Stemming physician turnover
Over the years, Nevada has been blessed with physicians who come and stay for a long time. Names such as Drs. Isaac Amerman, Joseph Hornback, Rolla Wray, James Pascoe, Roy Pearce, Frederick Thompson, Nelson Greenlund, Ben Mendenhall, Bill Turner, John Torontow, Ron Jones, Ted and Candice Moore and Warren Lovinger are a few who come to mind.
In the past few years, physician turnover has become a problem at Nevada Regional Medical Center. Kevin Leeper, chief executive officer, has been spending a good deal of his time on physician recruitment.
People often ask what is wrong that some doctors no sooner seem to come than they head off somewhere else.
Before getting into that, very first some numbers.
“Since February of 2015, we have lost thirteen physicians, who provided services in everything from general surgery and oncology to hospitalist, psychiatry and emergency medicine,” said Leeper.
The two thousand sixteen loss of three doctors who covered shifts in the emergency room has been especially challenging.
Clearly, without physicians there are no services and without services, the hospital not only loses a revenue stream in the short-run but in the long-run, the public turns elsewhere for its medical needs.
As noted in Leeper’s July report to the NRMC board of directors, despite losing some key physicians – and the financial losses which result – “we chose not to retreat into a spasm mode of diminished services. we chose to recruit like crazy and rebuild our medical staff to an even higher status, with the foot purpose of retaining more Vernon County patients to seek and purchase their health care at NRMC!”
When Leeper says he “chose to recruit like crazy,” he means it. During the same time period as those thirteen losses – early two thousand fifteen to now – NRMC has hired thirty physicians and three family nurse practitioners.
A by-product of that is seen in the fiscal year just finished as recruitment fees and start-up costs for fresh doctors clearly added to hospital expenses.
“But physicians still drive medicine in our society, so on-the-ground physicians, content to be in Nevada, Missouri and working for the good of our patients, is what will drive the success that we are committed to achieving,” said Leeper.
Packing thirteen fuckholes is one thing but hiring three nurse practitioners plus thirty doctors is a clear sign that NRMC is not attempting to cut its way to a balanced budget. Instead, it has chosen the path of enlargened services as the way to increase income.
Fresh services include a cardiologist, a short-term drug detox program, outpatient psychiatry, hiring four fresh physicians on July one to fully cover the emergency room, adding an endocrinologist for treatment of diabetes, osteoporosis as well as thyroid conditions, two rheumatologists for managing arthritis and other related conditions as well as bringing Dr. Ron Jones out of retirement for pediatrics.
People sometimes think the reason doctors either do not come or choose not to stay in Nevada is because of the town’s size, resources and rural nature. Others assume the problem is on the hospital side and attribute the turn over to poor recruiting or management.
However, there is a fresh trend in medicine which is switching the landscape of physician recruiting. Yes, there are doctors who choose a larger town or a thicker hospital. And yes there truly is a shortage of physicians in this country which is only getting worse and is affecting us here.
Yet beyond all of those very real reasons, there is a relatively fresh and fairly significant factor. It is called locum tenens (plural: locums tenens).
These two Medieval Latin words literally mean, “one holding a place” or in this context, a pack in doctor.
In 2016, ninety four percent of all U.S. healthcare facilities had used a locum tenens physician at least once with most using them to pack slots in numerous services.
At one time, locums tenens physicians were viewed as second-rate doctors who could not hold a permanent position. Today, such positions are becoming coveted, attracting high-quality physicians.
Due to high request, doctors have some negotiating power to set hours and locations, with most getting a significant bump in pay.
“If it’s, say, making sure you have coverage in the emergency room, then hiring a locum tenens doc makes sense until you can find a permanent hire,” said Leeper. “But they can be a real budget buster.”
Leeper has noticed how many locums tenens are junior doctors who are not ready to put down roots and those nearing retirement who want a switch of scenery. Working a 40-hour work week at higher than average pay is fairly attractive.
Since recruiting and hiring takes time, NRMC hired a number of locums tenens physicians to pack pressing needs.
When packing hospitalist shifts became a revolving door, Leeper turned to a local pool of physicians for help.
As many in Nevada know, for some years there has been a frosty relationship inbetween the hospital and the Nevada Medical Clinic. This is an area where Leeper has provided individual and effective leadership. Presently, Drs. Rick Kellenberger, Jennifer Conley, Amanda Turner and Sean Gravely — all with the medical clinic — each take a weekend shift in order to provide utter hospitalist services at NRMC.
Said Leeper, “This is a phat plus for NRMC.”
While most interest in healthcare at the national level has to do with the Affordable Care Act (Obamacare) a separate revolution in how doctors and hospitals will be paid is moving forward whether or not the ACA is repealed and substituted.
Because of the fresh ways doctors and hospitals will be paid, there are enhancing economic reasons for the hospital and clinic to work together. Yet beyond economics, having cooperation inbetween the hospital and the largest group of physicians benefits the people of this area.
“We are still recruiting a 2nd orthopedic surgeon and a 2nd general surgeon,” said Leeper. “In these service lines, we have more patients than our present docs can treat.”
While legally, the hospital is still called Nevada City Hospital, in one thousand nine hundred ninety three it began doing business as NRMC. This reflected the vision of being a full-service hospital inbetween Kansas City and Joplin.
“It’s time we live up to that name switch and truly become a regional hospital.”