**I = Interviewer
**R = Robert Hickey
Welcome to the D&Y Innovators exchange. A podcast series focusing on medical staff development leaders whose dedication, work ethic, and unique industry approaches have enhanced and inspired their medical staffs to provide the highest levels of clinical service and quality patient outcomes to the communities they serve
With us today is Robert Hickey a tenured position recruitment leader with a Kaiser Permanente Mid-Atlantic division to discuss successful physician retention
I: Is there one defining program or quality that you’ve been able to identify and there could be several, that have led to such a market-leading presence in terms of physician retention? What do you see to be most influential in that arena
R: Success begets success.
One NCQA which is not by the popularity contest that’s purely by the numbers of quality – we were not the health care system we are today when I got here in 2008
We were number 235 in the nation of over 400 healthcare delivery systems
We affiliated with our northern CA group – and before the affiliation, they went to the kaiser health foundation and got them to commit to using 1.5 billion into this region. So, we did change tremendously.
We got this infusion, we had a lot of very talented physicians that did not have all the right tools and equipment to deliver what they wanted to deliver
The three things we look for in a candidate
All of our physicians have that, if you don’t have it you can’t play on our team
The three things in 2009 that we initiated and made very strong is
And a large part of that was becoming the true integrated healthcare model that kaiser was meant to be
We were working on the west coast very successfully – we were not able to do that on the east coast because we’re sending over 50% of radiology
We were chasing around reports, very inefficient as far as what we were doing, a lot of duplicated tests
Tests a lot of times are invasive on our patients, so the other thing too is that it’s not terribly healthy for someone to get a catscan here or there. Multiple catscans where it’s not necessary.
So, we started hiring up a storm, people could get all their care in 1 location. We have a lab, pharmacy, radiology at all of our centers — because everyone is into the same EMR system.
I: A true ACO?
R: Yes. We were a medical home long before they coined the term, which was kind of cool. We’ve been on electronic medical records since 2004. What I got here was a lot of companies that were really struggling to get onto electronic records. IT’s very expensive.
We’re the largest user and we’ve done 1 billion in renovations to that so that we have proactive care. And a lot of different things
I: That’s incredible.
R: Most importantly all our physicians are tied into that record, so they’re able to see things real-time.
For example, in 08 we did not have PACTS – which is the system for looking at films.
We integrated that into our EMR – now our physicians can see the picture and the report at the same time. They can share that picture and report with their patients at that time.
A large part of this is getting your patient to buy into their own healthcare. So that’s been exciting and fun.
So we went from number 235 to 85 to 15 in the nation. Cinderella definitely arrived at the ball.
Tom Hopkins was our top competitor in the area and we blew past them. Why? Because we knew what needed to be done, we invested the time, talent, energy to make it happen.
I think when you #235 in the nation you’re just trying to get through the day best you can. — when you get to be #15 in the nation you realize there’s only 14 ahead of you and you can see that you can win
I: Yeah, light is at the end of the tunnel, we can get there.
R: That’s right.
The whole mindset is it’s like a football game in the 2nd quarter, “wait a minute, we’re holding our own, but we can win!”
So, we went from number 15 to 16 – we said “Woah Woah what just happened?” One of the other kaiser regions jumped ahead of us. So, sibling rivalry being the way it is, we couldn’t live with that.
In 2009 we set a goal that we wanted 80% of our patients to be seen in 10 calendar days for every specialty, including dermatology
And Robby Pearl was the head of the medical group at the time, and i remember leaning over to my colleague saying: “Someone want to fill him on a tooth fairy – cause we are way way off from that.”
By February the following year, we’re hitting it in every category including dermatology.
So, again, the success begetting success… Tell me all the tools and equipment you need to be successful… And we told them, and they delivered.
So, a large part of that they threw back on recruitment, and said “our success is going to be the result of your success.”
R: If you can’t get us these people, we got a problem.
I: So there’s a symbiotic relationship?
I: In terms of what you have to present to the marketplace has to be accurate in terms of the reality of practicing medicine for this health system.
R: And another thing too, but having our physicians believe that this could happen because for years they struggled because they didn’t have the finances and the tools and equipment.
Now the other thing too is once we got them to believe and we started delivering – now getting the community to believe because once we talked about Kaiser Permanente most people were thinking west coast. I didn’t even know it existed here. When you only have 7% of the market share vs 40% of the market share in CA – that’s a big big difference
But, when NCQA came out which is not the popularity content, that’s the real numbers and we started having real success, what I’m really excited about is that a lot of the same physicians that were here prior to this that made this happen, we started hiring up a storm, hiring super talented people and they integrated super well.
The way we onboard people makes a big difference, we didn’t throw them in the deep end.
For example, in primary care they see 2 patients in the morning and 2 in the afternoon the first couple days, then 1 and hour for an extended period of time, then continue adding.
They need to get used to our patients, our patients need to get used to them
As we talked offline, 2015 we had obnoxious growth. We brought on our physicians the exact same way, we didn’t change it. Which was very hard on our veteran physicians, but they sucked it up and did it cause they knew what was appropriate.
I think it gave us a lot of credibility with our newer physicians, we also got a lot better as far as interviewing, asking the appropriate questions, fully disclosing what the job entails and things like that — instead of assuming that they know.
Cause we found that our turnover #1 reason why people leave us is: traveling spouse.
Number 2 reason retirement and distant 3rd was going back for fellowship.
That’s kind of been replaced by going home to take care of family
So 63% of the people want to be with family — 30% where they trained –7% go “oh this is a cool place”
…that 7% doesn’t stay.
I: Yeah. There is that long term hook to keep them there
R: Right. Target advertisements, recruiting, establishing relationships with the residency and fellowship programs. That was a big deal. We’re also tracking where we’re getting our candidates from closers.
What’s really exciting is in the last year 40% of our physicians came from referrals of our existing physicians.
Which means their satisfaction is pretty good because they’re referring to people. They believe in our system. To the point where they want to recommend us to their friends. And people like to work with people that they know, that they like, people they trust.
I: So from a trends standpoint, it’s very obvious that your organization was at the front end before very popular acronyms like ACO and things like population health management.
So really in the continuity of care and continuum of care from the time the patient is admitted until their discharged and then their post-care, what other trends are you seeing, Bob, from a specialty standpoint certainly as we talk about the rise in primary care, sort of the getting away from sort of the skeletons of the gatekeeper system and then where we are today from a specialty standpoint, what trends are you seeing within the marketplace?
R: Within the marketplace, we have people that are not going for cardiology for example cause they can’t find a job, hematology, oncology, etc.
So there is some market-driven things like that as far as their ability to find jobs. And what you tell internal medicine physicians that are considering a specialty:
You have a true passion for that? If you do go for it. Ok?
If it‘s not a true passion, you may want to consider either PC or hospital-based medicine.
HBM I think was very underrated as a specialty -0 it was recognized as a specialty in the last couple years where people are saying, “Hey this makes a big difference”
I: Yeah, the number of board-certified hospitalists is like 1,300. I mean, it’s an incredibly small number by comparison to individuals that are actually practicing hospital medicine.
Internal medicine trained is very well trained in hospital-based medicine, if they go directly into it. They lose that confidence if they do primary care, then switch.
The other thing to, is medicine has become so comprehensive and so intense, I think having the two different career paths of hospital-based medicine and primary care is worked out very well as opposed to the traditional way that we mostly grew up with as you saw your primary care doctor during the day, and you ran to the hospital in the evening.
Again that work-life balance did not become them. The other thing is medical technology and medical knowledge has kicked up so high that is’ very difficult to maintain that informational knowledge in all areas.
You’ve been listening to the D&Y innovators exchange featuring physician recruitment leader Robert Hickey with the Kaiser Permanente Mid-Atlantic division
Join us next time when we discuss cost reduction and containment with Mr. Hickey.