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The Standard Q3 2012

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3rd Quarter 2012 
October 2011 - September 2012

Industry Perspectives

Operation costs and demand challenges alleviated

Andrew Rossi and Beth Sheehan, Delta Locum Tenens

High operational costs have put a strain on patient access to doctors, particularly as the nation’s physician shortage escalates.

Adopting midlevel providers to support existing physicians on staff can have a huge impact on facilities looking to provide access to healthcare at a consistent level and boost revenue. Affordable compensation and shorter formal education requirements make these providers an advantageous solution to enhancing a facility’s outreach. Midlevel providers can help stabilize care and revenue in understaffed or remote facilities by maintaining patient flow and personal care. For example, in some facilities full-time physicians are only available during certain days of the week, limiting the patient load that can be seen. Having a qualified nurse practitioner on staff allows the facility to accept willing patients even during the days the physician is on call, rather than onsite.

The growing United States population has pushed the trend of utilizing midlevel providers to maintain quality care in areas that do not necessarily demand physician care. The range of midlevel responsibilities varies by scope-of-practice statutes in each state; therefore, it is important for facility administrators to be familiar with legislature associated with their state. For instance, in some areas, nurse practitioners practice independently from physicians, while other areas are more governed. Over the past few years, a trend has emerged in many state legislatures toward broadening midlevel responsibilities.

Midlevel providers can be particularly helpful in rural communities whose scope of practice statute is lightly regulated. For facilities struggling to retain multiple full- time physicians, on-boarding midlevel professionals is an extremely beneficial alternative. Often, remote locations have difficulty recruiting and retaining full-time physicians, yet can present an attractive offer to a midlevel provider who will support physicians already on staff. For the cost of an additional physician’s potential compensation, two midlevel providers can be hired—giving facilities a larger staff with outreach to higher patient loads. These providers can take on a great deal of an overworked physician’s workload or call schedule, which in turn allows the facility to see more patients overall.

Delta Locum Tenens Marketing Consultant Stephen Gault recently documented this trend in a customer-hospital in Alabama. Historically, the facility’s hospitalist program exclusively utilized MD hospitalists, which began taking a toll on morale and revenue at the facility as physicians’ work loads were stretched too thin. Within the past year, the facility began to implement the use of nurse practitioners. Subsequently, the physician workload decreased to an acceptable level and the hospital no longer had to pay for MD call coverage. This change increased quality of work life and boosted morale.

In a 2011 study published by Ohio State University Hospital, it is noted that over the next 20 years, rural hospitals will be in competition with urban hospitals for hiring from the same limited pool of physicians. As urban hospitals have a socioeconomic advantage in hiring, it is imperative that each rural hospital analyzes local future healthcare needs and devise strategies that will enhance hiring and retention practices.

Although utilizing midlevel positions has been readily adopted in several areas, the practice has received mixed reviews from skeptics. In a news blog posted by heartlander. org, one physician expresses his opinion that midlevel providers do not have the training necessary to identify complex conditions, as they do not receive as much formal education as a medical doctor. However, the blog also cites another physician’s counter argument that midlevel providers can draw on their own training and credentialing, and refer patients to their doctor or an emergency room if a critical condition falls outside of the provider’s scope of practice.

Education requirements for nurse practitioners can vary by specialty, but at minimum, require a Master of Science in Nursing, licensure and proven skill sets as a registered nurse, and licensure and certification depending on the nurse practitioner’s specialty. Physician assistants must complete a bachelor’s degree and secondary accredited educational program. This usually takes at least two years of full-time study and typically leads to a master’s degree. Also, all states require physician assistants be licensed. In addition to the requirements above, CRNAs must have at least one year of acute care nursing experience and complete a minimum of 450 cases during their training. Every two years after being certified, CRNAs must be recertified by completing both practice and continuing educational requirements.

An additional concern with drawing on midlevel positions is the impact the providers may play on patient satisfaction. MinuteClinic, the Minneapolis-based organization of health centers, serves as a popular case study to monitoring patient satisfaction with midlevel providers. The clinics are staffed by CRNAs and physician assistants and treat common illnesses such as strep throat and ear infections. To date, the organization boasts a 95 percent customer satisfaction rating after processing over 12 million patient visits.

While there may not be a quick fix to the nation’s physician shortage, considering midlevel providers may ease some tension for facilities struggling to develop their staff or maintain an influx of patients in need of quality care. It is important for facility managers to know where their state lies on the scope-of-practice scale in order to understand their staffing options.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Potential Compensation From Interview to Placement Total Placement Fastest Days-to-Fill
Primary Care
Family Medicine $195,093 $20,184 $239,596 47 164 3
Internal Medicine $217,970 $26,929 $300,298 31 154 28
Pediatrics $191,588 $24,264 $218,088 38 113 64
Psychiatry $203,644 $23,617 $239,777 58 98 50
Obstetrics/Gynecology $274,815 $25,000 $348,846 50 179 68
Surgery
General Surgery $335,990 $28,830 $393,103 46 143 29
Orthopedic Surgery $493,120 $32,307 $660,000 84 117 83
Otolaryngology $397,000 $81,000 $501,353 51 222 15
Urology $406,029 $35,344 $505,620 87 195 82
Sub-Specialty
Cardiology $460,588 $23,333 $610,000 168 246 246
Oncology $417,464 $47,142 $499,713 77 213 138
Neurology $269,230 $25,000 $309,285 70 132 109
Pulmonary Critical Care $306,500 $35,714 $435,500 23 67 57
Gastroenterology $439,473 $41,192 $588,710 135 240 240
Hospital-Based
Anesthesiology $381,000 $16,000 $454,000 7 37 31
Radiology $500,000 $50,000 $750,000 80 101 101
Hospitalist $220,450 $23,230 $264,673 97 154 21
Emergency Medicine $241,214 $23,907 $289,374 45 133 30

Data reflects averages from placements and interviews by Delta Physician Placement from October 2011 through September 2012. “Potential Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Placements by Population

Data indicates the percentage of placements made from October 2011 through September 2012 by the population of the search facility’s metropolitan area.

Candidate Sources

Candidate Sources

Data indicates sources of candidates for placements and interviews from October 2011 through September 2012.

Market Demand

Nationwide Search Distribution

Nationwide Search Distribution

Map represents the percentage of licensed physicians by region working with Delta Locum Tenens.



Specialty Demand Comparison

3rd Quarter 2012 3rd Quarter 2011
1. Family Medicine Family Medicine
2. Hospitalist Internal Medicine
3. Internal Medicine Emergency Medicine
4. Emergency Medicine Psychiatry
5. Psychiatry General Surgery
6. Obstetrics and Gynecology Gastroenterology
7. Pediatrics Orthopedic Surgery
8. General Surgery Obstetrics and Gynecology
9. Family Medicine/Obstetrics Hospitalist
10. Urology Neurology
11. Pulmonary Critical Care Medicine Pediatrics
12. Neurology Urology
13. Otolaryngology PM&R
14. Orthopedic Surgery Cardiology
15. Urgent Care

Otolaryngology

Data compares the top 15 most requested searches initiated by Delta Physician Placement in the 3rd Quarters of 2011 and 2012.

Search Specialty Distribution

Search Distribution by Specialty Group

Data indicates the percentage of searches initiated by specialty grouping between October 2011 through September 2012.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. North Dakota
2. Alaska
3. North Carolina
4. Colorado
5. Arkansas

Data indicates sources of candidates for placements and interviews from October 2011 through September 2012.

Locum Tenens

Days Requested

Specialty Number of Days
1. Hospitalist 34,766
2. Family Medicine 15,658
3. Emergency Medicine 15,514
4. Nurse Practitioner 7,279
5. Psychiatry 5,672

Data indicates the top five specialties by days requested from October 2011 through September 2012.

Nationwide Physician Distribution

Nationwide

Privileging

Lowest Average
to Close Credentialing
Number of Days Lowest Average
to Close Credentialing
Number of Days
1. Iowa 11 6. Michigan 20
2. North Dakota 12 7. Ohio 24
3. Oklahoma 14 8. Virginia 29
4. Arizona 16 9. Montana 30
5. Utah 18 10. Wyoming 32

Total Privileging
files Completed

489

Average days
to complete a file

46

Data indicates total number of days - highest and lowest for a state to close credentialling from October 2011 through September 2012. This data represents all states Delta Locum Tenens has done business in during the past 12 months.


3rd Quarter 2012
 
October 2011 - September 2012

Industry Perspectives

The key to therapist retention within your reach

Jaeson Babb, Vice President of Perm Recruiting, Delta Flex Providers

A major concern to any industry, employee retention can be impacted by a

number of factors and continues to challenge physical and occupational therapist directors across the board. In an attempt to best combat these challenges and gain first- hand knowledge of recruiting and retention priorities, The Delta Companies requested direct feedback from therapists within the company’s database through a recent survey

and several one-on-one interviews with willing participants.

In the September survey conducted among a sample of working therapists, 64 percent of respondents listed their top priority in a job search as compensation rates and location of the offer. These factors typically correlate with one another, depending on the specifics of a job offer.

“In extremely desirable areas, some facilities are able to leverage their location in order to offer compensation packages on the lower end of the scale,” said recruiting consultant Tony Spyropoulos. “That said, facilities in less desirable areas can counteract this by offering higher compensation rates and more appealing incentives – such as student loan reimbursement, various bonus structures and relocation assistance in order to stay nationally competitive.”

In addition to giving a facility an appealing job offer, maintaining a competitive salary and reasonable incentive program was listed as an imperative strategy to therapist retention. One third of survey respondents listed bonus incentives as their top factor in deciding to maintain their current position. For new graduate and supervising physical therapist Deborah C., opportunity for financial and professional growth are of equal contribution to job satisfaction.

“Promotions, opportunity to grow with the company, and increased pay are all factors that would likely keep me satisfied with an ongoing position or facility,” Deborah stated. She also suggested that facilities looking to boost retention should offer support for new graduates with opportunities for growth and professional development.

This sentiment was mirrored by new graduate and physical therapist Sarah D. who said that although quality of patient care was her top priority in evaluating a hiring facility, the opportunity to better her skill professionally was a huge plus when weighing different offers. Sarah gave praise to facilities that utilize a mentorship program for incoming providers.

“It’s nice to have someone you can go to who has experience,” Sarah said. “Just as a way to double check if you have any questions.”

Feedback from the surveys also indicated that the development of interpersonal relationships was ranked among the top three priorities of which participants evaluated their job, ranking just under base compensation and proximity to home.

“One thing I look for in a hiring facility is the (interaction between the) rehab teams themselves,” Sarah pointed out. “Do they get along well and put patients first? What are the whole company’s values?”

In a study conducted by the Journal of Healthcare Management exploring the relationship between hospital culture and employees’ quality of work life, it was determined that cultural values are positively related to organizational commitment, job involvement, empowerment, and job satisfaction; and are negatively related to intent to turnover.

The development of a working relationship starts with an initial interview. Thirty-eight percent of survey respondents ranked the attitude of staff or personnel during the interview process as a first or second priority factor in deciding to accept a position. Sarah D. advised any therapist weighing an offer to request an onsite interview, if possible.

“Everything on paper may sound great, but it is important to get to talk to people and see how things run in person,” Sarah said.

Data from the survey also indicated that incentives such as student loan repayment, relocation reimbursement, and a competitive benefits package were well-received tools in recruitment efforts. Float physical therapist Tim R. actually ranked facility benefits as his top priority in a job search.

“For me, the biggest thing is what benefits does the employer have to offer? (In my) current position the most important things for me were a base salary —my last job was commission and that was unsettling—PTO, schedule consistency, health insurance, dental, vision, life insurance, continuing education and professional development, and student loan repayment. Benefits are more important than wages.”

As an experienced therapist who has worked in multiple facilities, Tim R. said the best advice he can give to directors looking to boost retention is to offer recognition and appreciation to provider.

“Be honest, kind, and treat your employees (or potential employees) with respect and kindness,” Tim said. “Give them consistent and honest feedback and reviews. Let them know they are needed and an essential part of a team. Make them know they are appreciated.”

For most facilities, increasing therapist retention will incorporate a combination of factors. “The key is to determine which options are viable for your facility and will keep your offer in the game,” Spyropoulos said.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Healthcare Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Student Loan Repayment Relocation Reimbursement From Interview to Placement Total Placements Fastest Days-to-Fill
Rehabilitation
Physical Therapy $82,179 $8,997 $36,431 $3,724 28 80 3
Occupational Therapy $74,878 $6,541 $20,500 $4,820 21 72 13
Speech Language Pathology $62,286 $5,667 $10,883 $2,947 6 132 46
Extenders
Nurse Practitioner $97,500 $7,745 $33,444 $7,465 24 83 13
Physician Assistant $104,881 $6,100 $25,818 $5,057 20 67 7
Allied/Other
Registered Nurse $68,232 $3,705 $9,320 $5,958 15 64 14
Pharmacy $114,738 $5,000 $8,736 $4,000 10 49 21
Medical Technology $56,491 $1,636 $2,000 $4,529 22 50 21

Data reflects averages from placements and interviews by Delta Healthcare Placement from October 2011 through September 2012. “Total Annual Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Placements by Population

Data indicates the percentage of placements made from October 2011 through September 2012 by the population of the search facility’s metropolitan area.

Years of Experience

Years of Experience

Data indicates the average years experience of candidates for placements and interviews from October 2011 through September 2012.

Market Demand

Nationwide Search Distribution

Nationwide Search Distribution

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from October 2011 through September 2012.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. Texas
2. Alaska
3. Indiana
4. Oregon
5. Virginia

Compares all states for the top 5 candidate placements as initiated by Delta Healthcare Placement from October 2011 through September 2012.

Specialty Demand Comparison

3rd Quarter 2012 3rd Quarter 2011
1. Physical Therapy Physical Therapy
2. Occupational Therapy Occupational Therapy
3. Nurse Practitioner Physician Assistant
4. Registered Nurse Nurse Practitioner
5. Physician Assistant Speech Language Pathologist

Data compares the top 5 most requested searches initiated by Delta Healthcare Placement in the 3rd Quarters of 2011 and 2012.

Travelers

Assignments by Specialty

Specialty Average Length Contract
to Start Date
Average Length
of Assignment
Physical Therapy 4.6 weeks 13 weeks
Physical Therapy Assistant 4.4 weeks 12 weeks
Occupational Therapy 5.5 weeks 13 weeks
COTA 3.1 weeks 11 weeks
Speech Language Pathology 5.5 weeks 12 weeks

Data is compiled from assignments placed by Delta Flex Travelers from October 2011 through September 2012.



Facility Demographics

Assignment Settings



Years of Experience 

Years of Experience

Data is compiled from assignments placed by Delta Flex Travelers from October 2011 through September 2012.

Top Licensure States

top_licensure_states

Map represents top licensure states by Delta Flex Travelers on behalf of healthcare facilities from October 2011 through September 2012.



Licenses Per Quarter

Licenses Per Quarter

Data is compiled from assignments placed by Delta Flex Travelers from October 2011 through September 2012.



Licensure Cost

Specialty Average Cost of License
Physical Therapy $205.42
Physical Therapy Assistant $210.67
Occupational Therapy $264.25
COTA $167.25

Data is compiled from by Delta Flex Travelers from October 2011 through September 2012.