This is Brian Ackerman. Today I want to talk to you a little bit about rethinking primary care recruitment. If you’re in the recruiting business, you know how difficult it is to attract and retain primary care physicians in particular. What I want to do today is really outline why you might want to begin to rethink some of those efforts and maybe redirect some of those efforts in the future.
Let’s begin by looking at an average community and the amount of primary care visits that might be driven from that community. We’ll call that kind of the traditional approach. You can see in this example community about 500,000 physician visits are occurring in a given year. Let me pause right here and say, from a medical staff planning perspective, this is why it’s so critical to be sure that you are quantifying need based off of visit volumes and physician volumes, as opposed to physician-to-population ratios. As we’re getting more advanced in terms of their projections and trying to understand need, and particularly some of the nuances with future care delivery, physician-to-population ratios simply do not work anymore.
So going back to focusing on visit volumes, we can then begin to more specifically isolate what future visits might look like, as we think about improved care practices. Those improved care practices could include a variety of things, things related to primary care, medical home use, doing a better job of care management and removing individuals out of the emergency department. Again, we can quantify that move. And specialist physicians practicing specialty medicine. Again, so many specialty physicians are spending a fair amount of time focused on primary care needs of their patients, when in reality, if we had a sufficient primary care base in the community and care management for those individuals outside of that specialist office, the specialist might, in fact, have more of an opportunity and willingness to really push those patients back into community primary care setting.
So altogether, when you look at those improved care practices, we’re talking about nearly doubling the amount of demand for primary care resources. So what does that look like from a physician perspective? We would think about 100 physicians would be necessary to serve that caseload. And that’s in terms of today. If we were to simply ramp that up based off this improved patient access and care delivery models, we would end up with about 200 physicians needed in the community. And that’s simply not feasible. It’s hard enough to recruit a handful of physicians. If you can imagine trying to double the size of your adult primary care presence in the community, it’s nearly impossible. So we have to think about ways to think differently about recruitment and ultimately primary care delivery.
So we want to talk about modeling primary care transformation and really beginning to move away from traditional visits. Again, as we move away from traditional visits to more of a progressive look at how we might care for this population, we can incorporate things outside of physician visits, such as expanded use of advanced practice providers, and certainly e-visits, televisits, things of that nature, to get us kind of away from a traditional thinking and really ultimately impact the physician need going forward. So in this instance, if we were to go from a traditional all the way over to a progressive, you would, in fact, need fewer primary care physicians than you have today in order to support that need.
And so, traditional thinking would say you need more physicians. And clearly, that is just a difficult challenge in the environment that we currently work and live. From a new thinking perspective, we want to kind of change the terminology and the approach and ask, “How do we fully leverage those physicians that we have?” And so that may be the use of advanced practice providers. From a recruiting standpoint, if we are going to shift some resources to maybe care teams and focusing on recruiting to bolster up the physician practices in that way, recruiting additional positions beyond just the physicians.
And the other thing that’s still an opportunity in a number of markets is practice consolidation. Again, over the years, a handful of hospitals have purchased or acquired a number of different independent practices. And often those practices are still very much operating independently. So is there a way for us to consolidate some of those practices in a meaningful way that allows us to really drive larger population health efforts in primary care medical homes throughout our community, while we’re also doing a better job of really leveraging the positions that we have? So those are just some considerations to keep in mind as you’re recruiting for primary care and really developing your medical staff plan going forward.