Recruitment & Retention Strategies

1. Recruitment & Retention Strategies Results from a Survey of Pennsylvania Clinicians Suzanne E. Rossel, CHCANYS, Senior Director of Health Center Support www.chcanys.org

2. The Project • Goal: Identify successful recruitment and retention practices • Approach relied upon two analyses methods • A literature identify evidenced-based best practices for recruitment and retention of clinicians • A survey of 41 Pennsylvania clinicians working in primary care settings. • PACHC conducted this project, funded in part, under a contract with the Pennsylvania Department of Health.

3. Focus Areas • Organizational Selection and Preparation • Preparation for Hire and First 180 Days • Organizational Supports and Resources that Contribute to Satisfaction • Clinician’s Motivation, Satisfaction and Long-Term Commitment

4. Interviewee Demographics

5. Organization Selection • 78% of respondents indicated that Ties to the Area was the reason they came to the organization. • Particularly relevant for Physicians Assistants, Nurse Practitioners (PAs & NPs) and Behavioral Health (BH) Professionals

6. Organization Selection • Overall, 65.9% indicated that they wanted to work for the organization, comparatively: • 80% of medical physicians identified this as a reason • 67% of BH professionals and 61% of PAs & NPs said they wanted to work for the organization Sought out the organization based on reputation and team culture. The passion and commitment of leadership was contagious. Heard about employee satisfaction and manageable productivity.

7. Organization Selection • 36.6% selected the organization because of the loan repayment program I was buried by debt, was glad to find the loan repayment program. • 24.4% indicated the mission brought them. I wanted to give back to my community. I wanted to make a difference.

8. Preparation for Hire: “On-Boarding” Activities • 90% of all respondents indicated that they received some on-boarding activities • 92% of physicians indicated that they had regular communications • 30% indicated limited “on-boarding” preparation

9. First Day/Week • Over 68% were introduced to staff, and 66% toured the facility. • 51% had some orientation, which usually involved HR related items. • 34% received training/shadowing • 56% of NPs and PAs had targeted training. • 30% saw patients on the 1st day • Primarily physicians • Some noted a lighter or shared schedule

10. Improving Satisfaction in 1st 180 Days • 44% of interviewees indicated they would have liked more support • Several highlighted that the workload in the 1st days/month was challenging • 34% felt more “check ins” would have increased their satisfaction. • 17.1% discussed leadership, particularly physicians, as an important consideration for satisfaction

11. Organizational Support & Resources that Contribute to Satisfaction • 93% of respondents identified staff support as contributing to their job satisfaction. • 41.5% felt they had good staff support • 41.5% felt they had limited/inadequate support • A majority of physicians noted the need for improved/increased staff support. The happiness of a provider really depends on who you are working with. This can really make or break your day!

12. Organizational Support & Resources that Contribute to Satisfaction • Aspects impacting good staff support: • Maximized use of clinical support, particularly medical assistants • Support staff need to be used to the fullness of their licensure • A lack of a career ladder makes retaining quality staff difficult • Cuts to staff challenges ability of providers to achieve volume targets.

13. Organizational Support & Resources that Contribute to Satisfaction • Technology (IT) was seen as an important resource: • 71% of respondents discussed technology support, with a focus on electronic health records (EHRs) • 49% indicated they had good IT support • 22% indicated that EHR/IT support was inadequate. • There was interconnectedness between staffing and IT.

14. Organizational Support & Resources that Contribute to Satisfaction • Clinicians who felt they had good IT support noted: • Shift to EHRs was difficult but well supported • Received good IT orientation and support • Clinicians who did not feel they had good IT support: • IT understaffed to cover multiple sites • IT is always in transition • EHR is not maximized.

15. Organizational Support & Resources that Contribute to Satisfaction • Continuing Education (CE), support was available to most interviewees. • Some indicated that it was challenging getting to trainings because of work loads. • Leadership, Creativity, Innovation and Initiative • Over 50% of the respondents indicated they were given opportunities in this area. • Nearly 50% of all providers were unsure or felt that these types of opportunities were not available.

16. Organizational Support & Resources that Contribute to Satisfaction • Linking with peers. • 61% of interviewees did not know about opportunities or did not feel supported to link with peers. • Nearly 40% felt opportunities were available: • Working in the community • Speaking at conferences, going to meetings, etc. • Other resource supports were noted by a small number of respondents.

17. Connection with the Organization • Serving the patients was a primary motivator: • 85% of the clinicians identified working with the patient population as a significant consideration. • The patient-motivation was consistent across provider types interviewed. • Co-workers were seen as important for 60% of the interviewees, several mentioned: • Building a team culture • Working with technically competent staff • A sense of community, almost family.

18. Connection with the Organization • 41% of medical physicians and 57% of dentists prioritized their attainment of professional goals. • Comparatively, 39% of NPs and PAs and 33% BH professionals identified achieving their professional goals as important. • 27% of respondents identified their salary or loan repayment as a motivation.

19. Plans to Stay with the Organization • 59% said they planned to stay with the organization, • 24% said they were unsure, and • 17% said they did not plan to stay.

20. Plans to Stay with the Organization • Among interviewees planning to stay with the organization • 45% identified organizational commitment and support an important consideration • 41% identified job satisfaction as a primary factor influencing the decision to stay • 80% of medical physicians identified job satisfaction as a retention consideration.

21. Plans to Stay with the Organization • Among those who were unsure or did not plan to stay, the most frequently identified reasons: • 29% identified family considerations • 29% identified career/work • 17% identified financial/loan repayment. • The reasons clinicians said they would leave often related to management of the organization: • Concerns about the stability of the organization • Commitment to staff and high quality of care

22. Interview Results & the Literature Review • Organization Selection: • Both the literature and interview results highlighted the value of opportunities to receive training and/or previous experience with the setting/organization. • Rural considerations and community • The literature highlighted the importance of exposure to rural settings for long-term retention. • The interviews results emphasized community and family ties to the area.

23. Interview Results & the Literature Review • Organization Selection: • Transparency about job responsibilities was noted in the literature but was not specifically mirrored in the interviews • Organizational reputation was noted by interviewees • Organization being a good place to work was important • As was the mission.

24. Interview Results & the Literature Review • On-Boarding and 1st 6 months: • The literature emphasized: • Nurturing the relationship between clinicians and their colleagues • Allowing the clinician time to “ramp up” • These findings were echoed by the interviewees who identified the value of: • Shadowing/mentoring with other clinicians • Regular “check-ins” to assess integration

25. Organizational Resources & Support • The interviews highlighted recruitment and retention considerations that have impacted the clinician’s workload and need for support: • Care integration, meaningful use, data collection and reporting requirements • Pressure to become patient centered medical homes • Implementation of EHRs.

26. Organizational Resources & Support • The literature identified professional satisfaction in terms of opportunities for autonomy, especially in rural locations. • Comparatively, the interviews identified the opportunity for leadership, creativity, innovation and initiative. • This may be an area for further assessment

27. Organizational Resources & Support • Continuing Education Resources: • The literature identified CE as part of the benefit package/financial incentive that were important. • Most interviewees indicated that CE resources were made available to them, almost a “given.” • Other educational opportunities were limited

28. Organizational Resources & Support • Work with the Community and Peers: • Community involvement was noted as important in the literature. • Some interviewees noted the importance of community work and peers, but many were unaware of opportunities.

29. Provider Satisfaction • Service to the population, patients and mission were important considerations for professional satisfaction in the literature and interviews • Differences noted in the interviews: • Physicians noted the importance of realizing their work/career goals in terms of the type of patients, community, and/or system of care. • Comparatively, non-physician providers often mentioned the importance or relationships with colleagues as critical to their job satisfaction. • Quality of care was noted as an important factor.

30. Provider Satisfaction • Relationship with colleagues was underscored in the literature and interviews: • The literature identified “Poor” relationships with colleagues was identified as a factor for a provider to leave • Comparatively, many interviewees extolled their collegial relationships—in many instances this was a reason given for staying.

31. Provider Satisfaction • The relationship with administration/ management was noted by interviewees positively and negatively: • Management relationships were described as positive when clinicians felt their professional skills were valued, their opinions sought, and their personal/family life needs considered. • The interview results indicated a greater emphasis on this relationship than the literature review would indicate as a retention factor.

32. Provider Satisfaction • Salary and loan repayment considerations were identified by a limited number of interviewees as the most important consideration for retention: • In some cases when salary and or the loan repayment were seen as inadequate, the interviewees describe dissatisfaction with other aspects of their experience with the organization.

33. Conclusions • The literature and interviews highlight approaches to strengthen recruitment and retention activities. • Potential areas for further exploration: • Differences by provider types • Implications of health care transformations • Quality of care and the impact on professional satisfaction.

34. Conclusions • The interviews underscore recruitment and retention considerations: • Differences by provider types may be important • Health care transformation. • As part of this ensuring adequate, trained support staff is a core consideration. • The link between clinicians’ professional goals and the delivery of high quality care.