I've long been a fan of Medical Economics magazine. I saw this article on their website today. At one time or another, I believe most of us have had trouble getting in to see the doc on little to no advanced notice. Here's an interesting take on how walk-ins are a benefit and not a hindrance to a healthy medical practice .
-- WJ
You can make walk-ins work
Patients who come in without appointments can disrupt—or build up—your practice. A solid walk-in policy will make the difference.
Aug 17, 2007
By: Gail Garfinkel Weiss
Medical Economics
Key Points
Your practice should develop a policy for dealing with walk-in patients.
You might consdier having a "designated walk-in provider" who sees patients who come in without an appointment.
Tell front-desk staffers to verify walk-in patients’ account status and insurance coverage.
If you prefer not to see walk-ins, discourage them gently and offer them the next available appointment.
Charles Davant III, a family physician in Blowing Rock, NC, recently returned from a Baltic Sea cruise—paid for by walk-ins, he says. "In my three-physician practice, we take care of anyone who wants to be seen that day, provided they're willing to see whichever of us has an opening, and provided they're willing to wait."
Conversely, East Orange, NJ, cardiologist Shashi Agarwal views walk-ins with suspicion, stemming from "25 years of poor experience with this population." People who see a cardiologist without a prior call or referral, Agarwal says, "either are drug addicts who claim that they're new to the area or their doctor has moved away, gone on vacation, or died; or patients who present with expired insurance cards or pay with checks that never clear. And, of course, our schedule is disrupted by walk-ins regardless of their motivation and insurance status."
Love 'em or hate 'em, walk-ins are a fact of life in office-based medicine, so rules to deal with them are essential. Walk-in policies will vary from practice to practice, and even from physician to physician within a practice, depending on who's on call, who's looking for a heftier patient roster, and what sort of help the unannounced patients need.
Making a place for walk-in patients
Even if you accommodate people who show up at the front desk without a call or an appointment, you don't have to see every one of them. Jeffrey J. Denning, a practice management consultant with Practice Performance Group in La Jolla, CA, recommends that walk-ins get the same screening telephone callers do: Question them to determine whether their problem meets your emergent (see today) or your nonemergent (not today, but this week) criteria.
"Of course, true emergencies need to be addressed right away," says Denning. "But in the case of lesser emergent problems, the front-office staff can tell the patient you'll see him as soon as there's a break in your schedule. Or—better yet—the patient can be instructed to return at the end of the day to avoid wrecking on-time performance for scheduled patients."
Handling walk-ins will go more smoothly if you do your homework. Keep a running tally of how many patients show up with emergent and nonemergent problems, and adjust your schedule accordingly, says Denning. For example, if your practice usually gets two walk-ins with emergent problems on a Monday, save two slots on every Monday's schedule, to be handed out only that day—perhaps one in the late morning and one in the afternoon. Estimate how many nonemergent slots you need, too, so if a patient walks in on Monday with a problem that can wait, you can offer him an appointment later in the week.
In a group practice, who sees walk-ins? It could be a PA or an NP, or a "designated walk-in provider" (usually that day's on-call physician). At FP Sumana Reddy's five-provider practice in Salinas, CA, walk-ins are assigned to anyone who has an opening. "We've found this to be a great way to build the newest clinician's practice, since walk-in patients are more willing to see whoever is available, and to tolerate long waits," Reddy says.
Kenneth T. Hertz, a Medical Group Management Association senior consultant based in Alexandria, LA, worked with an orthopedic practice that funneled all walk-ins to an older physician who no longer did surgery. He, in turn, triaged those patients to the appropriate physician. "This helped accelerate access to the practice, and ensured that the 'operating' orthopedists saw a higher percentage of surgery candidates," says Hertz.
Solo practitioners need a walk-in policy that addresses the challenges of going it alone. In Taunton, MA, pediatrician Eric J. Ruby's practice, for instance:
The nurse must triage.
If it's a medical emergency, Ruby sees the child right away.
If it's not an emergency and his schedule permits, Ruby sees the patient in order of arrival.
If it's not an emergency and his schedule is full, Ruby asks the parent to bring the child back later that day.
If it's not an emergency and the patient can't return that day, Ruby calls the parent to arrange treatment and follow-up.
"We set aside 10 minutes each hour for 'catch up,' and flexibility is the watchword," Ruby says.
"Physicians often use the term 'walk-in' as a pejorative, but that needn't be the case if you're set up to handle patients who don't call ahead," says Judy Bee, Jeff Denning's colleague at Practice Performance Group. Some of them are teens and 20-somethings who've never developed a relationship with a physician and would make excellent additions to your patient base.
Educating patients, and getting paid
Once word gets out that your practice is walk-in friendly, you'll need to establish ground rules to keep walk-in traffic from compromising your daily schedule. Stefan Topolski, an FP in Shelburne Falls, MA, limits walk-ins to five-minute slots, with waits of up to two hours. "We do a little acute triage, then give them a follow-up appointment if medically necessary," he says.
Your walk-in policy should distinguish between new and established patients. In her solo practice in Mullins, SC, family physician Rosanne Hooks arranges her schedule so she can see walk-ins within 30 minutes—if they're already on her patient roster. If she's never seen the patient before, however, her husband and office manger, Wayne Hooks, contacts the patient's previous physician to get basic information faxed over.
Depending on your specialty, you might find it appropriate to see walk-ins under specific circumstances, which you determine and enforce. Sharon Packer, a psychiatrist in New York City, urges patients to call first "because the rest of the world expects people to schedule appointments, and I'd be reinforcing inappropriate behavior if I encouraged this practice." Occasionally, however, a college student's parents come by without notice at the time of the student's appointment. "With the patient's approval, I welcome them in for a moment, shake their hands, and apologize that I don't have more time to spend with the entire family that morning," Packer says. "I offer to schedule a family appointment at another time, but I've never had anyone take me up on it. I sense that families just want to see the psychiatrist who's treating their college-age kids."
FP Omar A. Khan discourages what he calls "show up when you feel like it" patients at his practice in Wilmington, DE, because, as he notes, same-day appointments are almost always offered to those who call that day. "The point is not to have a crowded waiting room," he adds, "as well as not to give pre-set patients the sense that a walk-in has taken their slot." Likewise, Michael Casser, a pulmonologist in Englewood, NJ, sees walk-ins because "turning them away is not a good ethical or business decision." But he encourages them to call first the next time because "that's usually less costly for them, and it means a shorter in-office wait."
Speaking of costs, your walk-in policy should include mechanisms to ensure that you'll get paid. Staffers at Sumana Reddy's practice noticed that patients who were in arrears would drop by in the hope of being seen before anyone noticed the red ink on their account. To avoid this, tell your employees to verify walk-ins' account status and review their insurance coverage. If you suspect that walk-ins are trying to slip under your payment surveillance radar, ask for full payment up front, with the promise that you'll refund any money you receive from third-party payers.
Enforcing an appointment-only policy
In FP Mike Christian's view, shoehorning walk-ins into a busy schedule isn't good for physicians or patients. "Everyone gets shortchanged," says Christian, who practices in Moses Lake, WA. "You can't justify missing something by saying you rushed because of a walk-in."
If you prefer to keep walk-ins at bay, make sure you're not subtly encouraging them, says Judy Bee. For example, how difficult is it for patients to get through to your office on the telephone? "Many walk-ins I've talked to simply grew tired of getting a busy signal or being put on hold," Bee notes. "Or the word might be out that on days when patients are told you're booked solid, those who show up unannounced are seen anyway."
If you want to limit or put an end to walk-in traffic, how do you discourage these patients without offending them or, worse, putting them and the practice at risk? Judy Capko, a consultant in Thousand Oaks, CA, recommends giving receptionists a "cheat sheet" listing presenting symptoms that should be reported to you or another clinician immediately.
Judy Bee stresses diplomacy, recalling a young FP who purchased a practice close to the Mexican border, where patients were used to showing up early in the morning and waiting to be seen. Little by little, the new doctor had his staff give patients appointments—either later that day or a few days hence—and ask them to return then. Those who continued to drop in were told, "It's a shame you didn't call first. Dr. Jones is fully committed today but can see you at 3 on Wednesday. Will that work for you?"
A not-so-subtle means of dissuading walk-ins is to tell them they'll be seen only if they pay a surcharge, as Scott Katz, a pediatrician in Plano, TX, does. "It's not intended to make a lot of money," he says. "Rather, it's to enable our office to run on time for the patients who had the courtesy to call ahead. It also applies to parents who make an appointment for one child, arrive at the office, and want us to see a second child." But Katz usually waives the surcharge if the child who's unscheduled is seriously ill.
Sometimes, no matter what you do, the walk-ins keep on coming, especially in pediatrics, where panicky parents rush children to the doctor for matters that turn out to be minor. "When we tried to be strict with parents, they complained that they came by because they couldn't get through to us on the telephone. If we tried rescheduling them, they went to the ED or another office, and we never saw them again," says Alberto Kriger, a pediatrician in Pembroke Pines, FL. "Even though it's sometimes disruptive to the flow of patients, we now just accommodate walk-ins."
"Usually," says Jeff Denning, "it's a matter of letting physicians have the practices they want and giving staff the tools they need to do a good patient service job."
Is that walk-in patient a drug seeker?
No one knows how many patients who show up at physicians' offices without appointments are looking to score their drug of choice, but some undoubtedly are, so it's wise to be vigilant.
What are some red flags to watch for?
New York City psychiatrist Sharon Packer is wary of patients who say their regular physician is on vacation—or say they're looking for a new psychiatrist but can't give a good reason for wanting to change doctors. Or they might claim that their last Xanax prescription was written in another state but they can't remember the name of the prescribing physician and just need an "emergency" refill.
"In psychiatry, many walk-ins are drug seekers who've been axed by their prior prescriber or who have used up their pills and are looking for a fresh start," says Packer.
Wayne Hooks, the office manager for his wife Rosanne Hooks' family practice in Mullins, SC, says that drug seekers often give themselves away. A 19-year-old requests OxyContin for excruciating back pain, for instance, but is vague about the trauma or condition that caused the pain and hasn't seen a physician in years. If Hooks suspects that a walk-in is there solely for drugs, he'll tell the patient that the doctor will be glad to see him but won't prescribe controlled substances without medical evidence—a note from another physician or an MRI report, for example—that such drugs are needed. "That's when they usually head for the exit," says Hooks.
Monday, August 27, 2007
Sound advice for new PC Docs, Residents & Med Students....
From AAFP.org....
New Physicians Tell All to Residents, Students
By Leslie Champlin • Kansas City, Mo. 8/22/2007
Practice medicine according to your principles. Don't compromise on your values, but be flexible enough to ensure financial health. Listen to your patients. Realize "you don't need a BMW."Do that, and you will flourish in an era when hospitals and communities are scrambling to hire family physicians.
That advice -- offered by new physicians Saria Saccocio, M.D., of Fort Lauderdale, Fla.; Kendall Campbell, M.D., of Gainesville, Fla.; Marguerite Duane, M.D., M.H.A., of Washington, D.C.; and Russell Kohl, M.D., of Venita, Okla. -- brought medical students and family medicine residents face to face with the real world Aug. 5 during "New Physicians Tell Their Stories" at the National Conference of Family Medicine Residents and Medical Students here.Newly minted family physicians are entering practice on the cusp of an upcoming serious primary care shortage. FPs can choose from a full menu of career options: urban or rural solo practices, academic medicine, or group or multispecialty practice. "You all have futures in family medicine," said Saccocio. "It is a little scary. I owed $70,000 to $80,000 (in school loans). But there are primary care shortages everywhere, in every state. Several hospitals in my area are begging for primary care physicians. There is no one to take care of the public. Emergency rooms are overloaded. And hospitals out there are offering income guarantees."Saccocio launched her solo practice in Fort Lauderdale with the help of a contract that guaranteed $16,000 a month for two years. The guarantee quickly became unnecessary, and Soccocio's practice soon was earning $22,000 a month. Recently, she realized she needed to give herself a raise.A successful medical career goes beyond income, however, said Saccocio. "You don't need a BMW," she said.Speakers urged participants to remember the key points of practicing satisfying, high-quality medicine: Capitalize on educational opportunities, delegate responsibilities for which you aren't trained, learn to say "no," and keep your patients' perspectives foremost in mind.
Learn, Learn, Learn
"You will always continue to learn," said Duane, who is the family medicine clerkship director at the Georgetown University School of Medicine and who cares for underserved patients at Columbia Road Health Services in Washington. "The thing family medicine does so well -- more than other specialties -- is preparing our residents to know how to learn, to use resources to expand their knowledge base."Kohl urged students and residents to capitalize on any learning opportunity."If there's anything you can learn, do it," he said. "It's better to have the skills that will lead to credentialing and choose not to use them than to have to do a procedure and not know how. Because when someone asks, 'Is there a doctor in the house?' -- all of your friends are going to look at you."
Don't Do It All
Too often, physicians open an office expecting to practice medicine but end up operating a business. "Contract out your billing," advised Kohl. "Hire an attorney you can trust to help you with employment law and other issues. And you need an accountant. Don't let your billing company be your accountant. That's like the fox watching the henhouse." Take these actions, said Kohl, "and you're not wasting your brain power fighting those little battles. You can take care of patients and hire people to take care of you."Saccocio agreed. However, that doesn't mean ignore the health of your business. "Have an interest in the business," she advised. "Understand what's coming in and what's going out, and that (the bottom line) should be black instead of red."
Learn to Say "No"
Family physicians enjoy as much, if not more, personal time than some of their counterparts. The key, said the speakers, is time management."Protect your time. You're going to be called on for so many different things," advised Campbell, who is assistant dean for minority affairs and a clinical assistant professor in community health and family medicine at the University of Florida. He's also a staff physician at a multispecialty clinic that cares for underserved people.Set aside workday time for administrative tasks and -- equally important -- preserve family and personal time, he advised. "Maintain those interests outside work. They breathe vitality into your life and into you," said Campbell, who has attended all of his daughter's soccer games and who serves as organist and choir director for his church's two choirs.
Begin at the Beginning
The doctor-patient relationship begins with the first telephone call, so ensure that patients interact with people, not technology, said Saccocio."Answer the telephone with a person," she advised, ticking off a series of other practice principles: "Listen to your patients. It's OK to say you're sorry. Be honest with your patients. If there are things you don't know, tell them. When you refer them, tell them why."Always, always be reasonable with your patients," says Saccocio. "You may not like all of your patients, but recognize your feelings and your responsibility to give them the same quality of care. If you're humble and modest, mistakes won't be a big deal and you'll get past them."Do that, she said, and you'll love your work.
New Physicians Tell All to Residents, Students
By Leslie Champlin • Kansas City, Mo. 8/22/2007
Practice medicine according to your principles. Don't compromise on your values, but be flexible enough to ensure financial health. Listen to your patients. Realize "you don't need a BMW."Do that, and you will flourish in an era when hospitals and communities are scrambling to hire family physicians.
That advice -- offered by new physicians Saria Saccocio, M.D., of Fort Lauderdale, Fla.; Kendall Campbell, M.D., of Gainesville, Fla.; Marguerite Duane, M.D., M.H.A., of Washington, D.C.; and Russell Kohl, M.D., of Venita, Okla. -- brought medical students and family medicine residents face to face with the real world Aug. 5 during "New Physicians Tell Their Stories" at the National Conference of Family Medicine Residents and Medical Students here.Newly minted family physicians are entering practice on the cusp of an upcoming serious primary care shortage. FPs can choose from a full menu of career options: urban or rural solo practices, academic medicine, or group or multispecialty practice. "You all have futures in family medicine," said Saccocio. "It is a little scary. I owed $70,000 to $80,000 (in school loans). But there are primary care shortages everywhere, in every state. Several hospitals in my area are begging for primary care physicians. There is no one to take care of the public. Emergency rooms are overloaded. And hospitals out there are offering income guarantees."Saccocio launched her solo practice in Fort Lauderdale with the help of a contract that guaranteed $16,000 a month for two years. The guarantee quickly became unnecessary, and Soccocio's practice soon was earning $22,000 a month. Recently, she realized she needed to give herself a raise.A successful medical career goes beyond income, however, said Saccocio. "You don't need a BMW," she said.Speakers urged participants to remember the key points of practicing satisfying, high-quality medicine: Capitalize on educational opportunities, delegate responsibilities for which you aren't trained, learn to say "no," and keep your patients' perspectives foremost in mind.
Learn, Learn, Learn
"You will always continue to learn," said Duane, who is the family medicine clerkship director at the Georgetown University School of Medicine and who cares for underserved patients at Columbia Road Health Services in Washington. "The thing family medicine does so well -- more than other specialties -- is preparing our residents to know how to learn, to use resources to expand their knowledge base."Kohl urged students and residents to capitalize on any learning opportunity."If there's anything you can learn, do it," he said. "It's better to have the skills that will lead to credentialing and choose not to use them than to have to do a procedure and not know how. Because when someone asks, 'Is there a doctor in the house?' -- all of your friends are going to look at you."
Don't Do It All
Too often, physicians open an office expecting to practice medicine but end up operating a business. "Contract out your billing," advised Kohl. "Hire an attorney you can trust to help you with employment law and other issues. And you need an accountant. Don't let your billing company be your accountant. That's like the fox watching the henhouse." Take these actions, said Kohl, "and you're not wasting your brain power fighting those little battles. You can take care of patients and hire people to take care of you."Saccocio agreed. However, that doesn't mean ignore the health of your business. "Have an interest in the business," she advised. "Understand what's coming in and what's going out, and that (the bottom line) should be black instead of red."
Learn to Say "No"
Family physicians enjoy as much, if not more, personal time than some of their counterparts. The key, said the speakers, is time management."Protect your time. You're going to be called on for so many different things," advised Campbell, who is assistant dean for minority affairs and a clinical assistant professor in community health and family medicine at the University of Florida. He's also a staff physician at a multispecialty clinic that cares for underserved people.Set aside workday time for administrative tasks and -- equally important -- preserve family and personal time, he advised. "Maintain those interests outside work. They breathe vitality into your life and into you," said Campbell, who has attended all of his daughter's soccer games and who serves as organist and choir director for his church's two choirs.
Begin at the Beginning
The doctor-patient relationship begins with the first telephone call, so ensure that patients interact with people, not technology, said Saccocio."Answer the telephone with a person," she advised, ticking off a series of other practice principles: "Listen to your patients. It's OK to say you're sorry. Be honest with your patients. If there are things you don't know, tell them. When you refer them, tell them why."Always, always be reasonable with your patients," says Saccocio. "You may not like all of your patients, but recognize your feelings and your responsibility to give them the same quality of care. If you're humble and modest, mistakes won't be a big deal and you'll get past them."Do that, she said, and you'll love your work.
A non- Michael Vick related Pitbull story.
Using Muscle to Improve Health Care for Prisoners
SAN JOSE, Calif. — Last year, shortly after receiving extraordinary powers to overhaul the medical system in California’s prisons, Robert Sillen, armed with a stack of court papers, issued a blunt warning to cabinet officials at the governor’s office in Sacramento.
Skip to next paragraph 
Multimedia
Peter DaSilva for The New York Times
Robert Sillen, appointed as federal receiver for prisons, speaking to the Sacramento Press Club in July. More Photos »
“Every one of you is subject to being in contempt of court if you thwart my efforts or impede my progress,” said Mr. Sillen, a silver-haired former hospital administrator chosen to carry out the overhaul of the prison medical system as the result of a class-action suit brought by a prison advocacy group.
Backing up his warning, Mr. Sillen handed out copies of a federal court order that named him the health care receiver for the California prison system.
In a subsequent warning, Mr. Sillen threatened to “back up the Brink’s truck” to the state’s treasury, if need be, to finance better medical services for the state’s 173,000 inmates.
State figures show that court-ordered changes to California’s prison system, including those in Mr. Sillen’s health care domain, have cost more than $1.3 billion, and the meter is still running.
For decades, California officials have tried to bring order to the state’s prison system, which is the largest in the nation. There have been lawsuits, special legislative committees and a declaration of a state of emergency by Gov. Arnold Schwarzenegger, but never has one person attacked a problem, piece by piece, with such blunt force and disregard for political convention as Mr. Sillen has the prison system.
Mr. Sillen, whose $500,000 annual salary puts him among California’s highest paid public officials, said he had never visited a prison or thought much about the penal system until a recruiter called last year to persuade him to accept what the recruiter called a “mission impossible.”
Now he has the power to hire, fire, raise salaries, build facilities, waive laws, tap the state treasury and have jailed any bureaucrat who tries to thwart him.
“In my opinion, Robert Sillen is not going to be happy until he’s running the entire prison system,” said a state assemblyman, Todd Spitzer, an Orange County Republican and one of Mr. Sillen’s detractors. “He’s a man who has utter disdain for the legislature despite the fact that we’re the appropriate body for budgeting.”
Mr. Sillen asked the federal courts last month to take on the costly — and politically contentious — task of reducing California’s prison population, including the early release of some felons.
The appointment of Mr. Sillen as federal receiver in February 2006 resulted from a class-action lawsuit brought by the Prison Law Office, an advocacy group based at San Quentin. A federal court in the suit found an average of 65 preventable inmate deaths a year in the prison medical system, which the court ruled was tantamount to cruel and usual punishment.
The California prison medical system was the biggest state agency ever ordered to be taken over by a federal court. The takeover was the most aggressive of several federal interventions into dysfunctional prison operations in California in the past 12 years. The federal courts also involved themselves in the prison system’s mental health, dental care, access for disabled inmates and juvenile detention operations, and in the use of force by corrections officers.
Mr. Sillen, 64, had been the executive director of the Santa Clara County Valley Health and Hospital System. Since beginning his new duties in May 2006, he has attracted hundreds of new employees to the prison medical work force. The medical staff had been experiencing a 20 percent vacancy rate, but Mr. Sillen raised salaries, in some cases by as much as 64 percent. He has siphoned off so many clinicians from other public health agencies that some now face shortages.
Mr. Sillen’s critics say that he has an authoritarian streak that has led him to wrest more control than he was given in his appointment by the court. Most troubling to some of his opponents is Mr. Sillen’s acknowledgment that he has no idea how long the changes will take or what they will cost.
The Prison Law Office filed a complaint in federal court in June saying that Mr. Sillen’s plans have “no concrete details of how any of the goals or objectives are to be accomplished, no real timelines and no metrics.”
In an interview in his office in San Jose, Mr. Sillen dismissed the group’s assertions. “When people ask me how long and how much,” he said, “I have a stock answer: Long. Much.”
Mr. Sillen speaks in rapid-fire, thrust-and-parry sentences often punctuated with profanity. He said his confrontational approach and broad federal powers were essential in trying to turn around an agency that had repeatedly failed to comply with court-ordered changes.
In a response to a demand by state lawmakers that he abide by state budgeting rules, Mr. Sillen wrote in a letter to the California Department of Finance last year that California’s appropriation process was “an immense waste of time (read taxpayer dollars) for little, if any, redeeming value” and that he felt “neither compelled nor obligated” to abide by state budget requirements.
Mr. Sillen says California politicians are reaping what they have sown. He attributed the state’s prison problems to tough-on-crime lawmakers who made political hay out of sentencing laws that filled the state prisons without expanding either the facilities or their services.
He has a standard diatribe concerning the criminal justice system that includes issues like the neglect of poor neighborhoods and the lack of alcohol treatment programs.
“I wouldn’t even be here if it weren’t for the politics,” Mr. Sillen said. “No one gets elected in Sacramento without a platform that says, ‘Let’s get rid of rapists, pedophiles and murderers.’ ”
Mr. Sillen says he has no need to curry public favor because he is backed by the federal court. He adds that, although few will say so publicly, his mission has given some politicians the political cover to embrace changes that might otherwise have been deemed too soft on crime.
Aides to Mr. Schwarzenegger, a Republican, said the threat of further court intervention was used to enact a $7.7 billion prison plan in April. The law will expand capacity by means of new construction and the transfer of 8,000 inmates to private facilities outside California.
Mr. Sillen, however, was unimpressed. Having made the governor aware of the need for new prison medical facilities, Mr. Sillen carved $1 billion out of the plan for his own projects and publicly criticized the expansion of prison space without adequate budgeting for medical workers.
After 15 months on the job, Mr. Sillen acknowledges that sick prisoners still suffer in ways deemed unconstitutional by the federal court and points to recent deaths as an indication of a long road ahead. In one case, Jonathan J. Smith, 32, a quadriplegic serving time for armed robbery, died while shackled in a prison van. The van, which had no air-conditioning and no medical staff, became lost for five hours last summer while returning to Centinela State Prison in Imperial County after a doctor’s appointment. Temperatures reached 109 degrees that day, contributing to Mr. Smith’s death, according to corrections officials.
In another case, a child molester, Melvin Fergerson, 61, died in December in his infirmary cell at Avenal State Prison. Prison officials said that Mr. Fergerson, who suffered from heart disease, had sat naked and nearly motionless for two days before his death.
Those incidents were among 552 inmate deaths in the prison system since 2006, according to the most recent state figures. Of those deaths, 161 warranted investigation of potential poor medical practices, according to an internal report. The report marked the first time in years that state officials had conducted thorough reviews of prisoner fatalities.
The poor state of medical care in California’s prisons was evident in the West Block clinic at San Quentin, the state’s oldest penitentiary and the first to be visited by Mr. Sillen. “It was unclean, it was unkempt, and there were no sinks, no phones, no faxes, no way to communicate, no nothing,” Mr. Sillen said. “And that’s the clinic. It was just worse than Third World conditions.”
Mr. Sillen announced that he would put San Quentin “under a microscope” and began a three-month program to address the problems.
He has since built a $1.6 million triage center and has broken ground on a larger, $150 million medical center, but the West Block clinic is such a low priority that it is still in the same small dirty room at the back of a prison gymnasium that had been converted into a dormitory to relieve overcrowding.
Women who work there as nurses avert their eyes as they pass 380 inmates who are lounging on rows of double bunk beds, standing in open showers or sitting on exposed toilets that line one wall of the former gymnasium.
A doctor who visits three times a week sits at a desk next to a toilet. He treats some 80 to 100 inmates each visit and cleans his hands with antibacterial sanitizer. There is still no sink.
___________________________________________________________________
Health care reform and the prison system. Talk about 2 hot button issues. Throw in a pitbull like Sillen and things get even more interesting. With election politics heating up, this being California and Sillen being Fed appointed, this could be something to keep our eyes on.
--WJ 8/27
Thursday, August 23, 2007
Medicare Says It Won’t Cover Hospital Errors
Medicare Says It Won’t Cover Hospital Errors
By ROBERT PEAR
WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.
Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.
Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”
Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.
In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.
“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.
The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.
It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.
One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.
Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.
Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.
“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”
Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.
Nancy E. Foster, a vice president of the American Hospital Association, agreed that doctors and hospitals knew how to prevent the transfusion of incompatible blood products and should not be paid more if they accidentally left objects in patients during surgery.
But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”
In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.
Dr. Tammy S. Lundstrom, the chief medical officer at Providence Hospital in Southfield, Mich., said, “The rules could encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital.” Moreover, she said, “Serious, costly infections can occur even when doctors and nurses take all the recommended precautions.”
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.
But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.
Eileen O’Neill-Pardo of Everett, Wash., said her experience showed the need for the rules. Her 82-year-old mother, Margaret M. O’Neill, died of an infection that developed during intestinal surgery at a Seattle hospital in 2004.
“The operation — to remove scar tissue — was successful, but the patient died,” Ms. O’Neill-Pardo said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”
Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.
Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.
Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.
Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: “I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”
-- Clearly there is need for Medicare and private health insurance reform, both in terms of finances and quality of care provided, but is this a solution, a band-aid or smoke and mirrors? Obviously, this is just one aspect of the greater problems anyway, but mistakes happen and so do non-preventable/unforseen infections. This puts the burden on the hospital staff to do a more thorough job or screening and prevention, which isn't a bad thing, but there's a price tag on that,too. Who's going to pick that up?
-WJ
By ROBERT PEAR
WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.
Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.
Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”
Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.
In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.
“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.
The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.
It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
Hospital executives worry that they will have to absorb the costs of these extra tests because Medicare generally pays a flat amount for each case.
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
Intravenous catheters are widely used to provide hospital patients with medications, nutrition and fluids, but complications are relatively common.
One state, Michigan, has had spectacular success with systematic efforts to reduce infection rates in intensive care units.
Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.
Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.
“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”
Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
The Bush administration estimates the new policy will save Medicare $20 million a year. But other experts say the savings could be substantially greater.
Nancy E. Foster, a vice president of the American Hospital Association, agreed that doctors and hospitals knew how to prevent the transfusion of incompatible blood products and should not be paid more if they accidentally left objects in patients during surgery.
But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”
In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.
Dr. Tammy S. Lundstrom, the chief medical officer at Providence Hospital in Southfield, Mich., said, “The rules could encourage unnecessary testing by hospitals eager to show that infections were already present at the time of admission and did not develop in the hospital.” Moreover, she said, “Serious, costly infections can occur even when doctors and nurses take all the recommended precautions.”
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.
But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.
Eileen O’Neill-Pardo of Everett, Wash., said her experience showed the need for the rules. Her 82-year-old mother, Margaret M. O’Neill, died of an infection that developed during intestinal surgery at a Seattle hospital in 2004.
“The operation — to remove scar tissue — was successful, but the patient died,” Ms. O’Neill-Pardo said. “The hospital staff did not take steps to control the infection, which took over her body. My mother died less than a week after the operation.”
Michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in The New England Journal of Medicine. The hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.
Hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.
Some of the complications for which Medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. Other life-threatening staphylococcal infections may be added to the list in the future, Medicare officials said.
Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: “I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.”
-- Clearly there is need for Medicare and private health insurance reform, both in terms of finances and quality of care provided, but is this a solution, a band-aid or smoke and mirrors? Obviously, this is just one aspect of the greater problems anyway, but mistakes happen and so do non-preventable/unforseen infections. This puts the burden on the hospital staff to do a more thorough job or screening and prevention, which isn't a bad thing, but there's a price tag on that,too. Who's going to pick that up?
-WJ
Wednesday, August 22, 2007
From The Wow Files.....
So, this is way off topic, but as a fan of sport I found this to be a pretty amazing story and a testament to healthy living. Besides, Mike Flynt was strength and conditioning coach at University of Oregon when I was there, so it strikes close to home.
Flynt, 59, Making Comeback with Sul Ross State University
"ALPINE, Texas -- Mike Flynt was drinking beer and swapping stories with some old football buddies a few months ago when he brought up the biggest regret of his life: Getting kicked off the college team before his senior year.
One of his pals asked why he didn't do something about it? So Flynt started a comeback -- at age 59.
Flynt has returned to Sul Ross State University in Alpine, Texas, 37 years after he left -- and six years before he goes on Medicare. And, he's has made the roster of the Division III Lobos and could be in action as soon as Sept. 1.
Flynt enrolled in graduate school so he can take advantage of his final semester of Division III eligibility.
Flynt is giving new meaning to being a college senior. After all, he's a grandfather. He's eight years older than his coach and has two kids older than any of his teammates. His youngest child just started at the University of Tennessee.
Flynt's position is still being determined, but he used to play linebacker. Wherever he lines up, just getting into a game likely will make him the oldest player in college football history. Neither the NCAA or NAIA keeps such a statistic, but research hasn't turned up anyone older than mid-40s.
And with around 200 pounds on a 5-10 frame, about the only visible difference from his playing days is a shaved head. He's in tremendous shape for his age because he's made a living out of working out.
A longtime strength and conditioning coach at Nebraska, Oregon and Texas A&M, Flynt has spent the last several years selling the Powerbase training system he invented. He recently taught it to some of the military's special operations forces, keeping up with them in their workouts.
Copyright 2007 by The Associated Press"
... Makes me excited to hit the gym tonight.
Flynt, 59, Making Comeback with Sul Ross State University
"ALPINE, Texas -- Mike Flynt was drinking beer and swapping stories with some old football buddies a few months ago when he brought up the biggest regret of his life: Getting kicked off the college team before his senior year.
One of his pals asked why he didn't do something about it? So Flynt started a comeback -- at age 59.
Flynt has returned to Sul Ross State University in Alpine, Texas, 37 years after he left -- and six years before he goes on Medicare. And, he's has made the roster of the Division III Lobos and could be in action as soon as Sept. 1.
Flynt enrolled in graduate school so he can take advantage of his final semester of Division III eligibility.
Flynt is giving new meaning to being a college senior. After all, he's a grandfather. He's eight years older than his coach and has two kids older than any of his teammates. His youngest child just started at the University of Tennessee.
Flynt's position is still being determined, but he used to play linebacker. Wherever he lines up, just getting into a game likely will make him the oldest player in college football history. Neither the NCAA or NAIA keeps such a statistic, but research hasn't turned up anyone older than mid-40s.
And with around 200 pounds on a 5-10 frame, about the only visible difference from his playing days is a shaved head. He's in tremendous shape for his age because he's made a living out of working out.
A longtime strength and conditioning coach at Nebraska, Oregon and Texas A&M, Flynt has spent the last several years selling the Powerbase training system he invented. He recently taught it to some of the military's special operations forces, keeping up with them in their workouts.
Copyright 2007 by The Associated Press"
... Makes me excited to hit the gym tonight.
Monday, August 13, 2007
MPCing and The Doctor Job
Creative Secrets for Looking For Your Next Practice Opportunity.
As I mentioned before, I used to manage a 3rd party recruitment firm. While we weren’t physician recruiters, we specialized in high end accounting and finance placements and collected fees of between 15-40K per placement, so there are some similarities there. Now, I’m going to ramble a bit here about recruiting in the accounting/finance world to set it up, but stick with me, because I will end up with something very relevant to looking for a medical position.
To a recruiter, a truly great candidate is like gold. The question is, what makes a truly great candidate? In general, it’s someone who is fairly rare. Each recruiter and/or firm has a different rating system for candidates. We used a system called AIP, where we rated candidates 1-5 (1 being the highest) based 3 criteria. A is for appearance -- just how sharp does the candidate look? I is for intelligence – how does this person’s technical knowledge rate with the average candidates you see in this specialty? P is for personality – life of the party or dead fish? Lastly, and not represented by a letter in AIP, we gave a letter grade for the overall place-ability of the candidate. After an in depth interview, reference checks and, at times, some testing we rated each candidate if a candidate rated very high over all (usually at least an AIP of 222B) and there weren’t a lot of other candidates with similar skills/specialty and a high rating on the market, we would “MPC” them.
MPC stands for “Most Place-able Candidate.” We turned the term into a verb, when we would tell everyone we know in a given field about the profile (no names, of course) of this “rare” commodity. This is an active way to really market your best candidates and differentiate yourself from other recruiters in the eyes of the hiring authorities and the candidates.
MPC-ing is an activity that every 3rd party recruiter knows about, but surprisingly few practice and it’s fruitful in many ways. Obviously, first and foremost, your goal is to find the candidate a position, which, depending on the candidate and how in-demand his or her skill set is, really happens. For example, I worked in a city where manufacturing was king. So, when I would come across an outstanding Cost Accountant with a manufacturing background, I picked up my phone and called all of my closest connections who were CFOs/Controllers/Cost Acct Mgrs in manufacturing and told them all about this candidate. Next, I wrote up a concise summary of the candidates profile and emailed it to everyone else in the industry and sit back and wait. Now, with a cost accountant, I would be fairly likely get at least one response back wanting to set up an interview, and that interview would sometimes lead to an offer or employment for the candidate. However, Cost Accountants were extremely rare and even a truly outstanding candidate wouldn’t necessarily receive an offer via those efforts.
The vast majority of the responses I would receive were along the lines of “This is a great profile, but we are not currently recruiting for a cost accountant.” Other responses that were at least as likely as setting up an interview for the MPC candidate, but were also great news for a recruiter were: “We don’t need a Cost Accountant, but we are looking for a Payroll Manager (or whatever)” -- thus uncovering a possible new job lead for other candidates – or “We’re not recruiting for anything right now, but I’d like to see what other options might be out there for me.” – thus uncovering a possible new candidate and, if that candidate goes elsewhere a new job lead as well.
The bottom line with recruiting is there is a ton of activity involved with uncovering each job and each candidate, let alone putting them together to make a match. So, you use as many tools as you can and you’re constantly looking for both candidates to place and jobs to fill. MPCing is a wonderful tool to really put forth a marketing effort for a great candidate, but you’re also fishing for other jobs and candidates. If a recruiter’s only activity was MPCing candidates and that recruiter was only looking to place that candidate with that effort, said recruiter would go hungry. While it happens, you can’t live off of only MPC placements as a recruiter.
Which brings me to back to the topic of physician recruitment….
The Doctor Job is a web tool for physicians where, for a fee ($1.75 - $3.00 per address), you basically MPC yourself. They work on the premise that “physicians find jobs by being in the right place at the right time.” Essentially, their site assists you put together a Cover Letter/ CV package and send it out to their list (other physicians and hiring authorities) based on the location and type of position you’re looking for. You put out the bait and hope you’re lucky enough to be in that place at that time.
While it’s all speculation on my part, I assume their list is probably pretty good, as they’ve been in business for a few years and for that type of business, the list is the lifeblood. While you’re paying for a little more service than just purchasing a list through The Doctor Job, the price for their service starts at $1750-$3000 per 1000 addresses, which is an outlandish amount to pay for a medical list, especially one that you can only use once. On a side note: there are other lists you can find out there that you can find with a simple Google search that you can purchase yourself and use as much as you like, but the prices vary greatly and so does the accuracy.
The Doctor Job claims to “find more jobs for physicians than any other source in the world,” but looking at the results from their testimonial page, which I assume are among the most positive results they get (otherwise they wouldn’t be sold as testimonials), the results, in terms of responses per out going messages are not any better (some not even as good) as I received as a recruiter when MPCing a candidate, which the hiring authorities knew came with a heavy price tag.
Other claims they make are this:
“Using a recruiter could cost you as much as $20,000 in lower salary and reduced benefits! Even though they dominate job boards, physician recruiters are only useful in a few situations. The fees they charge can be as high as $25,000-$50,000 or more! This means that
(1) 90% of physician employers will never use a recruiter, and
(2) Since the fees are so high, many employers who use physician recruiters pay a below-market salary to physicians (to cover the costs of the recruiter's fees).”
Well, I suppose using a recruiter “could” cost you, but this assumes that you, as a candidate, have no say in the matter. Whether you’re represented by a recruiter or not, if a medical organization wants to hire you and makes an offer, it’s your right, if not duty, to negotiate the best salary you can. If you accept an offer that is less than market value for that position, that is your choice, not the fault of a recruiter or anyone else for that matter. If you stand your ground, you’re going to get the pay and benefits that you should, based on your specialty, location, experience, etc. Further, if you ARE using a recruiter, they can often help in this endeavor. Recruiters, the good ones at least, tend to be skilled negotiators. It’s just part of their world.
As for the 90% of physician employers that will never use a recruiter… I’d like to know where they are getting their numbers. Here at Physician Recruiter publication and TheRecruiter.com, we talk to thousands of medical hiring authorities each month and one of the questions we routinely ask is “Are you using a recruiter to hire for this position?” and our results are not even in the same ballpark. Further, while it was accounting and finance rather than medical, as a recruiter I found that most companies that didn’t fall into the “mom & pop” category would gladly pay my fee to hire the right candidate for an executive level position, because those are key hires. The positions they often won't pay fees for are the more clerical functions. Last I checked, physicians make executive level incomes and are more important to more people than a Controller or Sr Financial Analyst, etc, so I don’t see how there’s any real difference. If the candidate is worth a fee, the hiring authorities will pay it.
One important difference between the MPC process that I described and what The Doctor Job is the all important rating system. While we’d all like to think we’re a “Most Place-able” 111A type candidate, we just can’t be. As a recruiter, if I MPCed 333C candidates all day, I’d place very few and eventually my contacts would stop taking my calls and would send my emails to trash prior to opening them. For this concept to really work a high percentage of the time, you have to be truly outstanding as a candidate, if you’re not, your CV will get tossed into the pile with the other also-rans. Even if you are a good candidate, the premise also relies on follow –up. With The Doctor Job, that all falls on you.
As to their main claim….. If The Doctor Job truly “find more jobs for physicians than any other source in the world,” then it seems it’s likely a function of the number of physicians using The Doctor Job being larger than the number of physicians using any other single possible option out there. And I'd still question that.
I believe in the MPC and I can understand where The Doctor Job is coming from. It's a smart idea and can see some benefit in what they do (it must work fairly well or they wouldn't remain in business), but I’d be pretty wary of putting all of my eggs in the basket of an organization who claims you’ll find your next position if you’re in the right place at the right time. Whether you use The Doctor Job or choose to get a list from elsewhere and you have the time to MPC yourself and follow-up, by all means do it. But if you’re actively looking for a position, I suggest you use other avenues (job boards, recruiters) as well, otherwise, you might be waiting to catch lightening in a bottle while less worthwhile candidates are accepting the offers that you should be getting.
- WJ 8/13/07
As I mentioned before, I used to manage a 3rd party recruitment firm. While we weren’t physician recruiters, we specialized in high end accounting and finance placements and collected fees of between 15-40K per placement, so there are some similarities there. Now, I’m going to ramble a bit here about recruiting in the accounting/finance world to set it up, but stick with me, because I will end up with something very relevant to looking for a medical position.
To a recruiter, a truly great candidate is like gold. The question is, what makes a truly great candidate? In general, it’s someone who is fairly rare. Each recruiter and/or firm has a different rating system for candidates. We used a system called AIP, where we rated candidates 1-5 (1 being the highest) based 3 criteria. A is for appearance -- just how sharp does the candidate look? I is for intelligence – how does this person’s technical knowledge rate with the average candidates you see in this specialty? P is for personality – life of the party or dead fish? Lastly, and not represented by a letter in AIP, we gave a letter grade for the overall place-ability of the candidate. After an in depth interview, reference checks and, at times, some testing we rated each candidate if a candidate rated very high over all (usually at least an AIP of 222B) and there weren’t a lot of other candidates with similar skills/specialty and a high rating on the market, we would “MPC” them.
MPC stands for “Most Place-able Candidate.” We turned the term into a verb, when we would tell everyone we know in a given field about the profile (no names, of course) of this “rare” commodity. This is an active way to really market your best candidates and differentiate yourself from other recruiters in the eyes of the hiring authorities and the candidates.
MPC-ing is an activity that every 3rd party recruiter knows about, but surprisingly few practice and it’s fruitful in many ways. Obviously, first and foremost, your goal is to find the candidate a position, which, depending on the candidate and how in-demand his or her skill set is, really happens. For example, I worked in a city where manufacturing was king. So, when I would come across an outstanding Cost Accountant with a manufacturing background, I picked up my phone and called all of my closest connections who were CFOs/Controllers/Cost Acct Mgrs in manufacturing and told them all about this candidate. Next, I wrote up a concise summary of the candidates profile and emailed it to everyone else in the industry and sit back and wait. Now, with a cost accountant, I would be fairly likely get at least one response back wanting to set up an interview, and that interview would sometimes lead to an offer or employment for the candidate. However, Cost Accountants were extremely rare and even a truly outstanding candidate wouldn’t necessarily receive an offer via those efforts.
The vast majority of the responses I would receive were along the lines of “This is a great profile, but we are not currently recruiting for a cost accountant.” Other responses that were at least as likely as setting up an interview for the MPC candidate, but were also great news for a recruiter were: “We don’t need a Cost Accountant, but we are looking for a Payroll Manager (or whatever)” -- thus uncovering a possible new job lead for other candidates – or “We’re not recruiting for anything right now, but I’d like to see what other options might be out there for me.” – thus uncovering a possible new candidate and, if that candidate goes elsewhere a new job lead as well.
The bottom line with recruiting is there is a ton of activity involved with uncovering each job and each candidate, let alone putting them together to make a match. So, you use as many tools as you can and you’re constantly looking for both candidates to place and jobs to fill. MPCing is a wonderful tool to really put forth a marketing effort for a great candidate, but you’re also fishing for other jobs and candidates. If a recruiter’s only activity was MPCing candidates and that recruiter was only looking to place that candidate with that effort, said recruiter would go hungry. While it happens, you can’t live off of only MPC placements as a recruiter.
Which brings me to back to the topic of physician recruitment….
The Doctor Job is a web tool for physicians where, for a fee ($1.75 - $3.00 per address), you basically MPC yourself. They work on the premise that “physicians find jobs by being in the right place at the right time.” Essentially, their site assists you put together a Cover Letter/ CV package and send it out to their list (other physicians and hiring authorities) based on the location and type of position you’re looking for. You put out the bait and hope you’re lucky enough to be in that place at that time.
While it’s all speculation on my part, I assume their list is probably pretty good, as they’ve been in business for a few years and for that type of business, the list is the lifeblood. While you’re paying for a little more service than just purchasing a list through The Doctor Job, the price for their service starts at $1750-$3000 per 1000 addresses, which is an outlandish amount to pay for a medical list, especially one that you can only use once. On a side note: there are other lists you can find out there that you can find with a simple Google search that you can purchase yourself and use as much as you like, but the prices vary greatly and so does the accuracy.
The Doctor Job claims to “find more jobs for physicians than any other source in the world,” but looking at the results from their testimonial page, which I assume are among the most positive results they get (otherwise they wouldn’t be sold as testimonials), the results, in terms of responses per out going messages are not any better (some not even as good) as I received as a recruiter when MPCing a candidate, which the hiring authorities knew came with a heavy price tag.
Other claims they make are this:
“Using a recruiter could cost you as much as $20,000 in lower salary and reduced benefits! Even though they dominate job boards, physician recruiters are only useful in a few situations. The fees they charge can be as high as $25,000-$50,000 or more! This means that
(1) 90% of physician employers will never use a recruiter, and
(2) Since the fees are so high, many employers who use physician recruiters pay a below-market salary to physicians (to cover the costs of the recruiter's fees).”
Well, I suppose using a recruiter “could” cost you, but this assumes that you, as a candidate, have no say in the matter. Whether you’re represented by a recruiter or not, if a medical organization wants to hire you and makes an offer, it’s your right, if not duty, to negotiate the best salary you can. If you accept an offer that is less than market value for that position, that is your choice, not the fault of a recruiter or anyone else for that matter. If you stand your ground, you’re going to get the pay and benefits that you should, based on your specialty, location, experience, etc. Further, if you ARE using a recruiter, they can often help in this endeavor. Recruiters, the good ones at least, tend to be skilled negotiators. It’s just part of their world.
As for the 90% of physician employers that will never use a recruiter… I’d like to know where they are getting their numbers. Here at Physician Recruiter publication and TheRecruiter.com, we talk to thousands of medical hiring authorities each month and one of the questions we routinely ask is “Are you using a recruiter to hire for this position?” and our results are not even in the same ballpark. Further, while it was accounting and finance rather than medical, as a recruiter I found that most companies that didn’t fall into the “mom & pop” category would gladly pay my fee to hire the right candidate for an executive level position, because those are key hires. The positions they often won't pay fees for are the more clerical functions. Last I checked, physicians make executive level incomes and are more important to more people than a Controller or Sr Financial Analyst, etc, so I don’t see how there’s any real difference. If the candidate is worth a fee, the hiring authorities will pay it.
One important difference between the MPC process that I described and what The Doctor Job is the all important rating system. While we’d all like to think we’re a “Most Place-able” 111A type candidate, we just can’t be. As a recruiter, if I MPCed 333C candidates all day, I’d place very few and eventually my contacts would stop taking my calls and would send my emails to trash prior to opening them. For this concept to really work a high percentage of the time, you have to be truly outstanding as a candidate, if you’re not, your CV will get tossed into the pile with the other also-rans. Even if you are a good candidate, the premise also relies on follow –up. With The Doctor Job, that all falls on you.
As to their main claim….. If The Doctor Job truly “find more jobs for physicians than any other source in the world,” then it seems it’s likely a function of the number of physicians using The Doctor Job being larger than the number of physicians using any other single possible option out there. And I'd still question that.
I believe in the MPC and I can understand where The Doctor Job is coming from. It's a smart idea and can see some benefit in what they do (it must work fairly well or they wouldn't remain in business), but I’d be pretty wary of putting all of my eggs in the basket of an organization who claims you’ll find your next position if you’re in the right place at the right time. Whether you use The Doctor Job or choose to get a list from elsewhere and you have the time to MPC yourself and follow-up, by all means do it. But if you’re actively looking for a position, I suggest you use other avenues (job boards, recruiters) as well, otherwise, you might be waiting to catch lightening in a bottle while less worthwhile candidates are accepting the offers that you should be getting.
- WJ 8/13/07
Thursday, August 9, 2007
On "A Physician On.."
Last night, I discovered a blog that I have not seen before called “A Physician on Job Search and Practice: What I Wish I Had Known as a Resident”. This is a well written and active blog with a heavy emphasis on searching for practice opportunities as well as other general thoughts and advice about your career and managing a medical practice.
As the Physician recruiter blog grows, our readers will grow an understanding that I feel it’s important to represent and look at issues from multiple angles. One thing that I appreciate about the “A Physician On…” blog is that it’s written from the perspective of a physician who has been though job searches using various tools, including 3rd party recruiters as well as a hiring authority who has recruited physicians. While the goal of each “recruiting process” is to create a win-win, the truth of the matter is that the hiring authority and the candidates are, in many ways, on opposite sides and clearly have different motivations and biases. While win-win situations do occur, often one or both parties is settling in some way, be it money, duties, location, experience or whatever. Throw in a 3rd party recruiter and there are even more variables.
As someone who has been through the recruiting process multiple times as a candidate, someone who has hired a lot of candidates by my own efforts, using 3rd party recruiters and using job boards, someone who has worked as a 3rd party recruiter and, now, as someone involved with specialty recruiting publications and job boards, I feel “A Physician On..” does a fairly reasonable job of capturing the reality of job search/recruitment. That said, I feel 3rd party recruiters are greatly over-vilified, as only the most extreme and negative examples and perceptions of recruiters are represented there.
I was able to read the majority of the entries from the last few months and, while I found plenty that I disagree with to varying degrees, there was a lot that I think is right on. At it’s worst it is an extremely thought provoking read and, at it’s best, up to this point, it is the most worthwhile blog I’ve seen on the subject of physician recruitment. “A Physician On..” is a place that I will be visiting regularly and one that I would recommend to anyone, physician or recruiter, involved in the process.
-WJ 8/9/07
As the Physician recruiter blog grows, our readers will grow an understanding that I feel it’s important to represent and look at issues from multiple angles. One thing that I appreciate about the “A Physician On…” blog is that it’s written from the perspective of a physician who has been though job searches using various tools, including 3rd party recruiters as well as a hiring authority who has recruited physicians. While the goal of each “recruiting process” is to create a win-win, the truth of the matter is that the hiring authority and the candidates are, in many ways, on opposite sides and clearly have different motivations and biases. While win-win situations do occur, often one or both parties is settling in some way, be it money, duties, location, experience or whatever. Throw in a 3rd party recruiter and there are even more variables.
As someone who has been through the recruiting process multiple times as a candidate, someone who has hired a lot of candidates by my own efforts, using 3rd party recruiters and using job boards, someone who has worked as a 3rd party recruiter and, now, as someone involved with specialty recruiting publications and job boards, I feel “A Physician On..” does a fairly reasonable job of capturing the reality of job search/recruitment. That said, I feel 3rd party recruiters are greatly over-vilified, as only the most extreme and negative examples and perceptions of recruiters are represented there.
I was able to read the majority of the entries from the last few months and, while I found plenty that I disagree with to varying degrees, there was a lot that I think is right on. At it’s worst it is an extremely thought provoking read and, at it’s best, up to this point, it is the most worthwhile blog I’ve seen on the subject of physician recruitment. “A Physician On..” is a place that I will be visiting regularly and one that I would recommend to anyone, physician or recruiter, involved in the process.
-WJ 8/9/07
Thursday, August 2, 2007
Great stuff!
I was clicking around the web last night and stumbled upon a couple very interesting sites. The first is www.SoundPractice.net . This is a website dedicated to all things about practice management featuring a number of blogs and podcasts on many different subjects. If you're involved in running your practice, you should really take a gander.
The second was on WebMD @ http://www.webmd.com/community/blogs. They have a number of extremely interesting blogs broken down by subject matter from a number of medical conditions and specialties to clinical trials to ethics. It's some very interesting reading and they seem to be fairly active communities.
- WJ
The second was on WebMD @ http://www.webmd.com/community/blogs. They have a number of extremely interesting blogs broken down by subject matter from a number of medical conditions and specialties to clinical trials to ethics. It's some very interesting reading and they seem to be fairly active communities.
- WJ
Wednesday, August 1, 2007
Cool stuff happening on our website...
Well, we've got some great things going on with our website. You can now download PDFs of our print editions @ http://www.therecruiter.com/Employment/Archive.asp. Further, we'll be emailing each edition to our physician and medical professionals opt-in lists as we release them. If you'd like to be added to our lists, please email your request with your name, email address and specialty to info@therecruiter.com or register online @ www.TheRecruiter.com .
Speaking of registering at our website.... If you're looking for a new medical practice opportunity, you can let our site help you do the work by registering and posting your CV or Resume online. Our recruiting partners (those who are advertising in the publication and on the site) have access to those resumes and if they have a position that might be a fit for you, they'll be able to contact you, even if you've missed seeing the position on the site or if it's a new position that hasn't been posted, yet. In addition to having opportunities come to you, we at Physician Recruiter and TheRecruiter.com will be giving a $250 gas card away to one new registrant who posts their CV/Resume on our site every 60 days. That's a pretty good incentive, if we say so ourselves. Prices at the pump are outrageous and I heard this morning that oil closed at a record high yesterday, so there's no break coming....
Thanks for your time and keep your eyes peeled on this blog and www.TheRecruiter.com for more news and developments about our site and the world of medicine.
-WJ
Speaking of registering at our website.... If you're looking for a new medical practice opportunity, you can let our site help you do the work by registering and posting your CV or Resume online. Our recruiting partners (those who are advertising in the publication and on the site) have access to those resumes and if they have a position that might be a fit for you, they'll be able to contact you, even if you've missed seeing the position on the site or if it's a new position that hasn't been posted, yet. In addition to having opportunities come to you, we at Physician Recruiter and TheRecruiter.com will be giving a $250 gas card away to one new registrant who posts their CV/Resume on our site every 60 days. That's a pretty good incentive, if we say so ourselves. Prices at the pump are outrageous and I heard this morning that oil closed at a record high yesterday, so there's no break coming....
Thanks for your time and keep your eyes peeled on this blog and www.TheRecruiter.com for more news and developments about our site and the world of medicine.
-WJ
Subscribe to:
Posts (Atom)
