Tuesday, April 19, 2016 | Joel Sauer
MedAxiom just completed its annual spring membership meeting (CV Transforum Spring’16), which saw record attendance, an amazing agenda and killer presentations. Each morning, prior to the start of the day’s agenda, the physicians in attendance holed off to talk about issues and opportunities unique to doctors. Every year—like clockwork—the conversation turns to an aging cardiovascular workforce and how to deal with physicians leaving call. This year was no exception and no small wonder, as this is a very dicey and potentially divisive topic.
This will be the first of a three-part blog series on workforce planning, which is intended to provide organizations with a roadmap to both anticipate and plan for current and future physician needs. The content will look not only at physician slow-down and call cutbacks, but also at creating a comprehensive plan for moving your entire cardiovascular program forward. In succession, the series will cover:
There’s a simple explanation why workforce planning is such a hot topic these days. The cardiology workforce is aging—with a significant chunk already over the age of 59. Table 1 shows the distribution of cardiology ages by subspecialty, along with how that distribution has changed over the last three years. Striking from the data is that currently 37 percent of non-invasive physicians are age 59 or older, with 8 percent over the age of 71. Interventional cardiologists are a bit younger, but not much, with 31 percent (nearly one in three) over the age of 59.
Certainly, these data don’t suggest a direct correlation with this age cohort and imminent retirement, but we’d all agree that these physicians are closer to the end of their careers than the beginning. Additionally, the ravages of the cath lab often necessitate that doctors leave interventional work and become more non-invasive. In fact, it’s this transition that may be driving the disproportionate age distribution of the non-invasive cohort.
Here’s something else that’s relevant. Production for a cardiologist peaks early. Figure 1 shows the distribution of work by age, using work Relative Value Units (wRVUs) as the measure. Physicians peak between the ages of 49-53 and then begin to trail off. By the time a physician is over the age of 59, production drops to 8,145 wRVUs per Full Time Equivalent (FTE), down from 10,037 wRVUs for those less than 59. That’s nearly a 19 percent reduction in work. When you consider that the median group size is around 17 physicians, a group that follows national norms, with around 30 percent over the age of 59, will need one extra physician to generate the lost production.
Likewise, a physician’s participation in the call rotation has a significant impact on production. Figure 2 shows wRVU production based on call participation. While the delta between full call participation and partial call is just 14 percent (nothing to sneeze at), the gap widens to nearly a 75 percent reduction when a cardiologist leaves call entirely. The impact is so great that just two physicians off call will require 1.3 additional full call FTEs to replace the lost wRVU production.
In Figure 3, you can see the impact of call participation on half days worked, a measure used by MedAxiom to normalize FTE status. As it shows, there is not such a significant difference between full call and partial call, with in fact, those in the partial call group working more half days than those taking full call. This may stand to reason, given that many groups have a half day off for “post call” duties; however, once a cardiologist drops out of call entirely, his/her daytime workload also drop precipitously, working more than three weeks less (on average) than those taking full or partial call.
Here’s another truth that has to be dealt with. The new generation of cardiologists entering the workforce may not be able to produce at the same level as the generations leaving. Work/life balance is often a much higher priority than in years past, which will impact your planning needs.
Additionally, there are gender-based differences. When comparing full-time male cardiologists to female cardiologists, the female cohort produces at about 80 percent of her male counterpart (Figure 4). Also noteworthy is that female cardiologists are much more likely than male cardiologists to work less than full-time (Figure 5).
It’s not the scope of this series to go into the reasons for these differences (although it should be noted that full-time female cardiologists also earn less than their male counterparts); rather to point out the need to consider the gender mix for planning purposes.
First and foremost, your workforce planning process should focus on driving organizational objectives; more specifically, the cardiovascular objectives or strategy and, when integrated, how that strategy fits into the broader organizational strategy. If you don’t have organizational objectives, get them. Otherwise, you’re simply rearranging deck chairs. You know the rest.
Although we don’t know exactly what the new value economy will look like, we do know it will push our workforce in several key ways. First, we’re being asked to take care of populations—even before they get sick—instead of just the acutely ill. Second, we’re being judged not only on our volumes (the old currency), but also on outcomes, service and cost. This Triple Aim will have major ramifications on how we staff, when compared to years gone by. The old paradigm of a physician and a patient in a one-to-one relationship simply won’t work—and even if it could—it’s too expensive for anyone to afford. Part of this service focus is around access, not just for in-person office visits, but beyond the office. Third, the value economy is pushing deeper sub-specialization in cardiology, which will also impact who and what we look for in the future.
Given all this, our workforce development needs to consider the entire clinical team (care team), not simply focus on the physicians. This includes advanced practice professionals (NPs, PAs), nurses and medical assistants. Gone are the days when our planning is as simple as “We’re too busy, let’s recruit a physician,” or “Dr. Jones just left/retired, let’s recruit a physician in the same sub-specialty.” In today’s environment, we simply must take a more analyzed and forward-thinking approach to workforce planning.
In part two of my blog, I’ll delve into qualitative metrics that can be helpful for workforce development.
Joel Sauer is Vice President of MedAxiom Consulting. His work includes full-service line development, co-management arrangements, workforce planning, compensation planning and integrations.
Joel Sauer, MBA, is Executive Vice President of MedAxiom Consulting. Joel consults around the country in the area of value-oriented physician/hospital partnerships preparing health organizations for the value economy. His work includes vision and strategy setting, creating and implementing effective governance and leadership structures, co-management development, joint venture and other innovative partnerships, and provider compensation plan design. Beyond the above, Joel has a wealth of experience in service line development, clinical strategy development, provider workforce planning; including care team creation and physician slow-down policies, MACRA and bundled payment planning, and operational assessments.
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