The Challenge: To help a health system prioritize recruitment in specialty medicine and surgery when faced with a uniquely competitive environment.
The Background: This client was a $5 billion system with a handful of hospital towers and more than 100 clinic locations. As a progressive system dedicated to health care rather than sick care, the client had an admirable record of focusing on and investing in primary care. As a result, across its four-county service area, the client’s market share in primary care ranged as high as 70%.
In specialty care, however, things got complicated. With academic medical centers to the north, south, and east, patients had no shortage of options, and physicians had their pick of well-regarded employers. The AMCs also created upward pressure on employment packages across the region, making it harder to attract providers at a cost that made financial sense.
In that situation, smart provider planning was paramount, and Ascendient was engaged to identify priority areas for recruitment and retention.
Our Work: Rather than a one-dimensional study, we approached the project from four different directions simultaneously. First, we used primary and secondary data to identify the specialties where providers were already struggling to keep up. Understaffed means overworked, so we wanted to know where heat might be building up in the system. Through Web surveys and in-person interviews, we asked medical staff to tell us where new hiring was most urgently needed.
Next, we studied the need for recruitment and replacement among current specialists. For each specialty practice, we determined the average age of providers as well as the share of providers older than 62. We then plotted the results on a 2x2 matrix to visually illustrate the urgency around succession planning.
From a financial standpoint, we looked at the system’s top 100 providers, ranked by margin contribution. Nearly 20% of those high-margin physicians were over the age of 62, representing a collective contribution of $40 million. Protecting that revenue would be key to financial stability, so we highlighted the specialties most at risk.
Finally, we overlaid all of the data with a health equity lens. Because provider diversity and culturally competent care are important to health outcomes, we looked at provider demographics versus population demographics on a county-by-county basis.
Our Findings: In terms of medical staff perceptions, the highest-need specialties were identified as behavioral health, gastroenterology, dermatology, endocrinology, and rheumatology. Because these are the people dealing with patients every day, we wanted management to understand that finding, regardless of any other filter.
Succession planning gave us another important result, with the greatest overlap in endocrinology, where roughly one-third of providers were nearing retirement. Other high-priority specialty groups had only half the concentration of providers in the over-62 category, indicating that the urgency was around current workload rather any future shortage.
The contribution margin data showed that management had some breathing room. None of the oldest, high-margin providers in the client’s home county practiced in one of the specialties identified by employees as a priority need. That meant that leaders could develop a high-revenue succession plan separate from the urgent recruiting effort around behavioral health, gastroenterology, dermatology, endocrinology, and rheumatology.
In terms of health equity, we found that provider demographics were fairly well matched to the population in two rural counties, while Black providers were significantly under-represented in the more urban and suburban counties.
The Outcome: Based on our analysis, the client is pursuing a multi-level provider planning effort that emphasizes immediate hiring for five specialties that are severely short-staffed plus near-term recruitment plans focused on high-margin specialties with aging providers. To get below county-level data for race and ethnicity, the client is taking into consideration actual patient data by specialty, allowing more targeted recruitment of Black and Hispanic providers to provide culturally competent care.
The Takeaway: Provider planning is a multi-faceted challenge, so it only makes sense to study your situation from multiple angles including medical staff satisfaction, community need, succession planning, financial impact, and health equity.
