Fourth and Last of Four Parts. Interview with Lori Schutte, President of Cjeka Search, Inc., A National Physician Recruiting Firm.

The Physician Landscape: Turn-Ons, Burnouts, Leadership, and Physician-Led Innovation Issues

Preface: I conducted this interview on behalf of The Physicians Foundation, a nonprofit charitable organization representing physicians in state medical societies. Most of these physicians are in independent, physicians-owned practices. The Foundation is interested in what attracts physicians to new practices, why and when they leave these practices after being recruited, what characteristics organizations employing physicians are looking for, and how the physician practice landscape is changing.

Q: Let’s get back to brass tacks. I see from your survey that the three big recruitment draws, not surprisingly given the state of the economy, are: one, compensation, 65 percent, income guarantees, 61 percent; signing bonuses, 42 percent. That makes sense to me.

A: I think that’s very, very accurate.

Q: It’s got to be. After all, it’s your data.

A: Everybody wants market-based compensation, not necessarily security.

Q: I work closely with The Physician’s Foundation, which represents all the state medical societies. We surveyed 300,000 primary care doctors. What was tangible about the survey was the tremendous loss of morale among physicians. Do you see that, or is the impact softened by the security of being in multi-specialty groups?

A: I spoke at MGMA, and I got questions from the audience about groups were handling physician burnout, which is more prevalent than it used to be. How is that impacting the physician workforce? During the Q and A, the question of sabbaticals to combat burnout came up.

Q: There’s a lot of comment in your survey about the demands of physician leadership and administrative duties. Is that more important than in the past?

A: The desire for physician leadership is growing. The number of physician executives is increasing. The questions are; How do you spot emerging leaders? And how do you develop them? And how do you pay them?

Q: I’m a student of physician culture. One of our tenets is: we all put on our pants, or our girdles, in the same way, and why should we pay colleagues more when they are not doing the clinical grunt work in the trenches. How does one compensate leaders?

A: There is a bigger question than that. What does the organization value? If someone has leadership abilities, you have to compensate them fairly. Those leadership skills, in combination with clinical knowledge, Are more valuable than clinical skills alone.

Q; I’ve interviewed Mayo leaders through the years. They want their leaders to keep one foot in the clinical trenches so they can retain their credibility among colleagues.

Earlier in this interview, you said the survey contained few surprises, and it was comparable to findings in previous years. Any second thoughts?

A: The biggest surprise was the spike in number of physicians desiring part-time work. The other surprise, so to speak, was that what physicians want and need will vary from group to group, and from individual from individual. The savvy groups are going to look at the heterogeneity of physicians, and are not going to try to look at one-size-fits-all solutions, but will ask: what’s important this individual, and how we can accommodate him or her? They will tailor packages that are important to that individual.

Q: I am interested in innovation. Three years ago, I wrote a book Innovation-Driven Health Care. There is a pervasive interest in developing innovation strategies within groups. Kaiser, for example, is trying to develop an innovation culture and started a national organization called Innovation Learning Network. There is the feeling we can innovate our way out of some of our problems – through open scheduling, or group meetings with patients with the same disease, or new practice models. Do you hear much about this among AMGA members?

A: They talk a lot about they can continuously evolve in terms of the use of mid-level providers, the use of electronic medical records, sharing of information to stay on top of a patient’s condition.

Q: So innovation falls under the mantra of continuous improvement of efficiency and care improvement. By the way, your survey mentions the importance of hospitalists, especially to primary care doctors seeking relief from night calls and weekend call. Do you see the hospitalist movement, now about ten years old, continuing to evolve?

A: When we are recruiting primary care physicians, we find they are either going one way or another. I want to be a hospitalist, or I want to do outpatient medicine only. Very few want to blend the two, and do things the only fashion way- my patients are my patients, I want to follow them from beginning to end, and I want to do both. Many groups are hiring groups of physicians just to be hospitalists.

Q: Well, the landscape she is a-changing. Do you have any closing comments?

A: No, we live in interesting times, as the Chinese are fond of saying.