Hospitals seeking to hire doctors who play well with others

Most hospital systems that have or are developing accountable care organizations say the new structure is affecting the way they hire physicians.

Seventy-eight percent of 105 hiring executives said they wanted doctors who were team-oriented, 68% were looking for physicians who were motivated by quality incentives, and 65% sought doctors who were technologically savvy, according to a report released Oct. 2 by the Medicus Firm, a physician recruiter based in Dallas and Atlanta. They’re asking for the skills in part because hospitals don’t believe all their physicians have them: 58% said between zero and half their physician staff were a good fit for ACOs.

“There are certain personality attributes and characteristics that, unless it was for a physician leadership position, I don’t think most places have really asked for before,” said Jim Stone, president of the Medicus Firm.

ACOs are becoming an increasingly common way of attempting to control costs and increase quality for patients with government or commercial insurance. According to Leavitt Partners, a consultancy based in Salt Lake City, 221 ACOs operated in 45 states as of the end of May. New ones are announced on a regular basis.

Independent practice physicians in an ACO usually are paid fees for services to participating patients and provided with the incentive of earning bonuses for meeting quality metrics or saving money on the cost of caring for a population. Employed physicians could be compensated in a similar way. In the Medicus survey, 61% said they would use incentives based on the ACO’s success as part of the formula for paying physicians, whether they were employed or affiliated. Seventy-five percent of respondents said they were adding physicians to their ACOs as employees only.

The health systems in the survey expressed optimism about finding doctors who are flexible in who they work with and when they work. Fifty-four percent wanted physicians who are comfortable working with physician assistants and nurse practitioners. And 41.5% were looking for physicians who are flexible with work schedules and willing to work nights and weekends and take calls at home.

“We’ve been looking for quite a while for physicians who would at least play well with others,” said Jonathan Swartz, MD, regional medical director of Montefiore Medical Group in New York, which works with Montefiore ACO. “We really want physicians to work in a team with nurses, medical assistants and other physicians.”

The Center for Medicare & Medicaid Innovation has designated Montefiore ACO as a pioneer accountable care organization.

A significant proportion — 46.3% — said ACO participation would modestly increase their physician recruitment needs, and 2.4% reported that they would grow markedly. In addition, 43.9% said recruitment would not change and 7.3% thought the need for physicians would go down. Eighty percent said they would need to hire more NPs and PAs.

Physician recruiters said finding candidates is already difficult for many hospitals because of the high demand for doctors. Therefore, there is a push for doctors to participate in various types of in-house training and development. Physicians, especially ones in primary care, are in short supply, and this is expected to worsen as millions more people gain insurance under the Affordable Care Act.

“An [EHR] can be taught,” Stone said. “Technology can be taught. The ability to work together as a team — sometimes that can be coached, sometimes it cannot. It is going to depend on the individual.”

The survey was distributed to hiring executives at 144 hospital systems, 139 of which did not respond to questions about ACOs because none had formed one or were thinking about doing so soon.