This essay reflects on the current physician shortages as revealed by the National Physician and Nurse Supply Survey and posted in the journal Entrepreneur. The survey carried on hospital CEO’s indicates 68 percent view these shortages as enigmatic and must be addressed (Caldwell 2007). This essay extensively covers physician shortages and the techniques the management applied to resolve this problem through a case study done on Banner Health. In specific, the problems discussed are workplace burnout and frustration which ended in loss of top talent. This highly affected client loyalty hence the overall financial performance of Banner Health. Management strategies on retaining physicians have also been tackled and have been in place for a year.
Job satisfaction in a physician’s work environment has been largely reduced by increased workload, lower workplace reimbursement and widely-felt powerlessness in the work environment leading to disenfranchisement and consequently leading to frustration. This is due to the fact that physicians rarely control global trends such as aging, cost versus reimbursement pressures, consumerism, changes in outpatient care and nursing shortages. Challenges such as conflict resolution, building workplace consensus and a rapidly changing market have been largely ignored in medical training. Intervention therefore, if not implemented, brings about physician workplace burnout. Burnout is a condition that occurs when demands placed against the physician exceed his personal ability to cope bringing about psychological anguish, physical illnesses, and clinical errors in the area of jurisdiction. Three priority items have been listed by the Maslach Burnout Inventory as: emotional exhaustion, decline in personal empathy and lack of self-actualization which weigh heavily in retaining surgeons. A study on 382 practicing surgeons in the U.S showed that 32 percent suffered emotional exhaustion, 13 percent felt depersonalized and 4 percent felt unaccomplished. This goes a long way to support that surgeons should not only be taught surgery but also life skills.
This case study is on Banner Health, a firm located in Phoenix, Arizona, and operates 10 hospitals in Phoenix and one in Arizona under its mother company. Banner Medical Group (BMG). Physicians are employed by the firm to provide adequate primary care for its patients and help with subspecialty calls on patient assists. Physician turnover rates were found to be in excess of 10 percent hence the management decided to implement an on-boarding program which would ensure physicians would not leave prematurely by fully engaging newly employed physicians.
The on-boarding program begins on the first work day of the surgeon and has been successful in orienting over 30 physicians into Banner Health. The program is based on a mentor-surgeon approach whereby the newly-employed physician is mentored by an existing physician who is more experienced within the context environment or process. This process deviates from the traditional mentoring process since it is not carried out by a single mentor but rather a co-mentor relationship such as different physicians for orientation, coaching on the system and organizational culture. The on-boarding program lasts for a year whereby the physician has matured to coach a new physician. Although newly hired physicians can be mentored by several physicians, responsibility to coach, field questions, and provide work-related tips and encouragement is assigned to a particular physician. Therefore, a primary mentor should be familiar with clinical and ethical guidelines, previous cases handled, chief measures taken, improvement of the overall process and leadership development. The relationship enjoyed between the two should be cordial since personal fulfillment and effectiveness depend on interactions with co-workmates and allied professionals.
BMG's chief medical officer, Bruce Bethancourt, personally handpicked the mentors at the first on-board meeting. A consultant was also hired to develop the picked mentors' orientation program in preparation for the new cohort of the soon to be hired physicians. This involved training sessions whereby a brief on the new program’s rationale was delivered on leadership, co-mentoring and proper communication skills were also taught in an interactive setting.
The management, through the on-boarding program set out the following objectives: First, a physician environment was to be created and maintained which enhanced high patient care levels, physician on-job competence, the relationship between staff and patients and physician output. Secondly, the management set out to retain newly-hired physicians for a longer period in order to create a conducive environment so as to offer quality services which are patient-centered. This was meant to create patient loyalty. Thirdly, the co-mentor relationship would ensure the newly hired physicians felt connected to other families and the community around them by shopping, dining and relaxing at communal points.
The process starts with a general orientation whereby the physician is introduced to the organization’s mission and vision, programs and services offered location of sites and facilities and the layout of the meeting rooms, offices and laboratories. Practical information on area of service and its intricate detail such as day-to-day operations, compliance and patient safety policies, computer data system, hospital regulations and bylaws and other critical issues are taught.
The program has been highly successful since only one year since implementation; no single physician has left Banner Health. Before the implementation of the program, high physician discontent levels after a few months from the date of hire were evident. This program has however been very instrumental in reversing the trend and has managed not only to boost morale among physicians and allied health professionals but also cut down on physician turnover rates.
In the face of low physician numbers and ageing demographic coupled with ever-increasing shortages, effective physician retention methodologies should be put in place to ensure safe, secure, patient-centered, highly effective and efficient services are offered. Frustration was observed to stem from the physician’s inability to control the dynamic global trends such as consumerism, nursing and allied health care professionals’ shortage and cost versus re-imbursement pressures. Physician burnout was a resultant of demands exceeding capabilities which consequently led to distress and critical workplace errors such as those causing patient morbidity. Therefore, the management found it critical to prioritize physician retention as a way of enhancing company success. This was tackled by encouraging feedback and continuously attacking problems such as inefficiencies, bottlenecks and any work-related barriers in the organization. Therefore, the co-mentoring approach was highly relevant in imparting knowledge gained from experience hence bringing up a new breed of physicians altogether.(Caldwell, 2007) (Simington, 2009)(Shukla, 2009)