Blayne Rush, MHP, MBA, is president of Ambulatory Alliances.
Q: What are the current top challenges facing ambulatory surgery centers when it comes to physician recruitment?
Blayne Rush: Physician recruitment continues to present challenges for ASCs, and it is an issue that will not resolve itself any time soon as surgery center owners need their contemporaries to bring procedural volume in order to keep their surgery centers profitable. It has been well-published and often spoken about that the ASC market is maturing and the number of surgeons who are not currently affiliated with an ASC has plateaued. Additionally, the hospital systems are looking to assimilate physicians into their system, either through employment models or purchasing their practices.
ASCs are all pursuing the same few independent physicians in a given market. It is challenging for ASCs to keep physicians and surgeons happily engaged when so many other ASCs and hospitals are aggressively pursuing them. There is also the challenge facing some physicians that would choose to do procedures in ASCs but are lacking the available capital to invest in that center.
Additionally, the lack of a well thought out and structured physician recruitment plan and process, as well as having someone on staff possessing the relationships, reputation and expertise to be able to convey the right message that will attract the most talented and qualified surgeons, is another major challenge.
Q: What role should ASC physicians play in recruitment?
BR: One of the greatest assets in recruiting new physicians is the support of the current physician base. This support can take form in a variety of ways, including speaking with new recruits, giving tours, attending new recruit open houses, making phones calls and agreeing to write letters to potential utilizers. The role of individual current owners will depend on their personalities and comfort level, but nonetheless, all owners should accept, as part of their ownership mindset, the responsibility to be part of the recruitment process. The role can range from sharing names of potential new recruits to being the champion recruiter.
Doctors know doctors, and often "recruits" are identified by their colleagues. You sometimes increase your chances of bringing new physicians on staff when they already know someone at the surgery center. At the very least, physicians are good at identifying potential colleagues.
All owners should be walking billboards for the center to their practice partners and other colleagues, as well keeping an eye out for surgeons who could be future owners or can bring cases to the center now. It's very important that the owners have a compelling "elevator speech" that briefly highlights the center's unique benefits and convey its message. They will be able to use this speech at medical meetings, continuing education courses as well as in the lunch line at the hospital.
Physician-partners should introduce themselves to physicians that are new to the area on a regular basis. The partners should tell these prospective investors and partners about the surgery center, noting that there could be an opportunity for them to utilize and invest in the ASC. They can encourage the new-to-the-area physician to talk with current center physicians. Physicians can quickly create an open door to recruits by picking up the phone and introducing themselves.
Some physician-partners will be uncomfortable "selling" the center to potential physician utilizers. These surgeon-owners can be reminded that they are selling their surgery centers all the time — each time they sell the utilization to their patients.
Q: Can a physician be too involved or not involved enough in recruitment?
BR: Great question. I have never seen a situation where a physician was too involved. The process typically leans towards not being involved enough. Physicians as a whole tend to be very busy people. While I understand this, I would counter that the process needs to be drilled into them that the added cases and revenue is going to be of great benefit to them personally in that it will increase the value of the shares they own. For those physicians who are not involved enough, it's tends to be impactful if you frame the physician recruitment results in terms of increased patient volume and profitability. This mindset can go a long way in helping physicians understand that being involved in recruitment is a good, worthwhile — and potentially profitable — use of their time.
Q: What recruitment tactics and tools used by physicians have you seen work well?
BR: The best recruitment efforts start with a commitment. Recruiting surgeons that will invest in your ASC and increase its profits can't be a hobby that you think about and pay attention to every once in a while. It must be a focused and coordinated ongoing process with someone that is accountable for its outcome.
Successful recruitment campaigns are as, if not more, important to the success of your ASC than strong payor contracts and business best practices. The most successful surgery centers have owners that have adopted a physician recruitment mindset. Those owners make the recruitment success a core requirement for one of the executives of the surgery center or look to outsource the process and then hold that person or company responsible for the outcomes.
Physician-owners sometimes look at physician recruitment as an "event." The most successful surgery centers understand and make the recruitment ongoing process. For some centers, this will be a paradigm shift and one that they will need to make. The market is changing, and those centers that do not adapt will not survive.
Recruitment of new physicians should be an agenda item at almost every board meeting. During discussion on this item, physicians should identify which physicians the ASC should be reaching out to. Ask physician-owners to come prepared to put forth a few names of physicians and a little background — if known — so that the designee responsible for recruitment can pursue that physician. Part of the ASCs plan should be to have a continually updated target list of physicians in the community that should be contacted and a list of physicians coming into the community for future consideration.
Q: What can ASCs do to help with and improve recruitment efforts?
BR: Surgery centers proactive in their recruitment efforts often provide their physicians with printed information — such as brochures — about their ASC to help with the elevator speech mentioned earlier. Some provide recruitment cards, which are similar to business cards but have the highlights of the ASC printed on the back of the card. These are small and easy for the doctors to carry around.
ASCs can also consider using a consistent, direct mail campaign to prospective physicians that alternate between letters from the partners, to brochures, to postcards, all with the end-goal of keeping the surgery center on the minds of the physicians that you are recruiting.
While some of the best leads and referrals come from the current surgeon owners, the most successful surgery centers also tap into other sources such as the following: anesthesia providers, traveling pharmacists and equipment and implant vendor representatives who are in position to provide leads. They can be your eyes and ears. Most people are willing to help — you just need to ask, and ask often.
For physicians utilizing but not invested in the ASC, have ongoing discussions with them, asking what you could to help them increase their volume or encourage them to tell their colleagues about the center.
Q: What can ASCs do to help those prospective physicians lacking capital to invest?
BR: To address such a situation where a physician currently doing procedures in your ASC does not have the available capital to invest in your center, some partners have sold shares to that physician with seller financing. This is an individual-to-individual transaction with FMV interest rate.
Additionally, some ASCs are setting up companies that provide anaesthesia and share the profits with new physicians that have an ownership position in that new company. Typically speaking, when creating a new company, the "strike" price is not prohibitive for new providers and is less than the buy-in for the ASC; this could allow a physician see a return on his or her investment.
Q: What approaches to recruitment have you seen not work well?
BR: Some of what I have seen that has not worked well is contrary to what was said above, such as not being transparent or selling equity to doctors before you know them well or verify their projected surgical volume is correct.
In addition, we have seen some centers attempt to create vastly different models for different physicians they are recruiting that do not work long term. For example, if a center is trying to recruit a surgeon that has a significant volume of procedures that he or should could do in your center and a lease model is created for that single physician, what message does that send to the physicians that have paid their dues and are not under that arrangement? While you need to be flexible in your approach and sometimes creative, you need to keep in mind that every decision has consequences.
Another issue that I have seen that has not worked is putting someone in charge of the recruitment process that does not have the experience and expertise to be able to champion your center and convey your unique message. This is an important role that needs someone who is tenured and has a history of success of speaking with physicians and recruiting. Putting someone in charge who cannot represent the ASC in a positive, encouraging manner may result in the projection of a misleading and negative image of the ASC on prospective physicians.
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