Lack of access to primary care is an issue throughout the country and especially so in rural areas.
Some years back, as part of the Daniel Hanley Center for Health Leadership, many health leaders from across the state of Maine came together (as HLD II) to understand the key motivators and incentives that will improve primary care physician recruitment in general and specifically within rural areas.
This collaborative group of leaders reviewed the strengths and limitations of historical data obtained through focus groups, survey tools and interviews. We then sought an innovative way to listen to a fresh perspective and selected the Voice of the Customer (VoC) as the tool to further explore this challenge in depth.
The Voice of the Customer provided a structured approach for interviewing a compiled matrix of individuals and positioning them to respond thoughtfully to a set of pre-determined and open-ended questions (with us interviewers truly being in inquiry mode). The interview responses were then subjected to structured analysis resulting in a compilation of recurring themes and detailed customer (in this case primary care physicians) requirements.
The outcomes from this effort were enlightening.
Through the historical review we learned that the typical approach to recruitment of primary care physicians was focused predominantly on compensation and technology.
Through the VoC process (again, truly listening to the primary care physicians themselves) we learned that they are less concerned with compensation and technology and more concerned with finding an organization that truly cares about its physicians and takes the time to understand and develop a relationship with the physician candidate and family. (We talk about patient and family centered care — primary care physicians are seeking physician and family centered recruitment).
Other criteria that are important to physicians, we learned, include:
- Finding an organization that is willing to create a practice model that positions the physician to honor his/her calling … to help people heal.
- Finding a practice that will develop support systems sensitive to what was learned and continues to be learned by listening to the physician and understanding his/her continually evolving goals and needs.
- Finding an organization with a commitment to collaboration. And no, we heard physician alignment strategies (as they currently stand) do not meet this requirement as they are typically organization or practice centric (financially centric) rather than designed for the improvement of health and well-being of patients, families and communities which (based on the research) requires care teams which themselves are whole and healthy).
The primary care physicians were also very clear, “pay me fairly but don’t follow the strategy of overpaying to recruit me (especially if the items above are not in place). Yes the recruitment effort might be successful (as defined by bringing me on board), but retention will remain an issue because the root-cause of my dissatisfaction will not have been addressed.”
They were also clear regarding their thoughts on technology: “Technology should be a tool to best support the healing encounter — not simply a tool to increase productivity (revenue).”
Lastly, the VoC yielded the following:
If I am a primary care physician and you are recruiting me and it becomes apparent that the fit is not right, focus on collaboration with other organizations and help guide me to another opportunity that is a better fit. Share information and candidates with other practices. The goal is to position primary care physicians for the best fit to improve access, to improve the health of individuals and communities.
Collaboration between practices will lead to improved recruitment and retention (will float all boats) and thus improve access (and will also decrease the cost of turnover). And as healthcare leaders isn’t this one of our responsibilities?
So much like the healing encounter itself, where relationship, listening, understanding, trust and collaboration are keys to success, so it is with primary care recruitment.