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  • Michael Jones
  • January 09, 2019 02:18:33 PM
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A Little About Us

Healthcare Career Resources is a blog for those who work in the healthcare industry. We cover topics ranging from current events to medical humor as well as more career focused topics such as job search and interview tips. We also publish articles written for healthcare human resources and physician recruiters.

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    Best Practices for Hosting a Physician Site Visit

    A well prepared, personalized, and refined physician site visit is essential to earning the trust of the physician and his/her spouse. The site visit is the most critical factor for determining cultural, operational, and philosophical fit. Healthcare organizations that successfully execute a physician site visit will stand out from the competition, earn the trust of the physician and spouse, and become their first...

    Step by Step Guide to Successful Physician Site Visits
    Wavebreak Media Ltd123RF.com

    You never get a second chance to make a first impression—especially when recruiting top talent in the highly competitive healthcare market space. Research by AAMC (Association of American Medical Colleges) indicates that the United States will likely see a shortage of up to 120,000 physicians by 2030.  Adding to the crisis, this shortage comes at a time of rising demand for healthcare services.

    The increased demand is primarily due to the aging and escalating population. In fact, the US population is estimated to grow nearly 11% by 2030, with those over 65 increasing by 50%. Additionally, roughly one of every three providers will be retirement age (65) in the next decade, making the physician shortage crisis one of the most significant challenges facing healthcare organizations today.

    As shortages rise and the market becomes increasingly more competitive, preparation and planning are critical for successful physician recruitment and retainment.

    25 Best Practices to WOW at your Next Physician Site Visit

    If an organization is planning a physician site visit, it is likely that physician recruiters, executives, and administrators have already engaged in a substantial amount of groundwork. The candidate has expressed interest in the opportunity, and based on discussions, the organization believes it could be a potential fit. Once the candidate has been selected for a site interview, it is time to make sure your organization or practice stands out from the competition.

    The following are 25 Best Practices to WOW at your next physician site visit:

    Pre-Site Visit Preparation:

    1. Create and provide a pre-visit information packet.
    2. Provide a detailed itinerary.
    3. Provide a cost of living comparison analysis between your area and the current location of the candidate.
    4. Plan and organize a community tour to introduce the candidate and his/her family to your area. Personalize the community tour based on their specific interests: schools, parks, housing, places of worship, neighborhoods, shopping, etc.
    5. Coordinate airline flights for the candidate and his/her family.
    6. Arrange for transportation for the candidate to and from the airport to the hotel of choice. Include transportation to the site visit and all required travel.
    7. Make necessary hotel reservations.
    8. Schedule and coordinate a dinner with the candidate and appropriate physician or executive leadership.
    9. Organize a meeting with a physician colleague and the physician’s family, aligning family situation, lifestyle, and interests.
    10. Schedule a meeting with a real estate agent you know and trust in the community.

    Site Visit:

    1. Leave a gift at the candidate’s hotel such as flowers, a fruit basket, or a welcome packet that will reflect the essence of your community. If the candidate has children, include an age-appropriate gift for them.
    2. Ensure you take candidate and spouse on the pre-planned community tour.
    3. Remember – if you recruit the spouse, you will have recruited the physician.
    4. Provide a tour of hospital facilities.
    5. Provide a tour of office space.
    6. Include a luncheon with key members of the medical staff.
    7. Include a dinner with appropriate hospital staff and/or community members.
    8. Remember time for extracurricular activities such as golfing, tennis, fishing, etc.
    9. Provide time for the candidate to meet another provider/colleague and his/her family.

    Post Site Visit

    1. Follow-up promptly with the candidate to address any questions or concerns regarding the site visit.
    2. Reimburse expenses quickly.
    3. Send a thank you with a small gift.
    4. Send the hospital newsletter.
    5. Continue thorough discussions and evaluate the candidate’s level of interest in your opportunity.
    6. Continue interviewing and answering questions until you have a signed agreement.

     

    A well prepared, personalized, and refined physician site visit is essential to earning the trust of the physician and his/her spouse. The site visit is the most critical factor for determining cultural, operational, and philosophical fit. Healthcare organizations that successfully execute a physician site visit will stand out from the competition, earn the trust of the physician and spouse, and become their first choice.


    Opportunities for Retired Physicians

    Many physicians spend early retirement in a state of shock. Are there really that many hours in the day? Restlessness and boredom set in quickly. You haven’t spent so much time with your significant other since…. ever. That may be an awakening. Income may not stretch as far as expected, or unforeseen obligations arise. There may be a yearning, still, to make a...

    Work options for previously retired physicians
    Borislav Marinic/123RF.com

    Virtually all physicians have, at some time(s), been able to keep putting one foot in front of the other because they were bolstered by imagining an idyllic retirement of the leisure afforded high earners. I thought that the rewards of practice were, and would always be, greater than the aggravations (“Family Medicine – Evolution and Rewards” 30 Oct 2014). Then EHRs invaded patient-physician relationships (“Electronic Health Records: The Scourge” 2 Mar 2017). At times, it may feel like one more day of EHRs and billing codes is intolerable. The workload shortchanges both patients and physicians of that which makes for the best care and physician fulfillment – relationships. There’s no time for those.

    Eventually, long-anticipated retirement arrives. I’d like to warn you – as often occurs, reality is no match for imagination and unrealistic expectations. Many physicians spend early retirement in a state of shock. Are there really that many hours in the day? Restlessness and boredom set in quickly. You haven’t spent so much time with your significant other since…. ever. That may be an awakening. Income may not stretch as far as expected, or unforeseen obligations arise. There may be a yearning, still, to make a difference.

    A return to work may be better than 24/7 leisure. You have a wealth of readily marketable skills. There are many nontraditional, nonclinical job opportunities for retired physicians, or you can create your own enterprise.

    Writing/Editing

    This is a great option if you’d like to work at home. There are countless websites that can use a physician’s expertise (contact us). Sites that provide responsible health/medical information may hire physicians to do the writing or to critique material for accuracy and readability before it is published. Continuing medical education courses may be written or reviewed by physicians.  Writing test items for board certification is an option. Many of these positions require computer literacy. Search ‘medical writing’ or something similar and you’ll receive more opportunities than you can manage. Writing/editing is working for me. It helps that I have a degree in journalism.

    Some physicians relish the time for creative writing. Suspense novels are popular subjects for physicians, but there are no limits on material or topics. It may take some footwork and time to find a publisher, but if creative writing is your passion, go for it!

    Healthcare Administration

    A healthcare administrator is concerned with handling the rules and regulations of a facility, as well as supervising staff. Understanding of clinical medicine and how healthcare is delivered enhance an administrator’s effectiveness, but these challenging positions also require skills that are different from those of a clinician. Many administrators have specialized degrees. The Bureau of Labor Services reports a 20% projected increase in healthcare administrator employment—but the BLS also reports that some healthcare facilities require a bachelor’s degree or licensure in healthcare administration management.

    Teaching

    Even if you are feeling drained by the demands of practice, you may enjoy using and passing on your expertise. Many retired physicians teach undergraduate science courses. Some nursing schools are using retired teachers. The University of Texas Health Science Center at Houston has a program that uses retired physicians to teach nursing. It’s a way to combat the nursing shortage, some of which is the result of a lack of nursing teachers. It usually requires recent retirement and computer literacy.

    Telemedicine

    These positions are an option for physicians who want to work at home. The word sounds like something new, but medicine over a distance is nothing new. Technology has made the practice easier, safer, and more effective.

    Volunteering

    If financial concerns are not the primary reason for working, volunteering in the physician’s own community or internationally may be rewarding. Many physicians enjoy caring for the underserved at free clinics more than they enjoyed former paying positions. They say that not dealing with red tape and administrative problems is rewarding. Insurance paperwork and complicated tests are irrelevant.

    International volunteering can take many forms. Volunteers may train local healthcare providers, set up continuing education workshops, lecture, or provide care. These opportunities may be as short as a few days or a commitment of a year or more. There are too many international volunteer organizations to list here, but a few of the better known are: 1) Medical Volunteers International (medvolunteers.org) 2) Health Volunteers Overseas (hvousa.org) 3) International Healthcare Volunteers (ihcv.org).

    Hospitalist

    This term was coined in 1996. A hospitalist cares for patients admitted to a hospital. S/he usually becomes familiar with a single location, working with the same staff in the same system. The schedule may be a few hours a week to full time. Some studies have shown that hospitalists can expedite care, reducing the length of stay and decreasing readmission.

    Locum tenens

    This means, literally, ‘to hold the place of.’ These positions use a substitute physician as needed, from one day to indefinitely. The work is easy to find, and the physician can often create the schedule s/he desires. Travel and working odd hours are requirements of some positions.

    Return to practice via a reentry program

    Returning to practice can be especially attractive if you have unforeseen expenses or if you retired with sub-optimal assets. Reentry may require some training, often continuing education, and SPEX – the Special Purpose Examination. There are several reentry programs in the United States. Some states provide the service, but some physicians may have to pay for it – usually more than $20,000. Consideration must be given, also, to the cost of malpractice insurance. Practices and hospitals may not be able to cover it if the physician has been out of practice for more than a couple years.

     

    If you take one idea from this blog let it be this: Plan. If you do find yourself searching for work opportunities after retirement a good place to start might be right here.


    How to Plan Thoughtful Holiday Celebrations for Healthcare Workers

    The holidays are approaching and healthcare facilities across the nation are looking to celebrate the season and their staff. With 24/7 operations it can be difficult to create opportunities to assure everyone has a chance to join in the fun and good cheer. The following are some tips to help you make the season as festive as you can....

    Celebrating the Holidays for Healthcare Workers
    Stefano Valle/123RF.com

    The holidays are approaching and healthcare facilities across the nation are looking to celebrate the season and their staff. With 24/7 operations it can be difficult to create opportunities to assure everyone has a chance to join in the fun and good cheer. When staff works around the clock, celebrations have to work overtime, but creating events that can hold up through the shifts can be challenging.

    Celebrations will need to be round the clock and accessible to all. The larger the facility, and the more buildings and locations, the harder it may be to create a single event. There are some festivities you can arrange for all staff, even as others are run by department teams. Mini celebrations are a great morale boost for teams, but institutional efforts show staff they’re appreciated from the top down.

    Something for Everyone

    Institutions can ring in the holiday season in every department with hot cocoa/warm cider stations. If workgroups use single-serve coffee makers, stock them up with the flavors of the season. A gift package of peppermints, fudge and marshmallows for each group makes for a festive feel in the break room. Adding a few decorations along with the gift bag adds a seasonal touch.

    A Bit of Entertainment

    Strolling carolers can make sure to hit every department and shift as they roam the facility bringing cheer to workers and patients alike. Actors can present holiday scenes as they wander in costumes. Contact local choir and theater groups to arrange a moving celebration for your teams.

    Holiday Lights

    If you have the space on campus, start holiday lighting traditions. Festive Menorah candle lighting celebrations can begin the season, followed by Kwanzaa candles and a Christmas tree. Consider serving coffee, cocoa, hot toddies and treats. Music of the season can play as employees mix and mingle to ring in the holiday season.

    Contests

    The ugly sweater contest is a holiday favorite, but don’t worry that your distributed teams can’t get in on the fun. Set up an online contest early in the season. Employees upload a picture of themselves in their ugliest attire and their colleagues vote. Prizes could be awarded with an ugly ensemble group picture to share with staff.

    Create a variety of categories for prizes: ugliest Hanukah, Kwanzaa and Christmas sweaters are just the beginning. Add subcategories like ugliest animal-, snowman- or gingerbread-themes.  Create a prize for sweaters with the silliest or sweetest sayings or prizes for the most ‘homemade-looking’ sweater.  Another category could be ugly holiday hats, while another could be costumes of employee’s favorite holiday tv or movie character. If you have in-house tv monitors, consider slide shows of the contestants and winners (great for Halloween costumes, too) for employees and patients to enjoy.

    Holiday Feasts

    If you have the capability to provide holiday meals over the season, consider having leadership do the serving. Workers rarely get to rub elbows with Administrators, and holiday meals served by leadership are a great way to show the institution supports its staff from the top-down. Whether serving staff in the facility’s cafeteria or serving the community off-site events, when top management gets involved in the fun and the service, the message is clear: we’re a team.

    Spread the Cheer

    If trying to cram an everything holiday into a few days near the end of the month is impractical, consider Holiday Week (or two). Hanukah begins December 22 in 2019, with Christmas and Kwanzaa on the 25th and 26th.  Smaller celebrations, staggered throughout the weeks, can assure everyone is in on the fun.

    Giving Back

    Few workers give back as much as those in healthcare. Every minute of every shift is dedicated to helping others. For some, the holidays have even more meaning when staff can give back beyond their professional reach. Facilities can partner with toy collection organizations, letters to Santa drives, or coordinate efforts with community partners to help those in need. Employees can volunteer to participate or coordinate, often finding these efforts bring more warmth to the holiday season than anything wrapped and tied with a bow.

    Giving Trees

    Are there staff members in your institution that could use a bit of help over the holiday season? A giving tree, where employees can anonymously submit needs can help spread the cheer. Staff members anonymously fulfill wishes for those who provide requests. If your institution organizes an in-house giving tree, set some basic guidelines: due dates to submit and fulfill requests, and perhaps spending limits. A volunteer or HR will need to privately coordinate how gifts are distributed to those who asked for donations.

    If your facility normally gives out a cash or gift card bonus to employees every year, consider asking employees if they’d like their gift donated to others in need. If there are community groups your institution partners with, or if staffers have a charity in mind, the option to divert some of the holiday cheer to those in need could be a heartwarming option. If your donations go to a single charity, or several, make sure to notify staff how much was donated in their names as individuals and as an institution.

     

    No matter how large or small your institution, celebrating the season is a great way to show appreciation to your staff. Not only will it brighten their day, spreading holiday cheer is a great boost to morale. Make the season as festive as you can.


    Nurse Practitioners and Physician Assistants – The Hot Jobs of Healthcare

    Health Care will always be a field with guaranteed growth and job opportunities. As the physician shortage continues, the number of Physician Assistants and Nurse Practitioners in medical offices and hospital settings will continue to rise. These roles offer a great starting salary and a fraction of the cost of education and liability that comes with being a...

    Np and PA Outlook
    archnoi1/123RF.com

    How many times have you visited a doctor’s office, urgent care, or hospital and received treatment by a Nurse Practitioner or Physician Assistant? Chances are high that it was more than a few times. This is not a surprise given the growth in both areas. According to Nurse.org, Nurse Practitioner jobs are expected to grow between 2014-2024 by thirty-five percent. Physician Assistant growth is not far behind, with an expected increase of thirty-one percent over a ten-year span. So why the spike in demand for these roles?

    NP/PA vs MD

    There are many similarities between the roles of a Physician Assistant or Nurse Practitioner and a Physician. In terms of their roles, Physician Assistants and Nurse Practitioners and Physicians tend to overlap, performing wellness checkups, sick visits, and depending on the state, prescribing medication. Some practices allow Nurse Practitioners to work autonomously, in a sense running their own practice, while others prefer the Physician Assistants or Nurse Practitioners to be closely supervised by an onsite physician.

    A Physician Assistant and Nurse Practitioner require two years of school after their bachelor’s degree, while physicians require four years of medical school. Typically, Physician Assistants or Nurse Practitioners can jump into the working world after passing their state license exam, while physicians will need to continue on through up to seven years of residency training and pass their medical exam and board certifications before working in the profession. The money saved in education alone is a huge benefit for many who decide to take the Physician Assistant or Nurse Practitioner path.

    Differences Between Physician Assistants and Nurse Practitioners

    So, what is the difference between a Physician Assistant and a Nurse Practitioner? The biggest difference between the two is the practice model on which they are trained. Nurse Practitioners are trained on a nursing-based model (patient centered), while Physician Assistants are trained in line with medical doctors (disease centered). Another major difference between the two is the area of medicine they practice. Nurse Practitioners select their area from the beginning of their program and tend to stick to a specific primary population, such as pediatrics or internal medicine. Physician Assistants tend to specialize and enter fields such as emergency medicine or orthopedics.

    Increased Median Salary

    Health care as a whole is a steady career field to work in, as the demand is always there. However, the salary expectations for these roles continues to climb. In general, Nurse Practitioners and Physician Assistants earn more than $30,000 more annually than Registered Nurses. Add a specialty and that number grows even higher.

    Physician Shortage = Greater Demand

    It is no secret that our country is facing a severe physician shortage. In fact, by 2030, the United States is expected to have a shortage of over 120,000 physicians. With the always increasing cost of college tuition, the number of students attending medical school will continue to decline. The students who do successfully complete medical school and their residency are picking up salaried roles with hospitals and chains over opening their own practices. The Primary Care field will see the greatest shortage as the United States population continues to age and doctors continue to move away from the field.

     

    Health Care will always be a field with guaranteed growth and job opportunities. As the physician shortage continues, the number of Physician Assistants and Nurse Practitioners in medical offices and hospital settings will continue to rise. These roles offer a great starting salary and a fraction of the cost of education and liability that comes with being a physician. Add in generally regular hours and ample opportunities, and it is no surprise that Physician Assistants and Nurse Practitioners have such a bright outlook!


    Current Nurse Practitioner and Physician Assistant Job Openings

    Nurse Practitioner Positions

    Physician Assistant Positions


    Five Ways Medical Culture Harms the Doctor-Patient Relationship

    Current medical culture has evolved over thousands of years. It dictates how we treat each other and ourselves. It's an insidious culture of self-neglect, unspoken hierarchies, jousting, and undervalued humanity. As physicians, we are expected to establish rapport and trust with our patients while enmeshed in medical culture. Our "values, norms, and practices" are to care for patients as we would our own family members. The success we're striving for is to have best possible outcome for all of...

    How to Transcend Medical Culture to Provide Better Patient Care
    Mark Adams/123RF.com

    “The culture of a workplace – an organization’s values, norms, and practices – has a huge impact on our happiness and success” – Adam Grant.

    Current medical culture has evolved over thousands of years. It dictates how we treat each other and ourselves. It’s an insidious culture of self-neglect, unspoken hierarchies, jousting, and undervalued humanity.

    As physicians, we are expected to establish rapport and trust with our patients while enmeshed in medical culture. Our “values, norms, and practices” are to care for patients as we would our own family members. The success we’re striving for is to have best possible outcome for all of our patients.

    But our goals and culture are antagonistic; good patient outcomes will occur despite medical culture, not because of it.

    Below are just five ways medical culture undermines the efforts to establish a successful doctor-patient relationship.

    If we can’t be sick, you can’t be sick

    “Compassion for others begins with kindness for ourselves” -Pema Chödrön.

    I was once working with a physician who was suffering with flu. I overheard him tell a patient “If you’re not at least as sick as me, you don’t get a work note.”

    Medical culture is clear on this: Doctors may not miss work for sickness. If you must, you should try to get your shift covered.

    I have personally seen physicians working with:

    • Symptomatic brain masses
    • Acute appendicitis (During his shift, he completed a work-up on himself and checked in to the hospital after consulting his own surgeon once the shift ended.)
    • Ovarian cancer (Came to work, left for chemo, went back to work)
    • Jaundice from advanced liver disease, on the transplant list.
    • End-stage AIDS (Saw patients from a wheelchair, too weak to walk)
    • Kidney stones, gallstones
    • Countless cases of flu, colds, gastroenteritis, sinus infections
    • Broken bones
    • Contractions from pregnancy (“Meh?—?if I start to deliver, I’ll just go to L&D”)
    • Sepsis from a urinary tract infection (to be fair, he had to leave his shift early to be admitted)

    That’s just the physical list. A list of psychological, emotional, spiritual or familial neglect would be even more robust.

    We feel we can power through physical illness and conceal our emotional needs. We prioritize a career and sacrifice our lives to the detriment of our overall well-being.

    When you treat yourself this way, it isn’t surprising that you’d treat others similarly.

    We define health by the absence of disease

    A patient wants to feel better; a doctor wants to make sure you’re not sick. If the patient is not objectively sick, the doctor is done.

    Maybe the patient doesn’t feel well, but there’s nothing objectively wrong. So, they’re healthy!

    These are misaligned goals. It’s hard to build an effective team when the members have different goals.

    With misaligned goals, it’s more likely that no goal will be achieved at all, or if it is, it won’t be achieved well.

    The life of a non-physician versus the life of a physician

    If you follow a traditional course to becoming a doctor, you’ll begin your education around age 18 and finish around 30. You’ll spend the time in between obtaining your education. When you’re done, you’ll have a median annual income of about $290K where the median annual income in the US is about $60K.

    There is a tremendous difference in those two lifestyles.

    For a physician to understand patients, he/she has to understand the social determinants of their health: legal, psychological, social, familial or financial barriers to their care. Your patients are homeless, addicted, abused and abusive, psychologically ill, trafficked and impoverished. Understanding their lives is vastly different than reading about it – and understanding is critical to establishing a therapeutic relationship.

    For a patient to understand a physician, they’d have to understand the unusually high degree of challenge, sacrifice, dedication, delayed gratification and achievement required to reach that goal. Physicians give up their twenties. They owe hundreds of thousands of dollars to get there. They have learned and been tested on libraries of information. They function at a very high level after not sleeping for days. They make life and death decisions.

    Many patients would not identify with a physician’s life, and the physician would not identify with theirs.  Putting them on the same team without addressing this difference in backgrounds will only make identification and alignment of goals less likely to occur.

    We’re must be reminded to acknowledge life

    The Pause” is a relatively new concept. When a patient dies, the medical team caring for the patient can carry out a 45 second pause to acknowledge that patient’s life and death. There is no proselytizing, just a statement that The Pause is being carried out followed by a quiet period. If one doesn’t feel comfortable with it, they don’t have to do it.

    I personally believe that this is a wonderful and powerful practice. I am in no way critical of The Pause itself. What amazes me is that as physicians, we have to be taught and reminded to acknowledge a life.

    We need a reminder that our patient who had a life, had birthdays, first loves, children, pet peeves, made jokes and had good times? They had favorite foods and secrets. They were someone’s little boy or girl at one point.

    We need to remember that they were alive.

    The Pause being a relatively new initiative (and one that was developed by nurses) tells you a lot about where medical culture is and has been.

    We depersonalize

    “The good physician treats the disease; the great physician treats the patient who has the disease” – Sir William Osler.

    We depersonalize when we don’t call patients by their names  (“The appendix in bed five.”). We do it to members of our own team: “Where is my nurse/my resident?”

    We do it every time we reduce the impact of diseases to the data associated with them: “There’s a 1/1000 chance that you’ll have a complication, that’s it!”

    These are all dehumanizing experiences. They communicate one thing very clearly: We aren’t connected to you; we’re connected to the pathology.

    This way of communicating is generally done for the sake of clarity and brevity. There are fourteen “Mr. Smith’s” in the waiting room. There’s only one with appendicitis.

    But over time, this communication does a disservice to the patient and distances us from the patients we serve. Our communication becomes our thoughts, and our thoughts distance us from the patients we serve.

    Tips On Transcending Medical Culture

    The good news is that medical culture is still evolving. Real-life experiences are prioritized for medical school applicants and medical education is focusing on those trained in humanities. Wellness is being emphasized and work-life balance is more of an expectation for employment than ever. But changing medical culture is like turning around a barge?—?it’s not going to happen immediately.

    Here are a few approaches to improve culture and in turn, start strengthening the doctor-patient relationship.

    Put the patient in their frame, not yours

    I start by thinking of one of my family members – one of my children for example.

    I then think of the patient as I think of my child. They aren’t “a patient”, but as “someone’s daughter” or “someone’s mom.”

    This is someone’s child?—?at one time, this was someone’s newborn baby. This person brings joy to his/her family.

    Thinking of patients that way helps you to identify with them. You understand them better. It lets you imagine your own mother coming home and talking about her doctor’s appointment that day.

    It puts the patients in the context of their life, not yours, and it humanizes them. When you do this, you start to think about caring for that patient as you’d want your own family member treated.

    Avoid corporate buzzwords; be human instead

    Be aware of corporate speak creeping into your practice. These are phrases and slogans designed to give patients the perception that they are having a good experience.

    We’re taught to use phrases like “I’m washing my hands now to keep you safe.” or “I’m going to close your door to preserve your dignity.”   Often, this is the same awkward phrasing used on patient satisfaction surveys, so when the patient is asked “Did the doctor do everything to preserve your dignity?” the patient will score it highly.

    The benefit of using these phrases stops with metrics such as patient satisfaction. Patients are generally savvy enough to recognize them as inauthentic and doctors often feel disingenuous for using them.

    These tactics are false dialogue – the doctors aren’t being themselves, and patients pick up on it. They don’t foster meaningful relationships.

    Find a shadow

    Identify a colleague who can shadow you for a few patient encounters and give you honest feedback.

    Let her observe you as you try to interact with patients as you typically do. Afterward, seek feedback on the human aspect of your care, not your clinical decision making. Asking her about your ability to establish rapport, ease a patient, answer questions, or your attitude can be helpful – we are often not perceived the way we feel we should be.

    When you receive feedback, listen without interrupting.  Learn what the difference is between what you think is happening and what is perceived.

    Use this information to improve your interactions.

    Care for patients away from the bedside

    There are a few ways to do this – call a patient at home to check on him/her. Or, assume a leadership role where you manage patient complaints.  It is impossible to do this and not gain a better perspective of the care you’re delivering.

    Hospitals have safety reviews for cases with bad outcomes. If you work in a hospital that has one, ensure that the patients and their families are invited to such a review. Regardless of what you think went wrong with a particular case, seeing it from the patient’s side is a powerful experience. It will change the way you view patient encounters and soften your approach to people.

     

    Medical culture is deeply ingrained and slow to change. Physicians need to hold their relationship with patients as a priority and maintain awareness of how that relationship is being undermined.

     


    Building the Rural Physician Workforce: The International Medical Graduate (IMG) on a J-1 Visa

    For this article, we will focus exclusively on non-US citizen, J1 Visa-holding physicians and rural primary care placement of these IMGs. Those recruiters new to rural recruitment and hiring IMGs for rural primary care positions need tools and tips to engage these well-trained and patient-oriented physicians for their healthcare...

    A Practical Guide to Recruiting Physicians on a J-1 Visa
    miroslav110/123RF.com

    Those in the primary care sphere predict physician shortages could reach north of 50,000 physicians by 2032. With just 9% of physicians practicing in rural communities where 25% make up the US population, rural recruiters must consider additional solutions and strategies to ensure rural primary care access is sustained. Advanced practice providers and technology-based care solutions are important to help close the primary care access gap, but International Medical Graduate (IMG)-delivered healthcare continues to be a critical piece to the solution as well. IMGs have proven quality and worth since the J-1 Conrad 30 Visa program began 25 years ago with its origins in work by Senator Kent Conrad (Kansas). IMG numbers are growing: close to 25% of physicians practicing in the US are non-US citizen IMGs; a small percentage of IMGs are US citizens that graduated from foreign medical schools. We will focus exclusively on non-US citizen, J-1 Visa-holding physicians and rural primary care placement of these IMGs. Those recruiters new to rural recruitment and hiring IMGs for rural primary care positions need tools and tips to engage these well-trained and patient-oriented physicians for their healthcare workforce.

    Pursue IMGs with Quality Training Who are Board Eligible

    IMGs attend medical schools outside of the US or Canada but train in US residencies and fellowships. The standards of entry for US training are governed by the Education Commission for Foreign Medical Graduates (ECFMG), an organization that has provided quality oversight of IMGs seeking US training for more than 60 years. An additional component of ECFMG oversight is that IMGs are required to take the United States Medical Licensing Examination (USMLE) to obtain a license to practice medicine in the US without restrictions. This involves passing the USMLE with at least 75% accuracy. At the forefront of ECFMG’s mission and work are quality initiatives to ensure that the best and brightest IMGs with excellent English as a second language (ESL) skills enter US training programs. Studies have shown that factors leading to quality physician care in the US are tied more to board certification versus native citizenship status or US medical school attendance. IMGs often come to the US with years of medical experience in their home country and essentially hit the reset button when they come to the US for primary care residency training.

    Recognize Loan Debt Is Often Not A Consideration

    For US citizens, the median tuition and fees for an in-state student to spend one year at a good, public medical school in the US is around $36,000. In some countries, international medical students rely on partial or even full state-supported tuition to pay for their medical school education. In other countries, up-front tuition costs may be less than one-third the cost of a US medical degree. Given that, most IMGs do not take out loans to pay for tuition; high medical and other healthcare professional student loan debt has the dubious honor of being largely an American fact of life.  Rural recruiters looking to hire mainly IMGs for Critical Access Hospital or ambulatory care positions should note that such practice locations do not need to be NHSC-qualified to be attractive to IMGs. In fact, IMGs are ineligible for NHSC loan repayment and similar programs unless and until they obtain US citizenship. Alternatively, programs like the Conrad 30 J-1 visa waiver are designed to support inclusion of IMGs in the rural primary care workforce.

    Find Cultural Fit

    People are more likely to build rapport with their healthcare provider when there are commonalities – country of origin, ethnicity, etc.  Nationally, the US Latino/Hispanic population makes up almost 17% of the total population. Texas, California, Arizona, Nevada and Florida have Latino/Hispanic populations ranging between 25-39%. It seems a no-brainer that matching primary care physicians by country of origin or culture to complementary rural opportunities is a solid fit. While training and medical school selection of Latino students remains too low in the US to meet cultural concordance in states with high minority Latino populations, groups like the Latino Policy and Politics Institute, based out of California, work on advocacy campaigns to help bolster both the US and Latino IMG workforce and draw attention to related challenges and propose solutions.

    IMG Training, Triage and the Takeaways

    IMGs often come to US residency training with significant medical practice experience within their home country. Like US Medical School graduates, IMGs have worked with patients who have complex medical conditions comparable to those in the rural US. Depending on home country origin, IMGs may gain intimate knowledge in how to work within a fragmented healthcare infrastructure, experiences transferable to practice in the rural US. Through these perspectives and experiences, IMGs are better able to navigate and utilize skills developed in their home country in rural primary care practice.

    Consider the Conrad 30 Waiver Program, Great for Smaller States

    Upon completing training, physicians on a J-1 Visa are expected to return to their home country to meet a two-year residency requirement to share the skills learned in US training in their home country. These physicians may seek a J-1 Visa waiver that allows them to stay and practice in the US for three years. Small or less populated states are best suited to the J-1 waiver program, as every state is allotted just 30 Conrad waivers without regard to size or need. Bolstering underserved primary care is the objective of the Conrad 30 waivers, so all states must set aside 25 slots for primary care, with the remaining five deemed flexible or “FLEX” slots assigned at the state’s discretion for non-primary care specialties in communities in need. Most rural communities are competitive for these waivers, but each state’s program may operate a little differently. J-1 waivers may be requested through State Health Agencies, typically through state Offices of Primary Care (PCO). These waivers require full-time employment in underserved communities with an expectation of employment for three years. That employment must start within three months of approval of the J-1 waiver. Your state PCO can be invaluable in helping navigate the process to obtain a J-1 Visa and serves as your partner for submission of these waiver requests.

    Conrad 30 J1 Waiver Program Resources

    Seek Alternate Avenues for J-1 Visa Holders

    Those recruiting for Rural Health Clinics (RHCs) or Federally Qualified Health Centers (FQHs) have an additional tool of the Department of Health and Human Services (DHHS) path for J-1 Visa-holding IMGs. To qualify, RHCs or FQHCs must be in HPSA areas with scores of 7 or higher. Employers in states that are part of The Appalachian Regional Commission (ARC), an agency partnership of local, state, and federal governments, may obtain J-1 waivers through a comprehensive application process at the discretion of this program and for a flat fee. A similar program, Delta Doctors, through the Delta Regional Authority, helps IMGs with J-1 Visas get waivers through employment in “distressed” counties and parishes in Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. There are other avenues for the primary care physician on a J-1 Visa; check with your PCO to see which may be a fit for your IMG’s situation.  Always be mindful that working with J-1 Visa-holding physicians as they go through the waiver process requires additional time to ensure application requirements and deadlines are met so plan accordingly. For a one stop shop about working with physicians on J-1 Visas, checkout the National Rural Recruitment and Retention Network’s (3RNet) toolkit.

    Additional Conrad 30 J1 Waiver Program Resources

    Support Your IMG Through Seeking A Green Card

    Long before an IMG seeks a green card, she or he should hire a good immigration attorney, which will serve them well regardless of the path taken after the J1 Visa Waiver requirement is completed. Through a Green Card, IMGs can obtain permanent residence in the US to live and work here. Typically, IMG physicians obtain Green Cards through Program Electronic Review Management (PERM) Labor Certification or the National Interest Waiver (NIW). During the recruitment process and once a J-1 Visa Waiver and site are approved, the IMG physician files for the PERM Labor Certification with you signing off as the US employer. Be aware that PERM Labor Certification does involve your active participation to include proof that a promoted opportunity for the IMG’s proposed physician job did not yield any interest from US physician candidates. The next step in the process occurs after the IMG has completed the three-year service requirement of her or his J-1 Visa waiver. At that time, IMGs apply for PERM Labor Certification using Form I-485, the Adjustment of Status form.  Another avenue, the National Interest Waiver (NIW), does not include employer involvement. The NIW can be filed at any time, but there is a five-year service requirement. The conditions are a good match for rural primary care IMGs seeking a NIW, as NIW requirements mandate that they practice in a shortage or medically underserved area. Cost to the IMG varies with the PERM Labor Certification and NIW. In all cases, be ready to prepare and provide appropriate documents to support your IMG physician in her or his path to obtain a green card.

    Orient Your IMG to Rural Primary Care and the Community

    It’s important to note the ways in which IMG physicians can be supported by rural communities. Provide an open, helpful demeanor, so that your IMG physician feels she or he can reach out to ask about commutable mosques, temples, or other religious houses of worship or services she or he may seek. Offer to help your IMG make personal connections in the community and serve as a resource and guide. Don’t neglect to meet with administrative staff and other clinicians about your new IMG physician’s role in the community and be clear about expectations in orienting her or him to the practice and community. Resources should include social media for your practice and hospital to help your IMG connect to virtual community support. Read up on the culture of your new physician and be mindful of any nuances in communication. Be aware that common US colloquialisms may not translate to your IMG’s language directly, so help her or him navigate small (but still big, in the scheme of things) hurdles around US figures of speech. Organizations like the International Federation of Medical Students’ Associations (IFMSA) and ECFMG’s acculturation program are tremendous resources for you and the rural primary care IMG. It’s a two-way street for success, with equal parts diligence, clear communication, and understanding to set a course for meaningful connections between your IMG primary care physician and your rural community.


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