Five Tips for Managing Employed Physicians

The Q1 2016 Provider Advisoris focused squarely on the onboarding process and how providers are affected by it. This post excerpts a Q&A with HealthStream’s Nick Ferreira about some special considerations concerned with managing employed physicians.

We spoke to customers and experts concerning the management of physicians as employees and formulated these five key areas of focus:

1. Solve the Physician’s Problems/Roadblocks
   
   

   Physician roadblocks look different than those of other employees. Physicians are concerned with anything that presents a barrier to practice, and the barrier may differ depending on specialty. Surgeons may struggle with streamlining blocktime maintenance while radiologists might want to maximize flexibility in work location. ED physicians may see patient process efficiency as a barrier while cardiologists might struggle to attain flexibility in when they do Cath Lab procedures.

   These issues can’t be solved with a better performance appraisal or more employee engagement data. Addressing the roadblocks requires different thinking and influence than the typical talent management challenges. HR may need to collaborate with other resources in the organization to ensure there is a smooth process for discovering and addressing physician-specific challenges.

2. Build Two-Way Communication

   Facility-to-Physician: Communicate to Build Relationships

   Physicians want to know they are part of the patient team. How we communicate to them goes a long way in changing that perception to a reality—and the reality is that relationships are important, and relationships help create and maintain a better practice environment. Mona Tucker from Seton Medical Center, Harker Heights recommends “Communicate, communicate, communicate—get to know physicians very well and develop real relationships with them; also help them build their relationships with others.” According to a 2015 HFMA survey, less than 40% of physicians believe the hospital treats them fairly in terms of the business relationships.

   At the least, standard employee communications, or a version of it, should reach the physician. Department level success stories, the facility’s financial results, and notices of social events are all important to build that relationship. Information that is worthy of repeating in other settings, such as the number of specific specialty procedures per year, also helps physicians build their own business relationships. Where physicians are not official employees, ensure they have an email address for that facility. These small actions help build those critical relationships.

   Physician-to-Facility: Give Physicians a (Meaningful) Voice

   Physicians must feel they have a meaningful voice toward leadership and their colleagues. Aside from communication to build strong relationships (as mentioned above), we must give physicians a voice on how goals are set and how a “bill becomes law” in the facility. Yet to give physicians a meaningful voice we must first speak to physicians with a meaningful voice. For example, we must use data-driven arguments and be prepared to discuss that data, results, and next steps.

   Physicians then need a mechanism to allow their opinions to be heard—at all levels. We must involve physicians and clinical leaders in major decisions and allow their input very early. Top-down decisions that occur without physicians’ knowledge usually garner poor reactions, unless it is a new regulatory change where there is no choice. Like any employee, physicians should have a voice in the key issues within their areas of expertise and on matters that affect their practice environment.

3. Demystify the Culture
   
   

   Physicians are aware they are a different type of employee— at least culturally. They may feel like outsiders who lack critical insider knowledge. As part of the patient care delivery team, physicians should not be left figuring out whether they are part of the culture or how to break into the culture.

   Something as simple as giving that physician a facility email address or the code to the staff refrigerator may build disproportionate positive social capital for them. Inviting physicians to employee events, such as job fairs and social appreciation events, also helps other employees to see physicians as part of the culture. Simple actions can make a person feel part of the internal culture.

4. Invest in Physicians Wisely
   
   

   Investment in physicians is often a touchy subject for all leaders. We know investment is needed, yet decisions about how and where to invest are anything but simple. Between different specialties and demographic needs of the patient mix, almost any investment decision comes under scrutiny from one party or another.

   We found that relationship-building and respect-building investments usually have high payoffs. For example, while capital equipment investment usually shows physicians that their “craft” and practice area is valued, the hospital recognizes that it is not necessarily better or more advanced equipment, but different or more diverse equipment that makes an impact on how physicians can practice. Another example occurs within continuing education, required for many specialties and subspecialties. A certification from The American Board of Internal Medicine can run upwards of $4,000 for application, fees, and exams. Yet another example occurs in physician recruiting activities. It is not just a signing bonus that’s needed—although Merritt Hawkins’ 2014 Review of Physician and Advanced Practitioner Recruiting Incentives indicates that 70% of their physician searches included a signing bonus. Beyond that bonus, it takes getting leaders in the organization (CMO, CEO, and CFO) to take time from their busy schedules to meet with physicians when they visit.

   When investing to build relationships and respect, effort and time can be more valuable than dollars.

5. Keep It Professional and Scientific
   
   When physicians are integrated into the culture, feel engaged with great communication, and have a meaningful voice, we must still remember the employer/employee relationship. It is important to keep the relationship professional and scientific. Even though the rapport with physicians may become great, accountability, both public and private, still exists on multiple dimensions. This accountability may necessitate tough conversations between physicians, leaders, and nurses—and these conversations must be transparent, science-based, and sometimes challenging. These tough conversations are easier to address when the relationship is professional and scientific.
   
   From addressing physicians’ most pressing challenges to investing in their practice environment, on the surface it appears the management of physicians is similar to how we manage other talent. Yet when applying these broader tactics to physicians, it is how we approach physicians that makes a difference. Physicians often lead the team that surrounds every patient, and we must integrate them into the patient experience in a way that enables the best patient outcomes.