Proven strategies for physician recruitment: Use for your ASC
Physician recruitment was, is, and will always be critical for the growth of ambulatory surgery centers, since we all want to deliver exceptional medical services to our patients. To date, there are multiple strategies on how to attract top-notch physicians. Unfortunately, many of those strategies are not effective in the post-covid, increasingly competitive market.
The only way to find out what truly works to recruit and retain talented physicians is to learn from the best and the most experienced in the industry. And that’s what we did.
Our most recent webinar episode, Master Class on Physician Recruitment in ASC, is packed with knowledge, experience, stories, and advice on effective physician recruitment strategies, all coming from an industry expert.
The expert, Janet L. Carlson MSN, BSN, RN, is a distinguished healthcare professional and an accomplished CEO, president, executive director, and director of nursing of multiple ASCs across the country. Being a seasoned leader, she knows how to coordinate recruiting and new physician onboarding to an ASC, as well as how to manage a clinical team to recruit and retain highly skilled engaged staff.
Together with our webinar hosts, dr. Biraj Patel (practicing anesthesiologist and the founder of PreferredMD) and Ashley Poulos (administrator at Midtown Surgery Center), they examined factors that influence the recruiting process in ASCs, addressed the challenges of finding surgeons in small markets, discussed all the best practices in recruiting efforts, and looked into leveraging technology to attract talent.
For the best learning experience, you can choose to watch the full webinar recording, or read the crucial excerpts below.
Dynamics of physician recruitment at ASCs
What roles are involved in physician recruitment at an ASC?
Janet L. Carlson: It starts with a combination of collaboration between the representation of the practice, specifically at an ASC it would be your medical director along with your administrator, and any key folks in the facility clinically as well as operationally. All of those people are stakeholders, and they should be at the table early on in conversation with physicians.
What factors influence the recruiting process?
Janet L. Carlson: There are so many factors that influence physician recruitment today, and honestly, they're dramatically different from when I came out of nursing school, or when some of my colleagues and physicians came out of medical school. We need to rethink the way that we've partnered with physicians in the past. The paradigm has shifted dramatically with the next generation of providers that are coming out of school.
I think at the beginning, it's very important for us to be open-minded when we're talking to these physicians to make sure that we're honestly listening to what is important to them. And what I hear a lot today are things like work life integration, and flexible work schedules.
Ashley Poulos: Do you hear it from surgeons, though?
Janet L. Carlson: Yes, I'm finding that some people want to work a four-day work week, they're willing to work very hard for four days in a row in exchange for the potential for three days off for that work life integration. Another thing that's very important to them is time off. They really want to have more than your standard long weekends with holidays attached, or a week here, a week there. I'm finding that some are wanting more vacation time, and that's more important than what their base salary would be. So that's another thing that has changed in the years that I’ve been involved with physician recruiting.
Ashley Poulos: Do you use that as a tool for providing ease of scheduling and everything, as why it's an advantage to go to a surgery center over the hospital, for that quality of work-life balance?
Janet L. Carlson: Absolutely. That's what you should lead with. With surgery centers and ASCs, you can offer greater block time availability. They have the ability to bring in new technology, practices, and procedures because traditionally ASCs are flat organizations. So you just need to make sure that you play by the rules and get the approvals that you need to bring in something new. But physicians like the ability to try something, to expand their scope of practice, and they can do that so well in a surgery center.
Ashley Poulos: There are several structures as far as how an ASC can be set up, which ones have you worked with so far? What are some advantages or disadvantages with each of those structures that we would have to look into when we're recruiting?
Janet L. Carlson: Traditionally, I work with the private practice independent physician model, where they own the surgery center as well. I've also had it where the physicians have been majority shareholder, with a management company as the minority share. And then finally, there's also another sort of model where the hospital will joint venture with physicians, and/or hospital joint venture with physicians and management company.
The advantage of the ASC really is the value proposition that you offer to the physician. For example, you can incent and reward them after their first two years of employment with a private practice. For example, they have a salary with the expectation that they'll be incentivized to sit for, take, and pass their boards. And then that will be the next offering if you will, where they are offered an opportunity, a partnership and to buy into the shares of the surgery center, which is a really wonderful way to round out their total compensation portfolio.
Ways of recruiting physicians in residency
Ashley Poulos: Are you engaging younger physicians that are earlier on in the career?
Janet L. Carlson: Definitely, we’re having conversations with PG year four or five. We're also having in-depth conversations with fellows. It's very important to communicate to them just what an ASC is, because not many people in residency or fellowship have had a lot of exposure to an ambulatory surgery center. They're traditionally working in the hospital academic environment. And they don't know that this is an option for them that they should consider upon completion of their program.
Ashley Poulos: How do you go about finding those surgeons that are in the residency and recruiting them at that early stage?
Janet L. Carlson: It's important to have yourself, your leadership team, and your physician partners to be attending a lot of the regional organizational meetings, whether it’s orthopedic, spine, or pain. Go to those regional events, even the state level events, along with some of the larger conferences that are the draw for this specialty, and that's where you can start having conversations in real time.
It's worth your time to go to these professional occurrences, which are pretty routine. You can tell when they occur every year, as organizers are good about communicating ahead of them – what dates they're going to be, and where it's going to be held (as a save the date). And then send somebody from your team. I always engage with the physician prior to an event like that, and I use that event to then have face time with the physician.
Referral strategy for physician recruitment
Ashley Poulos: Do you work a lot with the current surgeons as far as referrals?
Janet L. Carlson: Yes, in my experience, more tenured physicians still keep in touch with where they did their fellowship. They'd like to know what is the next graduating class, what the pipeline looks like. And that's another really effective way for you to bring new talent to your team by engaging your existing partners to reach out on behalf of your organization.
Tips to maximize the quality and the number of candidates
Biraj Patel: If I was running an ambulatory surgery center, and I wasn't linked financially to a physician group, one of the things that I would have to do is to recruit physicians to use the facility that we have. What would be your suggestions to maximize the number of and the quality of the physicians I was recruiting to use the facility?
Janet L. Carlson: I would target the independent physician surgeon practitioners in your area. I'm seeing a trend where a lot of the independent physicians are being boxed out of block time at hospitals, and so they are now being given a block time for example of Friday from 12:00 to 1:00. It's not even enough to do a case that they need, and so they're being pushed aside. It's been my experience if they're not employed with that health system, already you'll have their attention, that audience is ready, willing, and excited to look for additional block time. That is a huge incentive for them.
Biraj Patel: Do you have any tips as to how I can find physicians who are not part of a hospital groups? Is there a particular search or websites that you can use so that I know that they're independent?
Janet L. Carlson: Actually, I just do my own homework. I talk with the people on my team and, traditionally, the folks on my team that are working in my ASC, have worked with a majority of physicians and hospitals. They really know the inside scoop, especially if they scrub with them, they circulate with them. They have good relationships as well. And that's another component of communicating and having an introduction to a surgeon, is a lot of folks on your team, your anesthesia providers, they have these relationships that you could leverage.
Challenges of recruiting surgeons in small markets
Ashley Poulos: How do you deal with the smaller markets (e.g., in the smaller cities) when looking for the right surgeons to recruit?
Janet L. Carlson: If you have an ASC, for example, in an area like a hub and spoke, I would go to some of the smaller communities that surround you that have a reasonable drive. Many surgeons that I credentialed and gave them block time, they're willing to drive an hour themselves, and I've found that not only will the surgeons drive, but so will the patients. Their patients will drive and make the trip intentionally for the experience at an ASC. So I would look to the communities that are supporting and surrounding your community. It's very likely if it's a smaller area with not a lot of population, they're not likely to have an ASC that are able to offer block time. So again, that's something else in your toolkit that you can offer.
Ashley Poulos: When you're looking in a smaller market, do you do your due diligence to see what specialties are in that area before determining what your model is going to be at the center?
Janet L. Carlson: Yes. So we built our surgery center for interventional pain and minimally invasive spine, as you know.
However, if we were going to be in an area where there weren't CON restrictions, we could add additional partners. There are certain service lines that would marry well, if you will, with your platform, with the size of your ORs, and the skill set of your team that they could be able to take on a service line. So I've combined a variety of service lines very well that people originally thought couldn't happen. But once you start having your proof of concept case, and you do that case well, and you repeat it, you start breaking down any of the barriers there.
Best practices in recruiting efforts, shortfalls, and physician retention
Janet L. Carlson: Honestly, I think it begins with communication right up front. Communication is key number one. Along with that would be consistent communication. Physicians don't want to be engaged, then there's a lull, and then all of a sudden there's a burst of activity.
My recommendation is to keep it consistent, check in, even if it's a “haven't forgotten about you” or “checking in on you”. “I know you're going on vacation, so just touching base with you”. I set reminders on my calendar so that I can follow up with the right cadence, with the right physician, recruit, or partner potential.
The other thing that is key is the clarity of communication. Are you conveying the message for your practice, for your ASC? Are you delivering the same message that your director of operations, your medical director, your senior partners are? Are you making sure that when you have these one-off conversations with that potential physician recruit, are you all saying the same thing? So the clarity of the message is just as paramount as the communication itself in general.
I call it the four C’s. And the fourth C is culture. Are you able to convey the culture of your workplace? I believe that you end and begin with culture. It is the most important thing. And so while you're communicating what your value proposition is, what the opportunity is for them, how their career could just thrive in this environment, are you also sharing the culture of the workspace and how imperative that is?
Ashley Poulos: How do you go about keeping all lines of communication similar as far as what's been conveyed to that surgeon that you're recruiting?
Janet L. Carlson: It's actually something that we talk about at Commonwealth Pain and Spine. We make sure that we are tracking the progress of conversations, we’re choosing a person who is in charge of that primary conversation, and we’re giving each other updates constantly. Our communication around that is very intentional.
Ashley Poulos: But not every person that would want to come on board is necessarily in the position to be able to invest. So do you take a different approach when you're discussing that with a non investor, but just trying to bring a physician on board?
Janet L. Carlson: Absolutely, you can tailor an offer to the needs of a physician, and recruit to “marry” the needs of your practice and your ASC. So if they don't want to invest, then maybe there's an earn-in opportunity over time. Maybe you can offer them smaller shares with a syndication over time as they can afford it.
There are quite a lot of ways to get creative. You just want them to see the overall picture of how they can practice in a mostly autonomous setting in an ASC, how they can handle more cases because they're lean, effective, and efficient operationally. These types of things are important to them as well.
Ashley Poulos: You were talking about the work-life balance before, do you find that physicians aren't necessarily wanting to invest, they're just looking for an ideal place to do surgeries?
Janet L. Carlson: I think that it’s crucial to share with the physicians the structure of the business, when you have them there. Share some high level things, talk about the opportunities they would be offered for partnering with your team. Like I said, they haven’t been taught about the business side and the operational side of an ASC. That’s your opportunity to shine the light and to educate them on the benefits of an ambulatory space.
Ashley Poulos: Where have you seen some shortfalls in the recruiting? For us personally, our partners will work very hard to get a physician on board. Once it gets to the credentialing, our team takes over, and we are doing everything we can to get the physician on board to do the credentialing. And then they just quit responding to us. And it's not that there's a break in communication, but there's a change in whom the communication is from, and there seems to be a drop. Do you find that that happens, and how do you overcome that?
Janet L. Carlson: I've seen that happen. I would say that that lends back to an earlier topic we were talking about, to the people that would be involved and responsible for credentialing that physician. They should be at the table discussing early stages with the physician, to let them know we're going to do everything we can to handle all the paperwork and the credentialing. And that we're also going to do our best to be timely in it and follow up on it. Communication, consistency, and making their life as easy as possible because it's a very stressful time for them. And that transition is very important.
Another shortfall that I've seen, is regarding the succession planning in the practice. That's important for the newer partners that are joining to know that if there’s going to be senior partners retiring, it would make sense that they're going to sell their shares, and there are more shares available for the younger talent once they are board certified.
So I've seen inconsistent communication, or inconsistencies around succession planning and policies for a practice around that. I've seen where physicians have joined practices, done their board collections, sat for their boards, and been certified and ready to be offered partnership, and then turn it down because there hasn't been the follow through on the succession planning which they were promised.
Ashley Poulos: Do you think it has to come from the top as far as where they're wanting to hear the communication from?
Janet L. Carlson: I think it has to come from all around, but it needs to also come from the top. They need to be reassured. I think check-ins every 30, 60, 90, and 120 days are important as well, so that you can identify any barriers or troubles.
They may feel like they can’t speak up right away because they're really cognizant of not wanting to be viewed as a troublemaker, so to speak, so give them a safe space to say “you know it would be great if X”, “it would be good if Y”.
Make sure to have that consistent top down communication, tell them that they’re doing great using their block time — “We're watching your clinic grow your schedule, do you need more time anywhere? What can we do to accommodate you?”
Ashley Poulos: Say we have a surgeon that's done with the recruiting and once they're in, how much should the administrator or the office staff court their scheduler or their office manager? How much does that play into the long term relationship with that surgeon?
Janet L. Carlson: That's very important. We usually take the physicians to the offices that are potential areas they could be working in. It's nice to host a lunch at an office in the clinic space, and let people meet and greet, and so they can see, again, the culture piece. They can see who works there, who they’ll be working with on a routine basis.
Same thing in an ASC, let them come and shadow in the ASC. Let them come and stand in the back by the whiteboard and just watch how things run. Seeing is believing. And if they see that you are a well run machine, you're taking care of your patients first, patient safety is number one, and that you're doing everything you can to accommodate the physicians as well (you're getting creative around block time, you're releasing time, or people can have a flip room, you're not closing your rooms down at 3:00). All those things are important. And having them come in the back and watch you on a very busy clinical operational day, that tells them more than you ever could.
Ashley Poulos: Do you ever host events just for the office team, like the managers, to come to the surgery center and have an open house? So that they can come see the surgery center and meet the team and everything?
Janet L. Carlson: Yes, we've done that a variety of ways. You can have an open house in general. We've also partnered with our vendors to have training, whether it's an after hours lab on saw bones, or something like that. We bring in the healthcare professional that's a specialist in this device, and host that after hours, and invite all the physicians that are in the area, but as well as the physicians we’re recruiting. That's a great way to show off your facility as well.
Ashley Poulos: Speaking of the vendors, how much emphasis should we put on working with our vendors to get recruitment and leads?
Janet L. Carlson: That's one of the first things I talk with them about in the get-to-know-you phase. I’m asking who their vendors are. What is their preference? Because I'm not there to tell them that they have to use a completely different implant right out of the gates that they’re not familiar with, or they’re not comfortable with. I'm seeking to understand what the needs of the surgeon are, and then it's my job to go after making sure the pricing is at a place where it can be affordable, where we can do that case in the surgery center, and that it’s safe for a patient. We can have a margin on it as well, and the physician can use what he's comfortable using.
Ashley Poulos: Going back to investors and non investors — if you're trying to recruit investors, but you aren't as profitable as you want to be, how can you still capture new investors to come on board and show them the value of the center?
Janet L. Carlson: I've actually had physicians join my surgery centers that were outside of the practice that primarily owned the ASC. We identified some additional block time that wasn't utilized, and we didn't have the need internally. So I went out in the community and found a new service line and offered these people an opportunity to work at our surgery center, which they were thrilled with at first. And it was sort of them getting to know us, us getting to know them. When we got comfortable with one another, we were able to offer them shares in the ASC. They were immediately aligned, on board, and rewarded with taking cases to our center.
Ashley Poulos: But what if overall you're not as profitable as you want to be? The distributions, they aren't there. You still have to build that practice and grow it, and obviously have more investors come in. I'm sure over the last few years we've all had some difficulties as far as how things have panned out. So as we're trying to recover from that, how can we still bring more surgeons in?
Janet L. Carlson: Offer your open available block time to surgeon utilizers. There are additional physicians in the community, traditionally independents, that need time anytime to do the majority of their cases. Therefore, the talking points with them are that their surgeon fee is the same for them no matter the side of service. They can get paid in the hospital, or they can get paid at the ASC. And the value of bringing their cases to an ASC is that they're going to be able to handle typically more cases in a day than they would at a hospital. So they potentially could be reimbursed more at an ASC because of the lean efficient operations that ASCs are known for.
Emerging trends in physician recruitment
Ashley Poulos: What trends do we have as far as recruiting physicians? And what can we do to offset some of the hurdles that we've encountered over the last say 5–10 years?
Janet L. Carlson: Just to reiterate some of the earlier points that we were discussing:
- A sign on bonus
- Flexible work week
- Occasional flexible work week
- Potentially even the four-day work week
- Generous vacation package
- Willingness to partner with their vendors of choice (and you negotiate the pricing to accommodate their preferences)
- Supporting their desire to participate in research
About supporting their desire to participate in research. These are physicians that are passionate about what they do, and they are striving to be the best in their field. Commit to them that you will support their participation in their professional organizations, their attendance at these conferences, being willing to participate in research.
A lot of people are surprised when they hear me say: “do you have any interest in research or publishing?”. They're shocked that I would ask that question at an ASC because typically they think that that's only possible in a hospital setting. I've had a surgery center where we had our own research department. So that is another thing that really piques their interest.
Ashley Poulos: You mentioned offering health benefits and a sign on bonus. Is that only if they're going to be employed by the surgery center? Or are you able to do that through an investment opportunity?
Janet L. Carlson: They wouldn't be employed through the surgery center, they would be a partner in the practice, assuming that the practice is the majority shareholder of the ASC. And in this example, that's where you would offer them a base salary with a track to partnership in a clear, delineated fashion that they can look at. And it's the same for every recruit. This is the same path that everyone's going to have.
Ashley Poulos: If it's an independent surgery center, what sort of trends do you think would we have there going forward?
Janet L. Carlson: Think outside the box, be willing to market these surgeons, be willing to invest in their social media platforms. This is very important to them. They are trying to build their own brand. So they'll bring their brand with them, and you want to help build their brand while you build your own. Ask them about their ideas. We all know of the surgeon followings on TikTok and Instagram, their name is getting out there, younger physicians are embracing that technology, and patients are watching them.
Biraj Patel: I've seen a growing trend that third party administrators are approaching surgery centers to help them find surgeons. So that could definitely be a recruitment model or retention model, at least to increase volume. Janet, could you talk a little bit more about that, and your experience with that?
Janet L. Carlson: Definitely. I've had wonderful experience working with third party administrators. We work on a bundled pricing for surgery. The patient has no copay, it's very clean. It's traditionally paid in advance of surgery and so the patient isn't involved with any of it, and the third party administrators are shocked at how quickly we can add on a case based on the acuity of the need of the patient and putting the patient first. If that patient's been injured at work, we need to get them back to work and feeling optimally their best, so we want to take care of them as quickly as possible and get them back to work, and not be an impediment to the traditional lag time. We want to be the solution.
Ashley Poulos: And I think it adds to the professional development of the newer surgeons?
Janet L. Carlson: Yes, absolutely,
Biraj Patel: Because it increases their case volumes, and these are cases that ordinarily wouldn’t come to the practice, they come to the physician because of a TikTok following. They are booking cases directly to the facility, and now you're using that to build a greater relationship with the physician that is working there.
Janet L. Carlson: Correct. And you can tell that physician, look while we're getting you credentialed with all the payers, we'd love for you to be our point person to take care of these work comp, personal injury, more acute things, and start filling up your block time with that while we're getting you online with all the payers.
Ashley Poulos: Which we have even found with the third party administrators that our experienced surgeons are not willing to go with that bundled fee. So it's a direction to go with newer surgeons that are trying to make their mark in the field.
Janet L. Carlson: Right. And then also being willing to be a team player. For example, you have an after hours urgent care component to your practice, so being willing to pick up some of the calls, even though they'll be rotated through the call rotation. It exhibits tremendous goodwill if you want to pick up some of the times for some of the more senior positions that would really appreciate an evening at home or an evening with the family or something, and you can start just organically building your patient base that way as well.
Leveraging technology and digital platforms for recruiting
Ashley Poulos: What should we be using for recruiting, and how much does that play a factor in our recruiting efforts?
Janet L. Carlson: It definitely should be a key component if you have it at your availability to utilize. So why not get more creative about the way that we have traditionally approached physician recruiting? I think leveraging the technology is a bonus. And it also conveys to the physician recruit that you are up with the times, you are trending in that direction, that you would co-brand/co-market with them on their platforms, and you'd commit to that spend, if it is, to help them establish themselves, get their name in the community, and have your support.
Ashley Poulos: A lot of people say that their ASC has limited online exposure (referring to the poll conducted among the audience during the webinar).
Biraj Patel: I think it's a lost opportunity because right now you see so many technology platforms that facilities are using. That means patients are engaging on them. You have those same platforms that are credentialing physicians, and now because you have a physician on there, and you have a patient on there, you can use that to market to additional patients, or internal marketing to use physicians from a different specialty at that facility. We do that at PreferredMD, and we grow the case volume with that particular function in mind. If a patient is already using the technology to communicate with one physician, and they recognize the brand, they will find another physician at that same facility, thereby increasing the volume. It just makes sense to do that.
Ashley Poulos: Do you think in healthcare we're behind? Because patients are already utilizing it for scheduling and looking for surgeons. But, for instance, if you go to our website, I think it has not been touched in five or six years. It’s just not a priority for us. Do we need to move forward and utilize that as a tool for recruitment opportunities?
Biraj Patel: Absolutely. You want the patient to be able to come to your website, recognize the same digital platform that they've already been on, they're familiar with, to find their next physician, and that's going to grow your volume organically.
Ashley Poulos: For patients, yes, but what about physicians? How can we use different tools to reach different surgeons? To make them show the interest in the center and to want to be part of this ecosystem?
Biraj Patel: You attract them in that way. You say that you'll join this platform, you'll organically grow your practice, and you will be involved in providing care for this population of patients that uses the facility. I think it's a great marketing tool for physicians.
Ashley Poulos: Do you think that in smaller markets, like smaller cities, that will be as effective?
Biraj Patel: Yes, it will work anywhere where there's a community, where there is a population of patients that physicians work within, and there's a facility. And I think if you have a community anywhere, big city or small city, you're going to have connectivity between the three parts.
And like you said, I think the healthcare industry is really behind. I think we’re always slow to change compared to other industries, like finance. And it's time now. I think there's a lot of interest, and as we touched upon with bundled pricing, I think it increases efficiency and has all the stakeholders pulling in the same direction.
Janet L. Carlson: It also demonstrates transparency. You're transparent with your pricing, you're transparent with your quality outcomes, and your patient safety initiatives. It just speaks volumes to the culture piece for the physician. And for the patient as well. You're communicating this on your digital platforms.
I've had patient engagement applications for certain patients post-op that had 98% participation, that was just phenomenal. It would push a notification to the surgeon and their physician extender that the patient had sent a message about a certain concern. And it sends the message with the patient’s phone number to the physician. The physician just picks up the phone and calls the patient. The goal is to take care of the patient in the moment with their need, to keep them out of the ER, and to keep them out of discomfort or any untoward outcome.
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