Rural Provider Retention- Retaining Rural Providers in a Competitive Market 1 Stacey Day, Director of Provider Recruitment, SCORH And Mark Jordan, Director, SC DHEC Office of Primary Care

Rural Retention Planning 2 Congratulations! You’ve recruited a great new Family Medicine physician, Nurse Practitioner, Physician Assistant, or other provider for that hard to fill Rural position.

…But this is just the beginning. RECRUITENTION = RECRUITING TO RETAIN a/k/a, You got them. How do you keep them? 3

While Recruiting, did you Develop the “Ideal” Candidate Profile for a Rural Practice “Match”? -Check-list of must-haves, and wants -Rural background? -Early determination of desire for career in medicine (“I’ve known since I was in 10th grade”)? -Rural Training Track somewhat predictive -Remember in replacing retiring physicians, may be a 1:1.5 FTE replacement=Work/life balance consideration 4

…of the beginning. Your first action after your new clinician signs the dotted line is to A. Cross your fingers, have a drink, and hope it works out. B. Cross you’re fingers and hope it works out. You don’t drink. C. Check this item off of your Provider Retention Plan and communicate with the team with whom you worked to recruit this new provider. This is just one step in an ongoing process. D. All of the above. 5

So What is a Provider Retention Plan? 6

A comprehensive plan that though flexible, comprises 7 -A focused, team approach -Formal and informal processes, to include Onboarding -Relationship building -Constant assessment and evaluation of skill sets of each member of the retention team -Communication loop

Why develop A Provider Retention Plan? Job Turnover For physicians -Practice different than expected or explained during recruitment -Physician and family never became part of the community -The “myth” of Rural America 8 -Feeling a Lack -of control over practice -of feedback (little to no onboarding) -of two way discussion -of appreciation = a GAP – between real or perceived expectations

Why Rural Retention? The Flip Side of “Just Recruiting” -Costly to recruit and train - time and resources -Patient continuity of care, trust -Practice “security” – fiscally, psychologically -Practice demise -if you go, who will provide care? 9 “ This is not at all what I expected or what they said it would be like!! Help!”

RETENTION IS PART OF A PROCESS, NOT AN UNRELATED EVENT -Physician retention begins with strategic planning, provider needs assessment, a recruitment plan, interviewing, hiring and orientation. -Strategic planning tells the organization where it is going and how it will get there. -Needs assessment should review efficiency issues, patient volumes and types of patients, market share, and determine the type of provider who will fit that need (associate staff or medical staff). 10

RETENTION IS PART OF A PROCESS, NOT AN UNRELATED EVENT -Interviewing process should be defined as part of the planning. Keep the surprises to a minimum. -Hiring should move the new physician smoothly into relocation and orientation. -Orientation is step one in developing a retention plan that is part of a total process, which includes a feedback loop (exit interviews, succession planning and the strategic plan.) 11

Retention Planning Worksheet 1) Create your team – keep in mind skill sets of all involved. Ideally -Coordinator -Onboarding Representative -Orientation Representative -Communication Representative -Spouse/SO/Family Liaison -Other Support Team Members 12

Retention Planning Worksheet 2) Identify Resources Needed and Those Available -Materials -Contacts -Budget 13

Retention Planning Worksheet 3) Retention elements and tasks with timelines –typically a three year plan -Onboarding Plan -Orientation -Recognition Activities -Social Activities -Mentorship -Practice Review -Satisfaction Surveys -Exit Surveys 14

Onboarding For hospital-based or larger practices -CEO calls or sends note welcoming physician to the practice -Professional Mentor selected for new physician -New physician is sent a copy of the Physician Mentorship program -Partner or Recruiter POC keeps in touch with physician and spouse to check in on relocation preparations 15 For independent rural health clinic or solo practitioner -Partner calls welcoming physician to the practice -New physician is sent a copy of the Physician Mentorship program -Partner keeps in touch with physician and spouse to check in on relocation preparations

Onboarding = An essential component to physician retention Physicians dissatisfied with the workplace have many choices. -Retention survey from Cejka Search and AMGA found that turnover is at its highest since 2007 recession at 6.8%. -Average turnover rate for physicians in their second to third year of practice was 12.4 percent. -Small groups suffered from a 20.8 percent turnover among physicians in those early years. Silver lining - medical groups that had formalized onboarding programs with a dedicated mentorship program showed a better retention rate. All from Mokasti.com, challenge-in-the-new-health-age/ challenge-in-the-new-health-age/ 16

Retention Planning “Key to physician retention is regular contact with physicians and spouses to stay abreast of how they are adjusting, and to anticipate any problems that may develop...The most critical element in any retention plan is a mechanism to “check in” on the physician’s expectations. Keep in mind the needs of physicians’ spouses and families because frequently physicians’ satisfaction depends on their families’ adjustment.” Tim Skinner, former 3RNet Executive Director, from 3RNet/ HANDOUTS AND FORMS/RECRUITENTION OF PHYSICIANS AND MEDICAL PROFESSIONALS,

Retention Plan – Year One Professional - Monthly Communication -To discuss practice development, community outreach, ongoing mentoring -If hospital-based, recruiter meets with new physician after two months to see if expectations meet reality. If small practice, partner physician will meet with new hire. -Some hospital-based practices assign committee duties and bring in physicians to work on projects. -Alternate options for small practices or solo practitioners? Telementoring? 18

Retention Plan – Year One Social - Monthly, then Quarterly Communication -To find out how family is adjusting, unmet needs, resources within the community? Social mentor/partners? -Spouse or SO Needs/Wants met? -Community connection -Religious needs met? -Educational needs met? 19

Retention Plan – Year Two -Physician and family deeply engaged in the community -Professionally physician is doing well and feels both supported while retaining some autonomy -Socially, connections are made and deepening -Continuous feedback loop to to “check-in” to see how things are going -Emerging family needs or changes based on children’s ages? Spouse or SO Needs/Wants met? -Community connection -Religious needs met? -Educational needs met? 20

Primary Care Recruitment and Retention Programs SC Rural Physician State Incentive Grant - State -Between $40-70,000 (total) for 3 year commitment -Fairly competitive– an average of 14 or so primary care physician awards made each year, with a handful of lesser dollar award advanced practice awards -Eligible physician specialties (outpatient only); FM, Peds, Ob/Gyn, IM -State Contact is Kristin Cochran/SC AHEC 21

National Rural/Recruitment/Retention Resource List 3RNet & 3RNet Resource Library HRSA Mokasti.com leadership-and-physician-retention-a-major-challenge-in- the-new-health-age/ National Health Service Corp (NHSC) National Rural Health Association (NRHA) Rural Assistance Center (Raconline)

SC Rural/ Recruitment/Retention Resource List  SC AHEC  SC Office of Primary Care  SC Office of Rural Health and  SC Office of Healthcare Workforce and Analysis