical to the success of the hospital's mission. This stems from the basic value that the hospital administration places on the role of physicians, who know their voices will be heard in their meetings and in conversations with the president and CEO. Clearly, physicians are essential to the success of Saint Francis.
Q&A with Physician Recruiter Christine Bourbeau
Christine Bourbeau is director of physician recruitment for Saint Francis Hospital and Medical Center, Hartford, Conn., and an affiliate, Bristol (Conn.) Hospital. A veteran of 18 years in the field, she helps recruit about 80 new physicians, physician assistants and advanced practice registered nurses every year.
In an interview with Health Progress, Bourbeau shared her insights about her work and the challenges of recruiting physicians.
HP: Your job is more than a 9-to-5 position, right?
When you do what I do, you have to make yourself available, because doctors are not always available 9 to 5.
A lot is done over e-mail. In one way, it has made it easier. On the other hand, it's taken away a lot of those phone calls where you want to speak with the person.
What we try to do beforehand is find out what exactly they want to do. You have to get into the doctor's head. If they are bringing a spouse, we'll set them up with a real estate agent. You don't want to waste the doctor's time and you don't want to waste your time. You want to put your best foot forward. You've got one chance because a lot of people are trying to recruit that same doctor.
HP: How much has the Internet and e-mail affected your job?
When I started recruiting 18 years ago, physicians waited for their journals to see the ads. A lot of journals where we advertise now have websites, and job postings are right there in 24 to 48 hours. Also, Saint Francis has an amazing website just for physicians.
Doctors are very sophisticated today. They usually already know a lot about the community. If they have kids, they've looked on the web to find out the best school systems. The Internet has helped us greatly.
On the other hand, doctors are shopping around. There are a lot of jobs for that one physician. You have to strut your stuff when they come in for the first interview.
HP: What are the top concerns physicians have when considering joining a hospital?
It all depends what the specialty is. If it's an orthopedic surgeon, it would be the technology. Do I have enough operating room time? Is the OR giving me block scheduling? If it's an internist, they want to know if a hospitalist program is in place. It's definitely a plus. For residents and fellows, they want to know if the hospital is an academic center. They want to know if it's a teaching hospital.
Most of all, physicians like to hear that the administration supports physician recruitment and that you're not hiring an outside agency to do it. Physicians coming to Saint Francis know that I've been here a long time. I know the doctors, I know the community, I know the people, I know the hospital. I can talk intelligently about what's going on.
HP: What are your boundaries in recruiting?
We sort of play match-maker. If there's a doctor who needs to hire an associate, the hospital is happy to help as long as it is a defined community need. That's the quid pro quo. We just can't help any doctor recruit any specialty. It has to be a specialty that is needed in the community.
We have a medical staff development plan. It's my road map. I know how many cardiologists I'll be recruiting, how many hospitalists I'll be recruiting. I know pretty much what I will be looking for in the next couple years. It's very well-orchestrated.
HP: What factors including location, schools, housing, etc., play in the decision-making process of physicians considering your hospital?
That is always number one. We are just two hours from New York City and Boston. We're an hour from the shoreline. There are physicians who want to be here because it's a reputable hospital, a teaching hospital. They want to know that they have the support of the hospital, and they now want income guarantees. When physicians come in for a job interview, it's nice that they know they will have a salary for the first two years. But, it's not always the money. It's rare that a physician will ever say to me, "What's the salary for the position?" If they do ask, then you know they are just shopping around.
HP: What are the main concerns of the hospital in making a decision about which physicians to hire?
We want to make sure the doctor comes out of the proper training program. We're looking for certain specialties we don't yet have on the medical staff to complement what we already do. We just completed a nationwide search for a chief of cardiovascular surgery. Saint Francis is known as the heart surgery hospital in Connecticut. It was amazing how many applicants we had. It was one of the most exciting searches we've ever done.
It's looking to see what talent we want to add to the medical staff. Who will be retiring? We have to look into getting more primary care physicians because primary-care doctors refer patients to the specialists. Everybody struggles with primary care physicians because many of these doctors coming out of their residencies are going into hospitalist medicine. They don't want to struggle with running the office and struggle with billing issues. They want to know their schedule. More physicians are choosing this route.
HP: Explain how the recruitment process works from the time you receive a resume to the doctor signing on the dotted line.
The doctor is usually at the hospital for one full day interviewing. We can pay for air flight, hotel, meals, wine and dine them for a day or two. Doctors love knowing they're being taken care of because that's one less thing for them to worry about. This is all something we can legally do as long as it is a defined community need.
After the candidate interviews, evaluation sheets are sent to all the people that have interviewed the candidate. After reviewing the evaluations by the department chair and search committee, a decision is made as to whether or not a job offer will be made to the candidate.
HP: What, in your view, are the greatest contributors to physician satisfaction? What are the greatest detractors?
Helping round out the staff. No questions about it. It's very difficult to keep physicians in place for a long time. The hospital needs to be contemporary. Doctors want to know there is a solid emergency room department, [up-to-date] equipment in the operating room. Good nursing. Press Ganey scores. Good patient satisfaction.
Surgeons usually want to meet the chairman of the emergency department. They also want to meet the chief of surgery. Doctors like to know that there is a hospitalist program in place and that administration supports physicians. They want to know that's it a well-run hospital that is making money.
HP: What's the role of the spouse in the decision-making process?
I learned a long time ago that it's the spouse who is making the final decision about where they are going to live. A lot of times, the spouse is the man who is staying home with the kids. We go out of our way to make everyone happy. We leave gift baskets in the room. If they bring their kids, we have things in the room for the kids. Getting a properly sized rental car. Getting a hotel room with enough beds or getting them a suite. You want to make them feel welcomed in the community.
HP: What changes do hospitals need to make in order to ensure growth in the profession?
When I first started in this business 18 years ago and put physician recruitment in place, we were one of very few hospitals in Connecticut with an in-house recruiter. Most used outside agencies. Saint Francis was very forward thinking and liked the concept of having more control over it. Now, probably 75 percent of the hospitals in Connecticut have an in-house recruiter. I started the Northeast Physician Recruiter Association. It's been in place eight years and has really taken off.
Physician recruiting needs to be organized more than ever because of the competition. It's a career that will only keep growing.
We insist on looking for doctors while they are still in their residencies and fellowships. You need to start dialogue with them. Send them info. Communicate via e-mail. Go to national career fairs.
HP: Saint Francis has taken a variety of steps to incorporate physicians into decision-making processes; i.e. they sit on boards and board committees; the CEO has an open-door policy. The hospital also has a marketing program to introduce new physicians to the community. Are these programs unusual, and have they made a difference in terms of both recruiting and keeping physicians?
Doctors love the fact that when they come on board, their picture will be in the newspaper. The key is you are going to make that doctor busy very quickly. There are lots of ways to promote physicians. It would be very difficult for them to do that themselves.
HP: What's the most satisfying aspect of your job?
My office is the first contact a doctor has to the hospital. I've actually had physicians come up to me after being at the hospital a year or two or three and say, "Do you realize you're the reason I came to this hospital?"
— interview conducted by Gabriel Kiley, managing editor, Health Progress
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