Heroes of Healthcare
Heroes of Healthcare

Episode · 1 month ago

Shift your Paradigm to achieve Physician Retention w/ Tammy Hager

ABOUT THIS EPISODE

Physician retention is quickly becoming the newest facet to join the crisis of healthcare in America.

From doctors choosing a career path at a young age only to find out it wasn’t the right path for them to physician burnout all across the nation in the aftermath of covid, turnover among physicians and medical staff is a growing problem.

Enter Tammy Hager, Executive Director of Physician Recruitment and Privileging at Surgical Affiliates Management Group, Inc., whose organization boasts a 96% retention rate - well above the national average. How do they do it? Is it inflated salaries, cushy retirement packages, or state of the art data collection? Turns out, the real answer might be in relationships and in listening to medicinal professionals about what they want.

Join us as we discuss:

  • What questions to ask medical staff to keep them on board
  • Finding balance in work/life 
  • How the big organizations are following suit 

To hear this interview and more like it, follow Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

Listening on a desktop & can’t see the links? Just search for Heroes of Healthcare in your favorite podcast player.

We are a surgical medical group, that we work life balance and we talked about what is work life balance for each of these positions individually, because it does mean something different for everyone, elm that we talked with. So it's about that personal relationship. And how do you understand why each of these physicians want? You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to the AROO's healthcare podcast. I'm your host, Ted Wayne. Joining me today is Tammy Hagar. Tammy recently joined the surgical affiliates management group, otherwise known called as Sam Gi, based in Sacramento California, as the executive director of physician recruitment and privileging. Growing up in West Virginia, Tammy saw firsthand how Ural communities often struggle to get the right medical attention. Since then, and now for almost thirty years, Tammy has been helping the medical communities by getting the right physician talent where it's needed the most. While most recently she served as the executive director of physician recruitment solutions for the medical marketing services and prior to that she was executive director over HR and talent selection for Mercy Health and St Louis Missouri. Tammy has worked with a variety of multi specialty physician practices, hospital based clinics and health systems and has successful track record in practice operations and physician recruitment. Tammy earned her bachelor's degree and MBA from Liberty University with an emphasis and healthcare management. Additionally, she is both a fellow with the Association for advancing physician and provider recruitment, a a PPR, and a fellow with the Advisory Board Company and a certified medical staff recruiter by the American Academy of Medical Management. Without further ado, I'd like to welcome to Tammy Hagar, to the heroes of healthcare. Welcome, welcome to the heroes of healthcare, Tammy Hagar. Hey there, kid, how are you? I'm great. Thank you for joining us today. Um. You know it's a it's a great topic for us. Um. We've talked about it sometimes in the past, but I think getting into today, talking a little bit more around physician, physician Um, little I want to say probably not so much about physician burnout per se. But what are physicians wanting right, which I think is a great different way for us to look at it versus just the burnout and how do we prevent burnout? But what are they really looking for? As you with your firm, are in heavy recruitment mode, like a lot of the healthcare industry, so heavy competition you've got going there Um. And so we'll, we'll, we'll start to look at that a little bit and I think we're gonna get a little insight today into the mind of a physician and what are they looking for. But before we jump in, do you mind tell the listeners a little bit more about how you got into Um, why you're passionate about working within healthcare and and uh, we touched on your bio before we jumped in, but tell them a little bit more about about Timmy. Sure, it's kind of funny, I don't think. I don't think people plan a lot of times what they're going to do when they grow up. I always knew that I wanted to do something that was going to be in healthcare and I kind of my husband was at a pastorn church in Arizona and I kind of fell into working for a family practice group out there and started learning every role in a in a practice and it started becoming a lot, a lot of fun to me. And then, as the years went by and started growing and not only did I work in family practice, all the different types of specialties. I was blessed enough when I moved back to Virginia to be a part of practices that sold to Korelian health system back then and I fell into a managed a role where I ended up running all of the practices for a Korean health system Um for a good number of years Um, and I think it helped that I actually knew what practices did from the inside out, so I understood how to work with positions, how to work with the nurses and all of that. Becoming a leader over that was I think it was tremendous. I had some of the best mentors Um ever. But that's really then how I got into recruitment, because when I was at Karelian we decided to partner with Virginia Tech to do a new medical school, which is now the Virginia Tech Karela Medical School, and we moved in to a clinic model and Um, I had recruiters that worked for me that I personally didn't know how we need to go about changing how we did recruitment. So I went to Cleveland Clinic, had friends there, spent some time with them and really learned people, processes of technology, brought it back and started the first in house recruitment department that Karelan Clinic had. Um kind of amazing and my my career to started growing...

...from there. My Passion, I think, really comes from growing up in West Virginia. Um My daddy was a CO owner. We didn't have the health care that we needed where I grew up and in the area that I lived and I always was really passionate about how do we serve the communities. Um, so running the clinics and then really looking at how we bring positions into some of those communities in a regional system like Karelian in Virginia. I don't know, it just kind of fueled my my passion Um and I've constantly thought about, no matter of what the organization I work with, how do we affect the communities that we serve? And I think if we all keep that in mind that's what makes us all successful and that's the passion behind why all of us should be doing what we're doing. Yeah, I mean it's it does. I mean so much aligns with us here at Jackson Coker, because that's that's really our purpose. We look at how many patients served each year because we know we're providing providers into places where there wouldn't be a provider if we weren't able to help them, help that rural community, that underserved community, have those resources. So yeah, I mean when you have that feeling behind it, and even our president, uh Tim Fisher, talks about you know, it's personal to him. He's had a situation where he lost a loved one because there wasn't enough. That what the right health care in a rural area. So Um, it does become very personal for people who have that, who have that experience or that background. So Um, I I understand why you're excited about doing doing what you do. Um. So let's talk about a little bit about so Um. What tell folks a little bit about Sam Ge? You guys are a little bit different in terms of, Um, your traditional hospital facility. Um. So why don't you talk a little what makes you guys a little bit different and then we'll tie that into you know, how you're recruiting and and and and what are your what? What are you able to pull from some of this doctor market that's so tight? Sure, sure, so. Um Surgical affiliates management group, Sangy. We are a surgical hospital group and we've been in practice for about twenty five years. And you know, I've worked in two major health care systems and I've worked in private practices. And the true difference, I think that when this when this practice was started, um the the original CEO of Leon, he wanted to figure out how does he make life better for the physicians who worked for the company, but how does he also make life better for the hospitals that needed the care and could not find the physicians to actually cover the services that need to be covered by the surgical specialties? So I think what makes us different hospitals partner with Usman and run their trauma surgery, their neurosurgery programs, the orthopedic programs, urology programs, and a lot of what we care for are the emergency patients that come through the e d, some of the consults that we treat in the day that the physicians see Um that no one may be there to be able to treat because a lot of times the physicians that are local they don't take the call they used to take and they there's gaps in the patient care model. So that's kind of how we were born Um as a company, to come out and really treat um the hospitals well and just be there to serve them when the patients needed to be seen Um. A lot of it's a really different model. In thinking about that, it's how much does a physician need to work um to be able to support his family, to be able to have a family life and to be able to have a life outside of medicine? And when you're doing trauma and these surgery procedures constantly, they there's a lot of burnout that's involved. So we've early on developed a model where physicians work so many shifts per month to be full time with US um. If it's general surgery, it's usually twelve to fourteen um if it's Um trauma, usually it's tend to twelve, like orthopedics, just depending on the model that we're in with the hospitals. But that then allows the physicians to be full time with benefits with us and they can actually do other things they can work another job, they can be in the military and serve in the military, they can do mission work if they want to. So they can actually have life outside of their job with us and we encourage that. Um. This has been our model from the beginning, but I think just over the past few years it's really started. I'm catching on with physicians because they've realized they want to do they want to do things differently. Um. It's not the way their dad practice medicine. They want a lifestyle so that they can provide for their families but also be able to be there with their families and go to their their kids plays and be able to take vacations with them. And I can tell you I've worked in practices where they weren't able to do that. The Dad was always gone or the mom that was the physician was always gone. I'm proud to work for a company you like this, because we always preached in the different organizations...

...where physician lead, Um, where physicians centric, but truly keeping in mind what physicians want. Um. It's not necessarily always about to pay. Um. What can we do differently to have them be able to have a life outside and practicing and then when they are practicing, we're there to support them. Um, they are they are truly to take care of the patients we have. We hire trauma medical directors that are on board Um to really be the interface with the hospitals so they don't have to worry about the day to day business of learning their their programs. Um. They can truly think about what's the best patient care. You know, what are the protocols that you put in place for the different procedures so that you know we have great outcomes, and the hospitals appreciate that because when you look at the outcomes, that is really important for them when they're looking at the dimbursements Um and you know the type of patients they begin to attract their facilities their care ratings. Yeah, that's great. Well, and it sounds like the model was probably a little ahead of its time, but I would say you're timing now, with everything that's going on, is probably pretty perfect, because you have this uh pent up demand of surgical needs that were postponed during covid so I've heard some statistics that some of the surgical units say they can start to go to three shifts just to keep up with the backlog. Right. So you know, it's not the we'll get them in early and we'll get them out and, you know, be done to the day. It's they have such a backlog that they could run through. They could run twenty four or seven, uh. So we know that the demand is there, but, you know, and then we have this whole dynamic that we're gonna talk about today, which is the physicians changing what they'll accept and changing how they want to work, uh, and how they and how can they work? So it sounds like the SAM g model might be, might might be, might be right at the right time. Um, the you know, you know, one of the things we keep hearing in the market, obviously, is physicians enter into a practice like where you were when you first, you know, started out, and they like that. It's smaller, it's more that cottage feel. It's not at home, but it's you know, it was kind of close to that. And incomes the big system, Um, and they acquire uh, these practices and it comes becomes more of the Um, takes the some of the personal aspects out and brings the more corporate expectations in and the physicians don't like they don't they feel that they don't have the opportunity to provide the same level of care because it starts to become a numbers game, number of people seeing dollars, build, all of that sort of thing, and they are really looking for opportunities to to do that. So, as you are outreved on that side of it, and I've actually written physician contracts based on that, you know have the R vues you need to produce to be able to generate the salary you want to generate, and I think that's one thing I loved. It's different about us because we don't base it on production. We look at compensation. What is what is really competitive for the regions they're in by specialty and they're just paid a salary. We don't we don't count how many patients they see. We want to make sure they take care of all of the patients that are there Um and take care of them well, and the only way to do that is not to have them count how many they're seeing. Um. It's made a huge difference. Well, you know, so let's let's let's stop there for a second because you know obviously your experience with Karelian and some other big systems. Talk Talk to us a little bit about explain what that was like. You know, where did those who implemented those things? I mean I'm not trying to say you know, Oh, there's the bad guy, but what kind of you know what brought that about and then how did you you know, how did you when you had to sell all that? How did you sell that? Right when you were talking to a physician to come on board and you said okay, and here are your expectations, how did they receive that? Yeah, I think it really depended on the physician you were talking with. You had to get to understand what were they looking for? Um, because if you have a physician that wants to be in private practice, he is not going to be able to work within the health care system constraints Um. A lot of the private practice folks were even crazier with how they produced Um based on what specialty they were in. Um. So what enticing them to come to a place like killion or even mercy based out of St Louis, of all hospitals that we've provided there? It was more of understanding. They really didn't want to be in a private practice. They wanted to be a part of a bigger system. Based on where they wanted to live and their location, which kind of sometimes limited them because if they wanted to be in a specific location, that may be the only place they could work health care system. So it was really getting to know what the physician wanted, and that's actually what we do...

...here when we do our recruitment marketing. We actually we actually do this based on reaching out to physicians who they don't necessarily want to work for a large health care system. They want they don't necessarily want to work for a private practice anymore. We are a surgical medical group that we work life balance and we talked about what is work life balance for each of these physitions individually, because it does mean something different for everyone of them that we talked with. So it's about that personal relationship and how do you understand what each of these physicians want? Yeah, that's great. We talked about that a little before and I want to touch on that. But I want to I want to back up a little bit because show and again I'm not trying to bash the big healthcare systems, but what is the attraction then? You know, what is the benefit for a physician today to say hey, I'm going to go work for a big you know, whether it be a providence or or a tenant or something, a big system. UH, is it? Is it the is it the pay or what are their aspects that makes them and I know everybody's different, so I'm not trying to paint everybody with the same brush. But you know what, what makes the big system attractive to a physician, especially when the first coming out, and I used to go in and kind of teach residents how to look for jobs. Um, I think one of the things is they can go in and join a group and it can be a very large group in their specialty and they have someone that can ment toward them the first, you know, one to five years so that they can truly understand to see medicine as about, and if they join a good group, whether it's at a large city practice, it's really good for them to do that. We all know there's different stages in their lives. As a physician ours it's a little different. In for running these surgery programs, we have to have folks that already have some experience. The only time we hire any new grads is when we have programs that are of the one center that we're running where we can have more than one surgeon on that a time to be able to take care of the patients and that you have that built in or yeah, you have that built in oversight exactly, and I think that's attractive to the younger guys coming out because, whether they want to admit it or not, they do need mentoring and being able to understand, you know, clinically, what to do and even perfect because I've had great physician leaders in these organizations that have taken younger physicians under their wings and then they brown them into two great physicians and then grow them into great leaders so that they can actually step up and lead in the health care system. So a lot of times, if these guys are coming out and they're wanting to not just practice medicine, but look, how do I grow my career a part of a health system a little bit more attractive to them. Unless you've come into a practice like you can grow into a medical director role and there's leadership roles that we have um that we actually are mentoring people for as we speak in our organization Um. But it's a little different than the large healthcare systems where they have a lot more physicians that can actually take part in that right. So I get and I guess the equivalent for for me on from a business perspective and not coming, you know, you know, not coming into healthcare until a little bit later in my career, but it's probably like a recent college graduate or so coming out and saying I'M gonna go work for IBM, where I'm gonna go work for procter and gamble, or I'm gonna go work at one of the big consulting firms, earnest store or something like that, because I get exposed to a lot and it provides me with the depth and breath of experience that I can then make me more marketable or, you know, in three to five years. Yeah, and it's interesting too, because people come out and they think they're going to take these roles, that it's going to really change how they look at what they're doing. A lot of times they figure out what they don't like. Yeah, I kind of Look Patrick Lynciana, is one of my favorite people Um and I kind of look at some of the things he's talked about for the years and I remember he said when he first came out of out of his out of graduate school, he went to work for a consulting firm and for two years he was miserable, but he was doing what he thought he should do to be able to become a consultant and help health care organizations. But he wasn't loving the work he was doing, the day to day hands on hands in your numbers, and that's not the way he fought and I think positions are the same way. I think they go into medicine because most of them really want to take care of patients. Um when they come out it's like it's not exactly the way I thought it was going to be. So that's why, you know, I was talking with him there. There are different stages in your career. So you come out, you kind of figure out, okay, this is what it's gonna be like the first, you know, three to five years, and then, by the way, as I'm having a family and figuring it, where do we want to be as a as a family? That's gonna Change how you want to practice as well. And then later in your career you're thinking about m you know, my kids are going off...

...to college and I'm beginning to be an empty nester. How do we want to deal with that? And then you sure, you know a retirement physician or close to retirement, that you don't want to give it up? How can you practice differently there too? And I think that's, you know, something that we offer from the beginning to the end, um that maybe some companies can't offer just because of the way that we work differently with each of the hospitals that we serve. Right. Well, I hear sometimes people say cradle to grave and I don't like that expression so much, so I say resident to retire. I love that. So yeah, well, and and yeah, and we'll dive into but I think, you know, you're right about the experience and it and and it does sometimes prove that it shows you as much what you don't want to do as you do want to do. I've got a friend whose son was his third year residency and surgery and he woke up one morning and said I don't want to do surgery. And you know, obviously the parents were very excited about that, but he decided to press the reset button and he wants to go into anesthesia. So he had to start, you know, he had to start all over again. So uh, but, you know, but doing it, you know, maybe they wished he had figured that out after year one. But you know it's true. You know that you know it's like. It is like getting out of college. You think you know what you want to do, but until you actually get your hands dirty and you get into it, you don't know what it's like. You know, and I specifically can think of a family practice position that I worked with back in Virginia. Love Him, just one of my favorite doctors, but interestingly enough, he lived in the family medicine because he really thought that's what he wanted to do and he came out practicing. In his first ten years he was miserable and then he thought well, I'll join a large health care system and see if I'll if I'm better at that. And I actually helped him um sell his practice to Karelian. That's how I became an employee of Karelian. I was one of these forties six practices that was purchased that I helped his help get his practice ready to sell and was a part of negotiating that sale. And when we saw he thought this is gonna be it, I'm really going to enjoy this. He was still just as miserable and I just don't think that was his calling. He's still doing it, but he was just kind of stuck and yeah, it's kind it's sad because he really wasn't. But I could always tell that there was just something missing and a little bit of unhappiness there, that he was never quite satisfied doing what he was doing. He would rather actually be out digging in planting trees, and that's when he was the happiest. So, you know, I think about that from time to time when I'm talking with these young guys and you know, they think this is what I'm going to do the rest of the life and I'm thinking, we'll see, right, we'll see, we'll see. Yeah, yeah, well, and I think it also makes you realize, when you do find what you really love to do, when you're passionate about, what a gift that is, right, you know, and I talked to some of the people on the show and I asked them, you know, when did you know you wanted to be in into in medicine, especially the physicians, and they say, excuse me, at a very young age I realized I wanted to be a doctor. I'm sitting there saying I I got I walked out of college and I said I have no idea what I wanted to do, you know, and these these people, at young ages, knew what they want to do and saw it through and are having a great career. So, yeah, that is a gift when you have that, when you have that. Yeah. So let's go back and talk a little bit about Um, what are so again, like we said in the beginning of the show, we talked about so much. Now is a hot topic. Two things. Physician burnout post Covid, during covid and secondly, physicians shortage. So we talked, we obviously we talked about that a lot. But let's talk about that from a different perspective, which is what are you hearing as you and your team are interviewing and trying to Um, uh, scrape and scratch, as we all are trying to find the physicians and make the right fit. What are you hearing from them? What do they want? Are they looking for, and how are you and your team approaching that? Yeah, it's it's interesting because most of the physicians we talked with, when they're when they're looking at we give them just enough in our job ads to have them want to call and ask us some questions so rather than us kind of dumping everything on them about Sam g, we just let them open up and some of the first questions I asked is, you know, I really you know, I really appreciate you calling and asking about this position. Tell me what it is you're looking for and actually have them start that conversation because you know they can talk about what they're doing now. But obviously there's something that piqued their interest in calling us. Um and we know physicians. A lot of times they look for jobs based on location. Um Compensations one of them. We don't even advertise our compensation, so we're not even having that compensation discussion until much later. So we figured if we at least get them interested in the location, then we can talk about what is that they're wanting to do. When we talk with...

...them, first of all they think we're a lolcum's company and we have to let them know no, we're not a LOLCOM's company. When we talk about you work in so many weeks per month. That really is to be able to get the qualify for the benefits that we offer. It's amazing, I think, the benefits when they find out that we offer we're not a large company yet um like a health care system, but our benefits are as good as the mercies and the Koreans that I worked for. We pay for those benefits for the employees. But when we start talking about that, it kind of piques their interest and then we start talking about what do they want to do? Tell me about how you care for patients and you know if you can do anything to care for patients and where you would want to be. How would you do that? And when they start describing it, then we can kind of let them know, well, this is what we do with this hospital, and we get into some of those details and it really does Pique their interests. They they find out who they're going to get to work with, who their colleagues will be, how they work as a team and they're not just thrown in there as the sole provider Um, how they actually we have what we call a culture of yes. We try not to ever say no to a patient, to our colleagues, to our hospitals, unless we have to. Our culture of yes means we're going to figure out how to get this done for the patients and do it in a way where they know that we care. When I'm talking to a lot of the physicians. That starts coming across immediately because you can tell which physicians a don't have now practice issues and they may be may have been in practice for twenty five years. That they talk about how much they care about the patient, the time they spend and talk to the patients, and that's what comes out in our interviews, is that caring side, and that's what we describe as our culture. How do we all care about each other and our patients? So when people talk about culture, I think, you know, they just want to they want to use that as a buzzword and we're not sure that it really is about. How does everybody care about each other? How do we treat each other to the point where we don't even have noncompetes in our contracts because we don't need to. They only need to work a few shifts a month to be full time. They can work more than that and make more money too, but we don't hold them to that. They can do what they want to do and I think that comes through with every conversation and it's different for each physician. So part of our job is to listen and that's the biggest thing that we do. Yeah, we we, we mentioned, I mentioned before. But you know, sometimes, I'm sure you're hearing, I want work life balance because I feel a little burnt out, I'm tired of the big system like we've talked about. And so how do you, how do you and your team define that? Right, because we said, I said earlier, right. Sometimes, you know, we hear it's a buzzword. I want work life balance. But when you press somebody and say we'll define that, what does that look like to me? They go work life balance. You know, they don't necessarily they haven't gone through the steps of what does that really mean? And we do to get them to explain. What does that mean to you? Well, I just don't want to work as many hours. So what would you do if you didn't work that many hours? Do you have a hobby? Do you have a family? Do you do mission work? What do? What would you do with those hours? And it really gets them to thinking about what would I actually do? Um and the interesting thing is, you know, many of our positions they move to the locations that there's. Some of our locate at some of the positions that we have. They can live where they are and we actually let them travel to those locations. So if someone needs to take time and take care of their aging parents, that's something that has come up with several of the folks the positions we've talked to recently because there's no one else to take care of them. And when they realize I'm actually they have time to do this, it's amazing the relationship it that we end up developing with them. The other pieces when we have these conversations, even if they decide it may not be the right time for them, a lot of times they refer as physitions. So you know you've done your job you get referrals. Um It last year and it's really amazing. Number two of ourspireds from referrals. So yeah, yeah, and I know Boston used to say the highest compliment anybody can give you as a referral. Because you know, I have my cell phone that I've had from Virginia since nineteen. I will hopefully, hopefully, hopefully, a new model. Yeah, it's a new model. Same. They know they can text or call me. I get phone calls from physicians that I've known for twenty five years and if they have a question I'll help them with it. They know that we're a resource for them. So it's kind of funny. That's how I think recruit the teams should be. What...

I also love is when we passed them off after they talk with us as a recruitment team, they always talked to either a chief medical officer, a regional medical directors or even our CEO, who was a physician. She's a trauma surgeon, and they still get the same story. It's not like we're all making this up. And well, I was just saying how they care from a physician perspective versus us as administrative people. Right, yeah, you know, I was going to ask you about that. So that's good. That's good that you talked that you brought that up. Is You know, it's kind of one of those things when if I'm interviewing and I say so, tell me, you know, what's the what's the culture like? I don't expect somebody say this is the worst culture you'll ever work and nobody's going to think that. You know, they're gonna say, oh, it's fantastic, it's fabulous. You know, sort of a thing and so so, since you probably have a level of skepticism, right, you know, when you're told, well, our culture is different. Is it just to saying the flexibility that you got just have that proves that, or how do you guys continue to reinforce the fact that this isn't just talk, this is actually our reality? Yeah, I think through with Um our physician leaders, because even though our CEO, chief medical officer and these regional medical directors that are overall of our programs, they're all still practicing. So they go in and they also do shifts, so they understand the day to day practicing and what it's like and when we talk them from some of the craziness that can go on Um in a hospital or with administration, they do that. So our physicians, if they have any they can go directly to either a medical director or chief medical officer or even Dr Share, our CEO, and kind of talk through that and say this is what's going on and they're immediately supported, whereas, I mean I've I've worked in healthcare, physicians can go and complain and not not get any results, and that's when you start notice some people they start getting a little unhappy and a little sunder and us who watched the job boards all the time starts seeing the pop out on the job boards looking for jobs. So I watched that and I can tell you since I've been here, and it's been about a year and a half, I watched for things like I've not seen any of our physicians out looking for jobs, and we can see that based on the databasis that we use and all of that. But they feel not just the flexibility but that they really haven't had in some of the past positions that they yeah, well, when you look at the data on physician burnout, lack of support is one of the bigger is one of the bigger things, and whether that's administrative support, nursing support, clinical support exactly. Uh, you know, that adds to that frustration because the additional hours that the providers having to do sometimes, as as we talked about, if not practicing medicine. It's uh, it's it's what they what one doctor said to me, it's silly work. You know, it's important and it's got to get done, but it's it's not what they should he or she should be doing, Um, in terms of being able to provide the level of care that that you mentioned, that they want to be doing and all that. So when you're bringing in your own recruiters your team. What what is the SAM G approach? What is the recipe? What's the formula? How do you I'm sure you get great recruiters who might have habits or practices that they've done recruiting physicians that are not the Sam g way or things like that. What's kind of your departmental Um Culture? To use this say, keep that word or and or, you know, Um secret sauce a little bit of what what you guys do and how you approach the market. So I think I'm blessed and the folks on my recruitment team have worked for me at two other health care systems and locations. So you've got that trust and you know that processes is one of the biggest things and being able to keep those processes every day. So it's trusting the following those processes. But I also think they understand. I feel like we have a mission here as an organization to really understand what physicians want and that's how we approached them with whether it's getting them to respond to a job or we're reaching out to them and even cold calling, because we do, we still do cold calling as a part of what we do, but in doing that really showing what our mission is and we all have lived this front. There's even in other organizations. So really I think that kind of the way we've always been anyway because again, all of our my goal has always been how do we take care of the patients and our communities? And my recruiters think about it the...

...exact same way. And while we're all remote now, it's not just the communities we live in nowcations that we've served previously, but now we think about, you know, the communities that were serving in Idaho or South Dakota and really digging in and understanding what those communities are about so that we can share information with the physicians based on what they need to know about, you know, why they would want those positions. We're also reaching out to physicians who they live in similar type area. So if they've been working in a particular location, they would probably fit well in this other location and especially if we understand if they have ties to those areas, so if they're within so many miles afore their spouse grew up, where their parents are, we actually look differently up growing things out and trying to grab any physician. We're pretty intentional on the physicians that we're choosing to be a part of our organization. Um, and I know that's different because a lot of people they think it's about quantity. We really think it's about quality, because then when we bring these folks on, both I want to bring people like them with them. So again, the relationship aspect. I think that makes it different. Yeah, Um, what are you? What are you seeing in the market? How are the bigger systems? Are they? Are they are they stuck in their Rut and they're just doing the same thing, or are they starting to have to pivot? Are they starting to have to change their narrative, or are and and is it Um, just change of a narrative, or they operationally having to go through some pretty major changes in order to not lose their talent to organizations like Sam g and others who are just saying, Hey, we just have to be different. Well, it's funny because I I am I'm a member of a P P R, the recruit organization, and it was blessed to run a few of the round table. I'm at the meeting enough serve on the board there and I was able to talk with some of the really bigger leaders in the Cleveland Clinics, the Bank of clinics. We sat together and just kind of talked about just what it's like now and while they used to not have a lot of trouble recruiting, they are now because it used to be their names that would really get physicians to want to be there, but they've realized it's not just about having a name. They've got to really figure out how they pivot and do it differently. So a lot of them are really using data behind it, which I'm a big believer in data, which is why we collect data on all the physicians where we where did they come from? You know everything that you would need to know about physicians. We really collect that data here and I've always done that and these organizations are doing that now so that they can understand the types of physicians that they need to have their recruiters target. So it's becoming way more targeted. They want to automate a lot of things, which automation is great, but there still is a human element that we have to keep in this, to keep the relationships, and that's something that I really do stress, because it's all about the relationships. So well, I think that's why recruitment as a whole industry, not just in physician but everywhere, has not gone the expedia or the travelocity route where it's fully online. That you know a lot of companies continue to try to do that. Say you don't need a recruiter. Just, you know, go put put the person in the shopping cart and check out. But it isn't. It's not that because we're not buying a UH, an inanimate object, a pen or a pencil. We're actually trying to pull in a relationship and somebody who doesn't just technically have the skills, the medical background, the technical skills, the ability, but culturally fits Um. You know, we've had lots of brilliant doctors who sometimes we call the brilliant jerk because they don't have the bedside manner right. So you're just like, man, if you could just get that part of it. But that's because I'm an important part of that and and I don't need I don't need money actually talk about that bedside manner. I mean we have this conversations so and I think you have to. You have to. It's part of the job. It is one thing that I've always preached is, as we think about recruitment. It's how do we retain because it's so expensive to have to keep replacing. Physicians are very expensive to replace. So as we go through this we do think about why do we want to reach out to these physicians that have ties to these areas? It's we want to retain them. We don't want to turnover. Our turnnomber rate is Um not our turn okay, good, yeah, attention rate. Yes, we have turnover rate. That's unbelievable. Right. That's huge and I can tell you at other organizations that I've worked at, one that I you know, was that not that long ago? We were like huge, it's not sustainable, and talk about money out...

...the door. Exactly exactly. I love less of the fact that some of the physicians from those organizations are to the organizations now and they've reached out to us to help them with some of their surgery programs and relationships I had with those physicians that are now running medical groups and some of the larger systems. It's nice that I've had that relationship because they'll reach out and I'll tell me what it is you'll do and I tell them we need you to come and do our urology program and our vascular program and again, it's about those relationships and they know that you're not going to steer them wrong. Um. And when you introduce them to our physician leaders, it's like this, it's what this magic little fit, Um, and that's fun for me. So I think that's something that I'm passionate about. And people always talk about my energy and all this, but if I really do get fired up about how all of this works and how it can work so well, Um, if we all just kind of do what we need to do to make it happen. Yeah, for sure. We used. We we used to say right, you know today's candidates, tomorrow's client right. So you always wanted to treat them good because you didn't know where they would land or where they would get promoted to. You know, candidate you placed last year now as a CMO at a location. So and and you said, and and they they have needs, so you can you can service them. So you know you're right. And and there are certain Um recruitment practices that we have. And it sounds like you guys have just said that just doesn't make sense. Let's let's flip that upside down and let's take this sort of approach, be a little contrarian and, uh, wow, all of a sudden, look, it's it's magical. Um. So, yeah, so I love that that you guys are are are are pushing that in that vein and in that, uh, that manner. Um. So just kind of as we we are kind of coming around the horn here and we're kind of wrapping some things up. Um. One of the things that we talked to it. I love to love to hear your thoughts is, you know, we we we talk often about that. There's not enough physicians. You know, we're not allowed to clone and and, as somebody reminded me, even if you clone them, you still gotta wait for THEM TO GET OUT OF MED school. So your thirty years before you know. You're twenty five to thirty years before that happens. And so you know, and and and. So what what is the solve? I mean you know, and I'm sure maybe if we had the answer we wouldn't you wouldn't be but you know what, what is the solve? What is the medical industry, Um, and the medical schools and stuff. What are some of the things we think we have to they have to do to try to help fix this problem, which is only going to grow. I really think Um, you know, you see there's quite a few medical schools that have jumped up, you know, over the past few years. It's really not don't I don't think the medical schools. I think it's the number of residency slots that get filled, because you only have a limited number of residents per specialty. That's where the hangup is and you've got people that have come out of medical school that they don't match for residency. So, yeah, the number I heard was about six or yeah, yeah, I heard about six thousand a year. UH, don't get matched right, crazy, thirty thousand and six thousand. And when you know you've got I could think of neurology is one of our toughest positions to feel. There's only about ninety practicing in the US and when you break down over the age of fifty five or sixty, you cut that in half again. So that means we've got about, you know, forturologists taking care of how many millions of people across the US? It's a big problem with Jerry intology as well. The same thing Gerry intology. We have. It's old. This big retiring and aging populace Gerry intologists is it's like one to twenty or something crazy. I look at okay, these are the residency programs. This is how many R in residency in you know, the first three ever, how many years? Um. I keep up with those numbers and it it's just kind of amazing that those numbers they don't change a lot over the years because they're not adding any additional slots for the specialties. I think part of that is government because, you know, a lot of the schools, a lot of the residency programs get government funding and we've got to figure out how do we work with that. Um, yeah, it's money. Yeah, it's money because, and he was the government and the funding. But I also understand the reason the university hospital systems and all that sort of stuff don't want to create more residency slots is because I have to have someone to train them, I have to have somebody to provide oversight. That's not billable revenue. You know, it's a little bit of a short sighted look, but that's that's that's part of the gap. It is and I think that's why, you know, physicians who work for us, there's a large program in color auto that...

...we're getting ready to run um and we're actually sort of helping them with their residency program so they're going to have folks who can be teachers. We work with current medical out in Bakersfield and for years and we actually helped them restart their general surgery residency program M. It's interesting that, you know, they weren't able to keep it going and they're interested in how do we grow our own physicians? You guys help us in. Dr Sheer, I think that's what what we're so blessed with. Not only ship good surgeon and a good leader for this organization, but she was in, you know, she was on the medical faculty of some some big, you know companies out West in California, so she knows, you know, residency programs. So we're an advantage because physicians can come here and just do heads down surgery. They can come here and be a part of teaching. Fact, actually, I meant to M A P P s. If they want to do that, thinks that they can do as a part of working for us Um. We have their work life balance. So it is kind of amazing. Yeah, well, I can hear it in your voice. I can hear in your the passion about it. Um, it's yeah, it's it's it is interesting and I think one of the other things you mentioned when we when we talked prior to the recording, was the cost of medical schools. Gotta get gotta get into control, you know, because you know, walking out with that level of debt and your ability to earn to pay off that debt is getting slower and slow harder to do. Um, you know the N Y U Model, which is, uh, primary care come in, because we need more primary care too. We need all of it and uh, you know, and we'll, we'll cover your medical costs. And you know, for these physicians to be able to go out of a good program like N Y U and come out of debt free is h is a huge, a huge draw. Exactly. It is. It is. I mean that's kind of an amazing, an amazing way for them to do things. But there's, you know, if they want to go work for nonprofit organizations, there's the way for them to get public service loan forgiveness, Um, but a lot of them they just don't realize that. So that's part of we can't do that because we're not a not for profit. But I do tell physicians, especially some of the younger ones that are coming out, I would advise you to do this and just take a look at it. You to do this. So if they may not work for us, but guess what? And they know how to take care of their student debt or I actually know companies that I can hook them up with that can help them with their student loans, to refinance them in a way so that it's not as detrimental Um, teach them to live on their income and not live above their income and to some of that under control coming out of you know, out of school. Yeah, yeah, you know, we talked about it earlier to the other thing is practiced with purpose, and I've again same thing friends. She's a nurse and her husban and a physician and he's finishing up his Indian health services, I H S uh, you know, residency and program and I think it was three years or so and he's coming out and all of his debt for serving in that community has been, has been, has been eliminated and he said that the experience was unbelievable. You know, that practice with purpose to be serving the Indian reservation people and all the health issues and concerns they have. He said, Um, he said, I can't believe they're paying me, wiping out my debt and I'm making the difference. And so, yeah, so there are ways to to uh, to to do this if you just have the creativity and the desire to to really do it that way and folks that will actually help you understand how to do it. So again, you know, as as a recruitment team and thinking about over the years all of the physicians that I've talked with. Yeah, like, like I said, I don't change my cell phone number because I'm I know at some point someone's call. Do you feel that way? And it's night, day, early morning. I get phone calls at five thirty in the morning sometimes. But I think being a resource for people is also very, very beneficial, because you know they're gonna come back and thank you one day for that. They'll send us a referral, they'll they'll come and work for us at some point. But I just feel that that's part of what we need to do, to give to these people, that we're trying to help them figure out. What do they want to do, where do they want to be? How do they want to take care of their families and how can we help them do that? It may not be working for us, but maybe, you know, it's some advice that we can give them on, you know, the next step in their career. Yeah, it's a short term, it's a short term philosophy or long term philosophy, you know, and then long term, long term usually makes it win. So, Tammy, thanks so much for your time. It was it was it was great to hear from you and great to connect and talk a about this and I'm glad we...

...were able to talk a little bit more about what's in the heads of today's physicians and how do we do this? Um, you know, we always, uh, I always close each episode with asking you who is your hero? Um, as you think back in your in your life, everybody has usually that one or two special people, persons, you know. And I thought about not relating this to healthcare, but I still have to relate this to healthcare. Um. Well, that's the show heroes of healthcare we love. So it's it's funny and I listened to everyone and who their heroes are. So some of them they use sports stars and all of that, but I really is a is a hero and healthcare. So when I worked for Karely and Um, it's kind of interesting in the Gosh. I started my career there in ninety four and as I grew in the organization Um, we actually when we're looking at becoming a medical school and become a clinic model, the Radiology Group that we had worked with for thirty years decided they didn't want to be a part of that. They were they were contract employees. They weren't employees of the organization. They gave us a notice and totally walked out on all of our radiology procedures for eight hospitals. So you can imagine the hundreds of thousands of procedures procedures that we were not going to be able to do right. I understood how to run practices that I'd never ran a radiology practice. I was blessed in that one of the physicians from that group that I had been friends with came over and became the chair of our radiology practice, of which we didn't have any radiologists. He and I um and just because of his leadership Um in eighteen months he and I were at each other's elbows constantly doing recruitment and we replaced twenty five radiologists in eighteen months and that's that's the ones that we hired. Now you can imagine we went through, if I if I remember correctly, we went through like three hundred and fifty radiologists to get to the ones that we need to get. And you know, I think of him and that he really became special to me because we, even though I was still running the recruitment team, running the practices and running we had to start a radiology practice. So running the business side of the radiology practice with him, Um, it was just it was a different role than I had ever been in and he was one of the kindest radiologist I had ever worked with. Um and I know I've never radiologists over the years, but he was genuine, he was kind, he he knew how to talk to people and he knew how to understand people. He really related and you think of radiologists kind of being in the basement, working in the dark, and he was totally the psit Um. He listened and he would let people ask questions. And it's kind of funny because as we went through all of that, I mean we hired specific neuro interventional you know, all different types of subspecialties and he could relate to each one of them as we brought them in, but we also were able to understand their personalities and how they would or would not fit into the organization. So that was like eighteen months and into that Um our families got to know each other. So we would like go to the lake together and my daughter just thought he was the stuff. She wanted to grow up and be ready on this because of him. Um, just he just was near and dear to my heart and he ended up they promoted him to being the chief medical officer for Karelian for a number of years and he served in that role Um with, you know, being able to be a true physician leader and hear physitions of all specialties and Um it was it was kind of sad because he did end up having a really traumatic disease and passed away in two thousand six, mm HMM. I think about him and everything. It was just an amazing man and he put everything on the line to be able to help the patients. That's what it was all about, was how do we take care of all of these patients right and it was just an amazing man. So sorry, that's okay, listen, if you know what, let's be authentic and if it, obviously it shows that this was somebody who was clearly very special in your life. The thing that's killing me is what was his name? His name was when Handy, and the funny thing is, like me, he grew up in West Virginia. He understood, you know, what it was like to be an areas where people didn't get the health care they needed, and I know...

...that's what drove him. I mean, you know, he went to Um, he went to a medical school in Charlottesville. He did his residency in Rhona for killion, so he was part of that community for many years, fabric of that community. Yeah, Dr Dr Wayne Brandy. Yeah, Dr Wayne Brandy, yeah, a in D e E. So, yeah, well, than well, I love that and thank you for sharing that with us and sharing with him and will U. we'll we'll always remember that name, somebody who made a big difference in a small community. Right. Definitely. Yeah, well, Tammy, thanks so much again for your time, thanks for your heart, thanks for your service and uh, you know, you're one of the people who really uh gives a physician recruiting a great name and we appreciate everything you do. Thank you. I appreciate you having me. All right, have a great day. All right, you too. We'll talk to him. You've been listening to heroes of healthcare. For more subscribe to the show in your favorite podcast player or visit us at heroes of healthcare PODCAST DOT COM.

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