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The Association for Advancing Physician and Provider Recruitment (AAPPR) is redefining recruitment to retention and is the only professional organization where physician and provider recruitment leaders and others who influence recruitment, onboarding and retention can connect, learn and advance their careers.
The marks of a good partnership are trust, transparency, and a desire to work together toward a common objective. Through AAPPR’s Corporate Partnership program, we seek organizations that provide these key aspects to our members and the physician and provider recruitment community.
Recently, Jackson Physician Search joined AAPPR as a Signature Partner, our highest Partner level, to support AAPPR’s mission of advancing and empowering physician and provider recruitment professionals with high-quality education, resources, and connections, so they can best serve their communities.
I spoke with Tony Stajduhar, President of Jackson Physician Search, to gain insight into what a partnership with AAPPR means to him and his organization. Tony shared how Jackson Physician Search is dedicated to supporting our members by partnering on original research, and with thought leadership and a knowledge base built on hundreds of years of collective experience to AAPPR members.
“At Jackson Physician Search, we support recruitment professionals based on our company’s values that include putting others first and doing the right thing,” said Stajduhar. “Recruitment is a long process, and it’s inevitable challenges will arise. We recognize that no two in-house recruitment teams are the same, and that every recruiting challenge is unique, so we work to understand the industry’s wide-ranging needs and to deliver support and solutions for each.”
Four decades into working with thousands of in-house recruitment professionals, Jackson Physician Search will provide AAPPR members with the resources, education, and expertise they need to improve recruitment efforts. From navigating the challenges of the ongoing physician shortage, to best practices for sourcing and recruiting, to gaining a seat at the table, Jackson Physician Search will share actionable insights on the most significant challenges facing our profession today.
“With the right tools, AAPPR members can drive real change in the healthcare systems they serve,” said Stajduhar. “We’re excited to collaborate with AAPPR and to be a resource for in-house recruitment professionals by listening, understanding their goals, and leveraging our knowledge from thousands of searches to share what we know – from trends and best practices that will improve their workforce strategies.”
As the largest, privately owned permanent physician recruitment firm specializing in physician, physician executive and advanced practice provider searches, Jackson Physician Search has dedicated significant resources to gathering data and insights that bring fresh thinking to the ongoing challenges in healthcare recruiting, and to the best practices that work today.
AAPPR is excited about the value this partnership will bring to our members and for the wide-ranging benefits it will have on our organizations and our communities.
In closing, Stajduhar said, “We’re here to support members in any way we can. We’re not just here to gain customers, but to be an extension of the team, a sounding board and a resource to serve our common goal of improving healthcare and ensuring communities around the country have access to the quality care they need.”
To learn more about Jackson Physician Search and their services for in-house recruitment teams, visit https://www.jacksonphysiciansearch.com. For more information on AAPPR’s Partner programs, visit https://aappr.org/partnerships/.
It’s no secret the market for physician and provider talent is more competitive than ever. Data from our 2022 benchmarking report shows physician shortages in many specialties are expected to continue climbing for the foreseeable future, making employee retention, burnout management, and well-being more important than ever. If not addressed, burnout and poor well-being of physicians, providers, and entire system staff has the potential to impact the quality of clinical operations and patient care.
To keep retention, mitigating burnout, and encouraging well-being top of mind for recruiters, HR staff, and leadership, we believe these three things are critical:
When constantly putting out fires and working to solve employee deficits, it’s difficult to prioritize intentional and thoughtful retention, burnout, and well-being initiatives. That’s why we always recommend engraining retention practices into everyday operations. Tactics like regular touchpoints can help identify issues and potential stressors, such as a lack of support or nursing staff before they’re full-blown crises. It’s also important to take a proactive approach to change management and look to involve physicians and their feedback in the decision-making process whenever possible.
Also critical to mitigating burnout and improving wellbeing and retention, is positioning physician and provider leaders at the forefront of retention activities. Just as physicians must personalize care to each patient, leadership and management need to personalize retention strategies to various teams, people and roles. Not every approach works for every physician or every healthcare system. Rather, empowering physician leaders to build a culture focused on connection will help leadership develop a deeper understanding of their teams wants, needs and concerns. This insight is critical in developing specific and individual strategies to ensure wellbeing, alleviate burnout and drive retention.
New technologies are essential to improving operations, efficiencies and even patient care, but AAPPR research also found new technologies and processes are a common cause of burnout, especially among older physicians and providers. In fact, our 2021 report on physician satisfaction and burnout found that over 33 percent of physicians cited burnout as the primary factor for early retirement, while 20 percent attributed an increasingly difficult technology and administrative workload as causes for early retirement.
The involvement of physicians in the roll out or development of new technologies and processes can help to ensure the technology works in a way that complements physicians and their roles, ultimately reducing day-to-day stress rather than introducing new stressors.
All of these things sound relatively simple in theory, but limited bandwidth amongst physician leaders can make it difficult to implement clinical-driven retention strategies. We recommend a few best practices to make this process a bit easier including allowing physicians to lead by example to promote the benefits of a physician-led recruitment program and providing physicians the tools and recourses they need to lead their own team programs. The most important thing leaders can do to support retention efforts is “know thy physician”. As recruitment professionals, we have a critical role in serving as the liaison between physician and leadership and can help nurture these important relationships and promote retention strategies.
Overall, proactively involving physician leadership in retention activities has the power to improve retention rates in clinical support staff. By giving physician leaders the resources needed to develop and engage with their team members, these leaders are empowered to meet with teams outside of the work environment and improve retention rates by understanding team concerns and challenges, as well as soliciting feedback on their own individual management styles. More than anything, an organizational commitment to the principle of “no decisions about me without me” may bey the key to avoiding administrative decision-making that doesn’t adequately account for physician needs.
Have you implemented any physician-led retention efforts at your organization? Share with us on social!
Facing unusually long wait times for credentialing and medical licenses in many states, physicians and advanced practice providers say it’s preventing them from making a living – and impeding patients from getting the care they need.
Physician and provider recruiters are well aware of the state medical licensing delays. For years, recruitment professionals have managed the challenges that prolonged state licensure delays have on new providers who are eagerly waiting to join an organization practice. In some cases, the unpredictable licensure timelines and unforeseen delays have resulted in organizations adjusting provider start dates multiple times. In turn, this can mean delaying appointments for patients who may have already been waiting to see a provider for quite some time.
The COVID-19 pandemic contributed to the backlog, adding to the physician shortage and other factors hampering healthcare recruiting – but does it affect patient care? Deborah Baker, Director of Legal and Regulatory Policy for the American Psychological Association,¹ believes it does. “If we don’t have efficient, consistent processing of these licensing applications, it’s just snowballing the overwhelming need,” said Baker. “This is more than just an administrative issue, this really is a public health issue.”
The length of time it takes to get a license in each state varies. Each state has its own licensing process, and although licensing requirements are very similar across the country, most states require physicians to be separately licensed in every state in which they practice. In addition to state-based licensure requirements, physicians performing services for multiple hospitals (like radiologists reading digital films via teleradiology) must be separately credentialed and privileged at each hospital.
The cause of the delays can vary, but state budgets and lack of staffing are common reasons. The processing speed can also vary by state and profession. Most states license numerous other professions and occupations, not just those in healthcare. Some states have independent medical boards that approve licenses, while others house their boards within a larger agency. Many states also use manual processing systems, requiring applicants to send forms, transcripts, and other records via fax or mail.
Physicians and providers need to be aware of the time it takes to get a license or risk being blindsided by licensure delays. Physicians are typically told it will take about sixty days, but in some states, the process can take six months or more. Prolonged delays have caused some physicians to pivot career plans or work in limbo in a location where they are licensed and credentialed until they can get a license to work in another state, practice, or hospital. All the while, patients await delivery of care.
Delayed licensing is not a new problem, either. In 2009, the California Medical Association2 filed a suit claiming that furloughs instituted by the state unacceptably slowed the state medical board’s processing of applicants for physician licenses. The state medical board had a backlog of applications well before California began its furlough program. In 2020, the healthcare system was already experiencing a physician shortage, impacting access to care, when the COVID-19 pandemic exacerbated the problem. It also revealed how ill-prepared state licensure and hospital credentialing procedures are when a crisis requires hiring more physicians to meet patient-care needs.
At the onset of the public health crisis, every licensing agency was forced to adapt. The Centers for Medicare and Medicaid Services (CMS) and almost every state in the country temporarily waived the requirement that physicians be licensed in the state where their patients are located.3 Many states waived or modified licensure requirements and renewal policies to ensure physicians with out-of-state licenses could practice in states with increased in-hospital demands. Did it help? NYC Health + Hospitals (at the epicenter of the crisis in the U.S.) was able to staff up to meet urgent needs during the pandemic,4 and there are numerous other examples.
The Interstate Medical Licensing Compact (IMLC)5 also provided much-needed flexibility to states that needed to license physicians to treat more patients quickly. The IMLC, an agreement between state boards of allopathic and osteopathic medicine, allows board-certified physicians in one of the member states to obtain expedited licensure in other member states. The Compact requires just one application for a physician to be licensed in multiple states where they intend to practice, which helps licensure to be completed faster and in fewer steps.
While the pandemic highlighted the need and the efficiency of the IMLC, it also changed how physicians used the compact. According to research from the American Academy of Dermatology Association,6 before 2020, a higher percentage of physicians used it for localized practice, with about 40% of physicians applying for licenses in a nearby state and an average of 1.6 licenses issued per application. However, after the pandemic began, locum tenens and telemedicine needs increased to account for 66% of applications.
What if physicians who get licenses in multiple states could also use the IMLC to maintain them? According to the American Academy of Dermatology Association,7 one of the biggest issues the IMLC hears from physicians is the difficulty in having multiple licenses with different renewal periods and continuing education requirements. In response, the IMLC is working to create a single source for physicians to log in to view all their licenses and track and control that information.
Virtual medical visits also dramatically increased during the pandemic. To prevent exposure to physicians and patients yet still serve patients, in-person visits were conducted by video. To address the critical need, some states also extended out-of-state licensing requirements for telehealth during the COVID crisis. For some specialties, telehealth has become a vital tool for physicians and patients alike, increasing and expanding access to care in communities. Under the revised licensure requirements, providers can deliver telehealth services across state lines, depending on rules set by state and federal policies. Interstate Compacts further simplify cross-state telehealth for specialists in participating states, according to the Federation of State Medical Licensing.8
Credentialing bottlenecks with organizations and payors can also affect patient care. Any physician opening a new practice, working across state lines, changing practice states, or joining a new hospital or healthcare organization must undergo the credentialing process within that practice or organization – regardless of how long they’ve been working as a qualified healthcare professional. The process requires extensive paperwork and multiple steps, and every state has slightly different requirements for obtaining credentials. Some states estimate traditional credentialing to be 30 to 60 days, while others warn credentialing can take anywhere from 90 to 150 days. Every day can impact a physician or provider’s ability to practice medicine legally, and patient care and access are hindered. The paperwork-filled processes can also increase stress on providers, drain physician enthusiasm, and affect their work-life balance.
Inefficient provider credentialing processes and mistakes can also increase costs. For many hospitals and health systems, 2022 was the most financially difficult year since the start of the pandemic. Research points to administrative waste as a critical driver of excess health spending. According to research from HealthAffairs,9 administrative spending accounts for 15 to 30 percent of healthcare spending, and at least half of that spending is wasteful due to a lack of standardization and coordination of administrative policies and procedures.
There’s no arguing that credentialing is a labor-intensive process. However, the industry is becoming more patient-centric, making it all the more important for physicians and providers to stay up to date with their credentials. That’s why many healthcare industry pundits believe automating the credentialing process can create efficiencies and substantially streamline the process. According to Physician and Practice,10 by importing information directly from primary sources like state licensing boards, a physician profile can be created and extended among health system locations. A physician could verify pre-filled data, supply any missing information, and spend 15-20 minutes versus three or four hours completing a lengthy document. Physicians also save the aggravation of refiling the same paperwork every time they move to a new state, a new hospital, or another practice. Automating and centralizing credentialing could also help healthcare organizations enhance provider satisfaction (think retention) and ultimately help deliver better patient care.
Healthcare staffing complications, exacerbated by the pandemic, put a spotlight on barriers that physician licensure and credentialing procedures have created for the delivery of healthcare. Understanding what the healthcare workforce needs to achieve desired patient outcomes and advocating for faster and easier licensing and credentialing processes is essential to patient care.
1. Building on the IMLC and expanding the Compact to all 50 states and four territories is an important step. It currently includes 37 states, the District of Columbia, and the Territory of Guam.
2. Having multiple licenses with different renewal periods and continuing education requirements is one of physicians’ biggest issues.
3. The proposed national physician license would strengthen our ability to respond to future crises, better allocate medical personnel to areas of need, and reduce administrative costs.
4. Automating the credentialing process can create efficiencies and substantially streamline the process.
5. Providing easier and faster credentialing can allow organizations to offer a unique benefit to the candidates with whom they work, build trust among patients, and deliver patient-focused care.
¹‘A real crisis’: License backlogs in some states are preventing health care workers from seeing patients https://www.nbcnews.com/health/health-care/-real-crisis-license-backlogs-states-prevent-health-care-workers-seein-rcna14740
²Fierce Healthcare: California Medical Association sues state over doctor licensing delays
https://www.fiercehealthcare.com/healthcare/california-medical-association-sues-state-over-doctor-licensing-delays
³Bipartisan Policy Center: What Eliminating Barriers to Interstate Telehealth Taught Us During the Pandemic
https://bipartisanpolicy.org/report/what-eliminating-barriers-to-interstate-telehealth-taught-us-during-the-pandemic
4JAMA Network | JAMA Internal Medicine: Modernize Medical Licensing, and Credentialing, Too—Lessons From the COVID-19 Pandemic, Donnie L. Bell, MD; Mitchell H. Katz, MD https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2775344
5 Interstate Medical Licensure Compact Commission, https://www.imlcc.org/³U.S. Department of Health and Human Resources: Telehealth licensing requirements and interstate compacts
https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/telehealth-licensing-requirements-and-interstate-compacts/
6,7American Academy of Dermatology Association (AAD), EXTENDING MEDICINE’S REACH: DermWorld takes a look at the Interstate Medical Licensure Compact, by Andrea Niermeier
https://www.aad.org/dw/monthly/2023/january/feature-extending-medicines-reach
8Federation of State Medical Licensing: U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19
https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf
9HealthAffairs Research Brief: The Role Of Administrative Waste In Excess US Health Spending
https://www.healthaffairs.org/do/10.1377/hpb20220909.830296/
10Physician and Practice: Streamlining credentialing to boost provider satisfaction, patient access by Grant Fields
https://www.physicianspractice.com/view/streamline-credentialing-to-boost-provider-satisfaction-and-patient-access
Mentorship. It is a familiar word, but what does it mean? When you think of a mentor, who comes to mind? A teacher? A coach? Perhaps a benevolent boss or a trusted colleague?
By definition, a mentor is “a trusted counselor or guide,” and mentorship is “the influence, guidance, or direction given by a mentor.” When I think of mentorship and the benefits, I think of the Three C’s: Counsel, Candor, and Confidence. In this article, I will profile two examples of successful mentorships gained through the AAPPR Mentor Match program, and you can hear in their own words what the experience has meant to them. With increasing emphasis placed on mentorship programs, how can individuals and organizations utilize these programs to grow and develop talent?
Mentorship encourages participants to improve both personally and professionally. It fosters a collaborative environment where there is a free exchange of viewpoints and ideas that can help to build diversity of thought. Mentorship programs make it easier for mentors and mentees to find each other and support a learning culture. Mentors feel satisfaction in sharing their wisdom and experiences with others and experience the opportunity to reflect on their goals and practices. Mentees gain an insider perspective on navigating their chosen career and access to resources.
In spring 2020, Ginger Canaday-Thompson, CPRP, had been a Physician Recruiter with Holzer Health System in Ohio for four years. While she has several years of experience, she wondered if she was doing everything she should to attract top talent to her organization. She also wanted to grow professionally and thought it would be beneficial to have someone to go to for counsel with challenges. Ginger turned to the Association for Advancing Physician and Provider recruitment and signed up for a mentor through the Mentor Match program.
That is how she connected with Dennis Burns, Provider Recruitment Manager at Tidelands Health in South Carolina. Dennis has been working in the profession for more than twenty years. He has long believed that mentorship helps the provider recruitment profession grow and evolve. Throughout his career, Dennis has enjoyed providing education and insight to others and discussing how the profession has changed and continues to advance. He also loves to share stories with other recruitment professionals.
Ginger and Dennis connected on Mentor Match and began to work together through the program. “We started by just getting to know each other. I shared my background with Dennis, and he shared his with me,” Canaday-Thompson said. Burns said that “it is about getting to know one another and building trust. From there, things start to evolve into sharing experiences, challenges, and talking about what we see in the profession.”
For the past eight months, Ginger and Dennis have spoken regularly. “It isn’t formal. We make the schedule. Some of our conversations are long, and some are short.” Canaday-Thompson said. Burns agrees and also points out that “it isn’t a time-intensive commitment, and we always walk away from our conversations having learned something from each other.” The pair have shared both personal and professional challenges with each other during this time and have become friends. Canaday-Thompson noted that “the success of the match is very dependent upon the attitude of both parties. Dennis has been very giving of information, tips, and suggestions and has brought a positive approach to all our communication. That, I think, made our chats productive and enjoyable.” From his perspective, Burns has enjoyed getting a new perspective, “especially the perspective of someone newer to the profession. Working with a professional like Ginger has helped me to continue to grow and, I think at the same time, also supports the growth of our profession. It is about different experiences coming together.”
Jessica Reynolds has been a recruitment professional for ten years and a member of AAPPR for five years, most recently as a Physician Recruiter with Keystone Healthcare Partners in Tennessee. In the spring of 2020, Jessica reached a point professionally where she was thinking about how to continue advancing her career and wanted to know more about AAPPR from an internal perspective. Jessica turned to AAPPR’s Mentor Match program. She found Aisha DeBerry, CPRP, the Atlantic Group Director of Physician and Provider Recruitment for Bon Secours Mercy Healthcare, who also serves on the Board of Directors for AAPPR.
Jessica and Aisha had similar personalities and were able to form a connection right away. “Aisha had a different background from me, but her career had taken her to the director level. I liked that. I also loved how transparent Aisha is.” Reynolds shared. At first, Aisha worried that because Jessica had over ten years of experience, she might not be able to offer her much. “I was honored to be asked to be a mentor, and our first conversation was so easy it just felt like a natural connection,” says Aisha. “I think mentorship is important at any point in your life or career.”
Aisha and Jessica never have an agenda for their conversations, and they both point out that they not only talk about their careers and professional lives but also their personal lives. “We have talked a lot about what it means to be black women in physician recruitment where we are not heavily represented,” DeBerry notes. Reynolds echoed her thoughts and shared how “Aisha and I talk about how to bring our voices, uniqueness, and perspectives to the table.” They can also relate to both being professional women with families and the challenges that can present. “We spend our days in the office, and then we go home, and it’s starting your second job,” DeBerry said. “We are able to bounce ideas off of each other, talk about our experiences, or sometimes we just talk about our families or things that are going on in our lives.”
Over the last six months, Jessica and Aisha have learned a lot from each other. Jessica found someone who is an industry leader and has a diverse background and experience. With their personal lives being almost parallel, she learned from Aisha what she has done in different situations. “Aisha’s transparency is fantastic. I would encourage anyone who is mentoring to be straightforward and open and to go into the mentorship willing to share things that are outside your comfort zone,” Reynolds said. “Seeing Aisha face some big challenges and still find a way to grow and contribute was inspiring and made me find new ways to expand my interests and involvement with my community.” DeBerry shares that “this past year has challenged all of us in so many ways.” The experiences she has had this past year pushed DeBerry to look at things differently. “At a time where you want to help but can’t, mentorship gave me an escape and a way to continue to do something good for other people.”
For those who have participated in successful mentorship programs, the benefits are tremendous. They range from learning skills that will carry them through their careers to tackling a challenging problem and include connecting with someone who has a unique viewpoint or experience and making a lifelong friend. Reynolds summed it up nicely by sharing that “Aisha gives me homework; she asks me questions that make me think and push me to be a little better. I also have a sounding board, someone who makes me slow down and put things in order.” For her part as a mentor, DeBerry says, “it’s my job to be honest and transparent. But it’s not just about providing all the advice and knowledge. You get so much out of mentorship when you’re open to receiving it as well.”
Canaday-Thompson and Burns shared they had a similar experience. Connecting through Mentor Match has translated into a friendship. “Mentors grow from the experience as much as mentees do. I’ve been fortunate to be able to share things with Ginger that are going well and, at times, the things that are challenging for me personally or professionally.” Burns said. From her experience, Canaday-Thompson feels that “I have someone I can go to with any problem or challenge I’m facing. I know Dennis is in my corner, and I’m in his.”
Mentors and mentees agree that it does not take a lot of time to participate and the ingredients for a successful experience are the same. It is essential to be open, both to giving advice and to receiving it. No one is expected to have the answer every time, but mentors and mentees find that they are better able to work through challenges together. Equally important is to remember to give back; the provider recruitment profession continues to grow through the work we do together. Last but certainly not least, members so often mention that it is the network of colleagues that make AAPPR so unique, and the Mentor Match program is just one way to connect with that network in a meaningful way.
To learn more about Mentor Match or enroll as a mentor or mentee, visit Benefits of Mentorship – AAPPR or email Liz Mahan at lmahan@aappr.org.
It cannot be emphasized enough that setting clear expectations in any relationship between an in-house recruiter and a chosen firm or agency is vital to success. Your candidates have expectations, and you take great effort to communicate with candidates along the way. Are we giving our contracted agency firms the same expectation setting? Both parties have expectations about the process and what success looks like, but are you on the same page?
In the current environment of the COVID-19 pandemic and the resulting level of uncertainty, in-house recruiters must take the lead. Remember, agency recruiters and consultants work for you or your organization.
Of course, you can’t control what agency recruiters do or how they operate, or how often they solicit, but you can manage the expectations of outcomes and how you and your organization will be represented to clients. You lead the hiring process and are ultimately responsible for the success of securing a candidate within a timely period. You are the one judged for the quality of candidates put through and so ensuring clarity with your agency partner is key.
One of the mistakes a person responsible for the search can make when dealing with agencies is putting off those calls and not communicating with them enough; at the beginning, during and when closing out a search. Vigorous communication reduces the natural information gaps and assumptions people will make in the absence of clear information or expectation. Elements such as search parameters, timeline, communication preferences, and how feedback in given and applied are all worthy topics.
Insider tip: Recall your worst interaction with an agency or firm. What happened that made it so difficult? Ideally, what could have created a different experience? Use that reflection and the lessons learned to guide expectation setting in all future contracts and continue to reassess what works and doesn’t.
You likely will find yourself needing to educate and set boundaries with the agency recruiter at the beginning of the process. If you haven’t already considered looking at the elements of project management, this may be an excellent method to effectively keep a search progressing. A search is more than just a series of scheduling interviews, meetings, calls, and tasks. It is also more than understanding what you need to do, what’s completed, and what’s overdue. While you may have something to learn from what an agency provides in terms of its process, you will want to clearly articulate and get the agency to buy into yours as well.
All of this preparation reduces the risk that something will go wrong along the way and increases the change of a positive search experience for you, the candidate, and the firm. You’re likely under a lot of pressure to begin right away but taking a bit of time at this stage will save you hours, days if not months down the road.
Setting expectations is not a “one and done” activity. Much as in project management, the process is managed all along the way. Expectations may need to be revised or changed, timelines may expand or compress and having ongoing communication is the only way to address these elements as they’re happening. No candidate wants to experience unnecessary delays because the hiring organization and the agency they’ve contracted with are not on the same page. Your candidates just may drop out of the process.
Expectation setting is a two-sided conversation. The agency may have its own expectations, processes, and timelines. They may also have some advice that could help the search so with a respectful and transparent relationship, these times of advice are worth the listen. You hired a firm because you needed help – now help that firm be successful in helping you.
AAPPR can help you develop your recruitment, onboarding and retention strategy with best practice resources that will reduce your search time, improve internal efficiencies and demonstrate to your leadership the value of well-resourced in-house recruitment teams. Join AAPPR to solve problems, share ideas, make better business decisions, learn how to do things better and get the support you need.
After attending the AAPPR conference in Orlando last month, and a few of our NP Now representatives were very impressed with Allison Dimsdale’s discussion on the topic, “Transforming Recruitment and Onboarding for Ambulatory APPs ” We were fortunate to be able to have an interview with her in order to further learn from her expertise.
Allison Dimsdale, DNP, NP-C, AACC, FAANP is the Associate Vice President for Advanced Practice for the Private Diagnostic Clinic at Duke University Health System. Her clinical practice is as a Board-Certified Nurse Practitioner in the Department of Medicine-Division of Cardiology, where she specializes in the treatment of heart failure, acute coronary syndromes and primary prevention of coronary heart disease. Her third appointment is as Clinical Associate in the Duke University School of Nursing where she lectures to graduate students in the areas of professional practice and cardiology and serves as content expert on student doctoral committees. She is an Investigator on clinical trials through the Duke Clinical Research Institute and is an active participant in nursing research initiatives through the Duke Translational Nursing Institute focusing on implementation science. She has an interest in creative nursing education and mentorship, as well as the leadership interface between systems of care, provider utilization, access to care and excellent patient outcomes. In her role as Associate Vice President of Advanced Practice at Duke, she is responsible for leading the effort to facilitate Nurse Practitioners and Physician Assistants to work to their full scope of practice by implementing ambulatory practice redesign with the aim to increase patient access to high quality, safe and cost-effective care.
Allison sustains active memberships in the American Association of Nurse Practitioners, American Heart Association, American College of Cardiology, American Nurses Association, and the North Carolina Nurses Association. She is a peer reviewer for Elsevier Publishing, and has been published in several nursing and medical publications including Circulation. She serves on a variety of community task forces and boards and was a Fellow in the 2016 AANP Leadership Program. She holds the Associate of the American College of Cardiology recognition and is a Fellow of the American Association of Nurse Practitioners.
She earned her Doctor of Nursing Practice (DNP) and Master of Science (MSN) degrees from Duke University, and her undergraduate degree from the University of Texas.
I have 21 years of experience as both a critical care Registered Nurse, and then a Nurse Practitioner in Cardiovascular Medicine at a large academic medical center. My doctoral work led me to a leadership role where I found myself designing and establishing best practices to design interprofessional teams to provide specialty care. This in turn, defined the need to create a structure to recruit, hire and retain Nurse Practitioners (NP) and Physician Assistants (PA) in ambulatory specialty practice. I am fortunate to be given abundant support and resources at Duke and was able to share my dream with Donna Ecclestone, FASPR, who quickly joined me to change our institutional culture, and to reframe how we bring Advanced Practice Providers (APPs) into our organization, and subsequently utilize their skills to provide increased patient access to high quality, high value patient care. This was a new concept for us and then led to the need to reframe and redefine our care delivery systems.
As APPs are now being asked to work as independent providers of care, their onboarding has become far more complex and important. As we all know, if a detail is missed around billing, or patient scheduling, or certification/credentialing – it becomes a work stoppage issue and thus a patient care issue. Reframing the way we do things and deploy APPs was the only way to create an Advanced Practice organization that provided professionalism and attention to detail in terms of hiring the right provider for the right position at the right time to take care of the right patient. That’s a mouthful, but it truly does define our goals. When an excellent interprofessional team is formed intentionally, everyone wins and the entire group can look forward to a long and fruitful collaboration in order to deliver the highest quality patient-based care.
The process of creating our Advanced Practice Office (which includes professional APP recruiters, HR and onboarding or integration) is one that we have defined and created along the journey. We saw the need as outlined above to create structure and advocacy for APPs, and to create intentional teams where APPs would be working to the top of their scope. We started with a strategic hire program, where in a small way we brought APPs into a funded subvention program for their first year of practice. These providers were carefully supported through the onboarding process, and gradually other practices around our enterprise started asking for our help in designing new practices as well as the recruiting and onboarding process. In order to meet those needs, our office expanded, and Donna developed tools for onboarding (referenced online checklists). We were able to combine with our Provider Recruitment team, which was important because in our state the nuances of NP and PA practice are unique yet important.
Today, our Advanced Practice Office offers practice consulting, recruiting, hiring, onboarding, practice metrics/data, transition to practice Fellowships, and regulatory oversight for almost 500 ambulatory specialty APPs. We continue to learn and grow and believe that APPs and their MD colleagues and practice administrators are better prepared for practice due to the professionalism, energy and enthusiasm of our office.
It is very important for recruiters to understand the professional landscape for Advanced Practice Providers. Although an NP was first a Registered Nurse, as an NP they are practicing medicine from the nursing perspective. This makes their practice wellness based and generally very holistic. A PA has never been a nurse, and they are trained to do the same work from a biomedical perspective. Once in practice for a few years and depending on the nuances of state laws (which are ever changing), their practices may look very similar. APPs are in high demand all around the country, and they will be attracted to an organization that from day one treats them as a professional. The communication, interviews, and hiring process is best done in a way that mirrors that of their physician colleagues. This will attract highly qualified candidates who can be assured that they will be treated professionally in your organization.
The difference between administrative onboarding and clinical onboarding is important. The introduction to the clinical practice is imperative to develop trust between the physician and the APP, and that trust must be bi-directional. A clinical liaison or access coordinator within the practice can be very helpful in designing a practice model and a patient flow that makes sense for the patient population. For instance, will the APP work alongside the physician and manage their non-direct patient care duties, or will they see patients independently in a proscribed visit flow (either manage their own patient panel, or see patients in combination)? Will they augment the MD work by providing a procedure clinic, acute clinic or rounding services? When these things are left to chance or are not well defined, misunderstandings happen easily, and practices are not well optimized. This may lead to increased turnover and attrition, which is expensive and demoralizing for the practice.
Advanced Practice Providers should always work to the top of their scope, training and licensure. Sometimes the answer to the need to grow a clinic is an excellent nurse rather than an APP who is trained and licensed to assess, diagnose, treat and prescribe. Avoiding competition between MD and APP for RVUs or patients, such as in the case of a productivity incentive, is imperative. The group should function as a team without such distraction or competition – in this way they can provide the highest quality, highest value patient care.
Recruiters should be sure they are posting a specific and relevant position description. APPs are increasingly trained as specialty providers, and don’t want to waste time applying for a position that is ill defined or lacks enough detail to determine a good fit. APPs should be treated and deployed as providers rather than as nurses for both job satisfaction and access to care. A good relationship with their recruiter and onboarder, and then with their clinical team can set the stage for a long and fruitful tenure in an academic medical center.
Interviewed by Dorothy Blalock, Director of Brand Management at NP Now
Telemedicine is already transforming healthcare in the United States. Barely heard of a decade ago, it’s now all the rage—with healthcare administrations across the country talking about how they can get in the game. While in a field as personal (and emotional) as healthcare, the goal is not to replace face-to-face physician communication, telemedicine does augment and help deliver care to patients who would otherwise have great difficulty getting medical help. Here are 3 ways it’s already transforming healthcare:
Our primary care system in the United States is already broken, and even patients in major metropolitan areas with an abundance of healthcare facilities, still struggle to find appointments. In reality, physical visits to the clinician are not always required, and a quicker and more efficient telemedicine consult is more appropriate. Certain technologies are also starting to show promise, which allow for “virtual examinations” to take place. Watch this space.
Certain outpatient specialties such as dermatology, which do not typically come into the hospital for consults, are perfect for the world of telemedicine. Especially if they involve a “spot diagnosis” without an array of tests. Other hospital specialties, which struggle to staff adequately and involve frequent emergent consultations—neurology being one such example—are already increasingly utilizing telemedicine.
For a long time rural America has struggled to attract and retain physicians. Telemedicine probably offers the best hope to those communities for receiving quality medical care. Ideally, the physicians should be located in the nearest major town or city.
There’s already a massive physician shortage in the US, and latest estimates project it could be even worse than the 100,000 projected within 10 years. Telemedicine probably represents the most promising method to help ease this looming crisis. The new tech-savvy generation particularly will be more open to seeing their doctor this way. Watch out for it being delivered somewhere near you soon.
About the Author: Suneel Dhand MD is an internal medicine physician, author and speaker. He is the cofounder of DocsDox (www.DocsDox.com), a service that helps physicians find local moonlighting and per diem opportunities, bypassing the expensive middleman.
We at Health eCareers had the distinct pleasure of hosting Carey Goryl, CEO of the Association for Advancing Physician and Provider Recruitment (AAPPR) at our offices. She was kind enough to organize a series of questions and answers among AAPPR board members on current trends, pain points and the role of AAPPR in physician recruitment. In this interview, we hear from AAPPR board members Tammy Hager, MBA, FABC, Lynne Peterson, MBA, FASPR, Robin Schiffer, FASPR, and Bruce Guyant, FASPR. Learn what these experts have to say.
Tammy Hager: Some of the biggest pain points in my role is not being able to get in-house physician and recruitment data instead of using search firm surveys and data.
Robin Schiffer: I have multiple roles. The biggest pain points are: Scheduling and credentialing locums. Hard to find specialties such as GI and Urology. Creating meaningful onboarding and retention strategies.
Bruce Guyant: Aside from just the sheer uber competitive market dynamics of a physician shortage, perhaps the biggest pain point is clinical leaders who do not have a strong enough sense of urgency in the hiring process.
Lynne Peterson: Besides the shortage of physicians, there’s not a lot of alignment between recruitment teams and operation teams. The operations team for example may not have realistic timelines and not fully know when to involve the recruitment team, and thus, finding the right candidate may not be successful if they don’t know the time it takes. For example, some specialties can take over a year to fill those open searches.
Tammy Hager: Organizations, including mine, are using tools to hire for cultural fit more than ever. This includes making sure the entire family is a part of the recruitment process to retain the whole family. In addition, in our organization, telehealth is a big component for many of the physicians hired. We are using that to work with other organizations across the country to provide care. Rural communities are even tougher to recruit for, so we are having to have a personalized and strategic plan for every one of our rural practices.
Robin Schiffer: All specialties need unique approaches when you are in a more rural location. We have to wow the physician and family. Start friendships from the interview day.
Bruce Guyant: Despite a limited pool of candidates to draw from, most senior administrative and clinical leaders still expect their health system or medical group to maintain time to fill averages that are as quick or quicker than the competition or the rest of the industry.
Lynne Peterson: There seem to be more physicians of all specialties going toward hospital or ambulatory practice. Also, physicians are moving more readily from one organization to another, where in the past they stayed their whole careers in one place. They’re more likely to move if their employment isn’t going well.
DO ANY SPECIALTIES NEED UNIQUE APPROACHES?
All: We find that primary care, psychiatry, neurosurgery, rheumatology, and neurology all need unique approaches because of the shortage of physicians in these specialties.
Tammy Hager: Our recruiters have a main focus on retention. We are taking a unique approach in how we reach out to physicians that have ties back to our areas (in the 4 states we serve). In addition, at Mercy Health, we reach out to residency programs that have a faith-based culture to recruit physicians to our faith-based system. Also, we have increased referrals from recent physicians we hired, and the recruiters do that by developing such a great relationship with them while going thru the recruitment and onboarding processes.
Robin Schiffer: AAPPR members that are in recruitment are working on finding a physician for the long haul. Sometimes recruitment firms are more worried about filling the position and getting paid. It depends on the firm. Some are excellent.
Bruce Guyant: The best way to influence job retention is to find the right candidate from the beginning. However, the truth is that recruiters have very little influence over the decision on the part of a provider to stay. Many organizations are seeing the value of having people on the team who are not recruiters who instead have focus on the on-boarding and retention piece full-time.
Tammy Hager: If recruiters truly look for physicians who fit culturally, have ties or spousal ties back to the locations/areas, and make sure the whole family is involved in the recruitment process, they can target those specific physicians.
Robin Schiffer: You don’t just look for skill. You look for a good fit culturally.
Bruce Guyant: The key is to understand your organization’s culture, team, and the needs of the position itself. The better you understand what is needed, the better you can appropriately assess “fit” upfront for your organization with the candidate’s needs and desires.
Lynne Peterson: Start the recruitment process early enough, and ensure that the proper screening is in place to get top talent. Know well in advance about credentialing and where the physician is in that process. At my organization, we do our checks and balances throughout the recruitment process to ensure the proper screening mechanisms are in place prior to offer and well before credentialing.
Tammy Hager: Many physicians do not know the different between in-house and 3rd party recruiters. We have to educate them, and we are doing that at Mercy with content on our physician career site, sharing content in specific magazines and journals that are sent to physicians, in residency program lunch and learns, and in email campaigns.
Robin Schiffer: I don’t think physicians realize the differences until they experience them personally.
Bruce Guyant: While Physicians are getting savvier and better at understanding the differences, most still do not know the differences. Even more really do not seem to care and just respond to each the same way and view them as a means to an end.
Lynne Peterson: I think it depends. On one hand, the 3rd party can advocate for them, but they’re not sure of the information they might get since the recruiters don’t get it straight from the organization they want to work for. The in-house recruiter has more in-depth reliable information, but they can be viewed as advocating for their organizations. It really comes down to what kind of kind recruiter they feel like they work with the best and how they go about their job search.
ARE MOST FULLY AWARE OF THE DIFFERENCES?
All: No
Robin Schiffler: It is really the recruiter at those firms. Sometimes you get lucky and find a gem!
Bruce Guyant: The most successful partnerships are those where communication has occurred up front with both parties fully understanding the needs and expectations of one another. Those who can do that and are respectful of the value of one another in the process will do well. I have personally had some excellent relationships with third party agencies who have sent me a high volume of quality and quantity of candidates.
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