6 Ways to Prevent Physicians From Leaving Your ASC

Physician recruitment and retention is a crucial part of ASC profitability, but holding onto physicians can be difficult as markets become more saturated and facilities compete for case volume. Here Robert Carrera, president of Pinnacle III, a management and development company, discusses six tactics to keep physicians at your center for the long haul.

1. Recruit loyal physicians in the first place. Physician selection is the first step to keeping surgeons at your facility long-term, Mr. Carrera says. "Physicians who have investments in multiple centers and a reputation for hopping around are typically not going to extend loyalty to you either," he points out.

If the physician is leaving another center to join yours, look into his reasons for leaving: They may be legitimate, but you want to know before you take on an investor who could just as easily leave you. "Is this the third center he has left? If so, he is likely to leave your center in a couple of years too," Mr. Carrera notes. He says it's a good sign if the physician is moving centers because the geographics of his practice has changed — or because his current center has stopped distributions due to financial mismanagement.

He says the physician's reputation is also important to consider. If the physician is known for making idle threats about leaving the center he is currently invested in, he may be more trouble than his case load is worth.  

2. Communicate about problems — and offer immediate solutions. Physicians may experience frustration with your center for a number of reasons, Mr. Carrera says. This frustration is natural, but an astute administrator consistently checks in with physicians and handles problems in a timely fashion. If physicians are left to stew over problems that could have been fixed, the center may lose providers unnecessarily.

Mr. Carrera says common problems including scheduling issues (can the surgeon get his cases on the schedule without too much hassle?), equipment issues (is the equipment in your facility updated and ordered to the physicians’ specifications?) and staff issues (are staff consistent and helpful in the OR?). He indicates the administrator should check in with physicians at least every other time they come to the facility, and OR managers and nurses should be tasked with checking in as well. "If there is a problem, you need to deal with it immediately, not sweep it under the rug so it can fester and turn into a long-term issue," Mr. Carrera says.

3. Provide financial data on a regular basis. Physicians expect their surgery centers to prosper; therefore, leadership should work to keep the center profitable and provide financial data to physicians regularly. Mr. Carrera recommends having an "open book management style" when it comes to financials by sending out a regular email or newsletter informing physicians of expenses, revenue and distributions. He says his company provides web access to all partners in the center to provide them with an opportunity to review the financials whenever they want.

Of course, providing the data is only half the battle: To keep providers at your center, you'll also need to stay profitable. Mr. Carrera says surgery center administrators must constantly monitor supply, equipment and staffing costs, assess payor contracts and perfect revenue cycle processes to ensure financial stability.

4. Make conservative predictions. If you're starting a new center, be conservative and realistic with your promises to physician partners, Mr. Carrera states. "If you're in a start-up phase and you've overprojected the center, your physicians are never going to be happy with you," he says.

Once a physician is disappointed, it's a lot harder to fix the problem than if you hadn't built up high expectations in the first place. He says the expectation for distributions should be based on the center's budget, projections, feasibility study and a realistic projection for the center's case mix, payor mix and specialty mix. "If you make any kind of prediction, it needs to be conservative and realistic," he says.

5. Recognize the most common reasons for physician dissatisfaction.
It will be easier to avoid physician dissatisfaction if you understand the reasons for it ahead of time, Mr. Carrera asserts. In his experience, the most common reasons for physicians leaving a center are:

Inconsistent or incompetent staff. Surgeons want to know and respect the OR staff they work alongside, Mr. Carrera says. Try to schedule the same staff members for each physician to improve efficiency, quality and interpersonal relations in the OR. Make sure any complaints about staff ability are dealt with immediately.

Perception of poor equipment. Implement regular equipment checks to ensure you're providing your surgeons with the proper tools for patient care. If a surgeon requests a piece of equipment, take the request seriously and determine when the center's budget can accommodate the request. Too many "no's" may make the physician feel undervalued.

Financial problems. Financial issues at the center will adversely affect distributions, which is sure to lead to physician complaints. Keep a close eye on your finances and constantly look for ways to cut costs and boost revenue.

Inability to schedule cases. A major cause of dissatisfaction is problems with scheduling, Mr. Carrera says. He recommends keeping a "turn down log" at the front desk, where any case that's rejected is written in the log. If physicians complain that they can't get cases on the schedule, you can refer to the log and determine whether the "turn down" was warranted.

6. Involve physicians beyond their regular duties. Mr. Carrera says the most effective way to physicians engaged is to provide great customer service. He encourages administrators to find ways to recognize and engage physicians outside their time in the OR. For example, he says his centers frequently host seminars to give their physicians added exposure to the community.

"We hold seminars in the lobby — maybe a foot clinic for a podiatrist or a talk from orthopedics – to drum up recognition for the physician’s practice," he says. When the center adds a new physician, he recommends leadership host a reception for the new surgeon in the ASC lobby. These gestures cost little money for the facility and go a long way toward showing physicians that they're truly appreciated.

Learn more about Pinnacle III.

Related Articles on Surgery Center Turnarounds:
Pinnacle III Promotes Robert Carrera to President and CEO, Moves Offices to Denver
Dr. Jennifer Lane Joins Hallmark Health Systems Bariatric Surgery Center
5 Trends Affecting Common ASC Specialties

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