Recent polls rank health care at the top of issues that matter most to Americans. In many cities and communities throughout the country, the biggest hurdle to improving health care is a shortage of physicians. At the Los Angeles County Department of Health Services (DHS), the second largest municipal health system in the nation, this problem is gaining urgency. DHS annually cares for 600,000 patients at 19 health centers and four hospitals, a daunting mission under the best of circumstances that is only compounded by inadequate staffing.
The physician most needed by DHS is the most fundamental – the primary care provider and the hospitalist, or inpatient primary care provider. In one estimate, California will need over 8,000 additional primary care physicians by 2030, a nearly one-third increase that experts say will be hard to meet. At DHS, which serves those without private health coverage, physician recruitment has an immediate qualitative impact on patients who otherwise have no other place to turn. The addition of a single physician means increasing access to care (preventive, primary and specialty) for 1,000 people. Moreover, the primary care physician is the lynchpin for more effective team-based care that DHS wants to expand but cannot without additional hires. This situation has prompted DHS management to reassess its recruitment system. Historically, each DHS hospital has been responsible for its own recruiting, but they all share a rules-bound process to hiring physicians, who are civil servants represented by a union. Now, pressed by the growing need for more primary care physicians, DHS is looking to form a centralized recruitment team with a streamlined approach to its mission, including such unprecedented measures as strategic marketing campaigns and increased stakeholder outreach and collaboration.
While developing new medical schools and making it easier for international medical graduates to practice in the U.S. could alleviate physician shortages over time, the problem will remain a challenge to the health care industry for the foreseeable future. DHS management believes the solution is not in retooling current recruitment practices but in creating a new approach, one that is equipped to deal with a more demanding scenario. The opportunity to play a leading role in formulating a new and robust method to recruit primary care physicians has enormous relevance nationally, where every health system is facing a similar challenge. In terms of public need, as polls make amply clear, the stakes could not be higher. To support this work, Los Angeles County will partner with FUSE Corps to host an executive-level fellow for one year who will plan, develop, implement and operationalize a physician recruitment program that is effective and sustainable into the future.
Project Summary & Potential deliverables
The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables that follow will be collaboratively revisited by the host agency, the fellow, and FUSE staff during the first few months of the fellowship, after which a revised scope of work will be developed and agreed upon by the FUSE Fellow and the host agency.
Starting in April 2019, it is proposed the FUSE Fellow will conduct a current state and needs assessment of DHS physician recruitment policies and practices. This will be supplemented with an overview of recruitment practices inside and outside the health care field. Extracting the best information from this process, the fellow will consult with DHS human resources and medical leadership staff to formulate a plan for a new centralized in-house team dedicated to physician recruitment and onboarding. Consideration will be given to a cost/benefit analysis of recruitment packages, such as relocation assistance and other perks. The plan will also include outreach and collaboration with stakeholders, primarily the physicians’ union and affiliated teaching universities. The fellow will then give shape to a marketing plan, which will include an understanding of what DHS can offer candidates, highlighting its accomplishments and importance to the community. It will also incorporate the national reach of the physicians’ union and other influential organizations to reach potential candidates. The fellow will advise on the best way to employ the marketing strategy, based on a cost/benefit analysis: in-house or through an outside agency. This preparation will be followed by implementation of the recruitment plan and an assessment of its early operational efficacy.
This fellow’s success in the endeavor will be evaluated based on several factors. A thorough analysis of current recruitment practices is essential, as is a needs assessment to pinpoint shortcomings. With a strong background in strategic planning and project management, the fellow will create a recruitment plan based on marketing, hiring and onboarding methods that streamline the process and attract a larger pool of primary care physicians. It will also be essential to engender a sense of stakeholder participation in plan development – internally (DHS management and the chief medical officers at each facility) and externally (the physicians’ union and teaching schools) – to ensure collective buy-in. The final third of the year will involve implementation of the recruitment plan, with an eye towards making operational improvements during the rollout and establishing continuity beyond the fellowship year.
- Conduct a landscape analysis: Get an overview of the current state of DHS physician opportunities and recruitment policies and practices, focusing on agency needs and the shortfalls in meeting those needs. Also, gather information on best practices in recruitment both inside and outside the health care industry, including the market and recruitment cycles for physicians completing residency.
- Formulate recommendations for centralized recruitment team and engender stakeholder buy-in: Define recruitment processes and practices, including recommendations for a centralized recruitment team with streamlined, innovative systems. Define team structure and composition, including recommended positions and other resources necessary for implementation. Seek in-house and outside stakeholder participation to further develop plan, culminating in collective buy-in.
- Assess recruitment marketing strategies: Apply specific marketing scenarios to the DHS context, considering the scale of DHS operations and the nature of public sector hiring as well as the market and national cycles for hiring physicians completing residency. Provide recommendations for what the ideal marketing strategy should be and identify capacity needs (in-house or contractor) for implementation.
- Initiate implementation of new recruitment team: If time permits, roll out new centralized recruitment team, setting clear short-term goals. Monitor progress, maintain close stakeholder communication and make changes to team processes and practices as needed. As the team establishes operational cohesion and efficacy, add longer-term goals to near-term tasks and conduct succession planning to ensure continued team success after the fellowship year ends.
- Elizabeth Jacobi, Chief People Officer, Los Angeles County Department of Health Services
- Hal F. Yee, Chief Medical Officer, Los Angeles County Department of Health Services
- At least 15 years of professional experience in strategic planning and project management, preferably with direct recruitment and/or marketing experience.
- Superior critical thinking and analytical skills.
- Ability to synthesize complex information into clear and concise recommendations.
- Ability to relate to a wide variety of diverse audiences with strong emotional intelligence and empathy.
- Excellent stakeholder engagement skills and the ability to use facilitative leadership techniques to coordinate stakeholder participation.
- Self-motivated, goal-oriented, entrepreneurial leader who can also be an independent worker.
- Persistent in obtaining information and creatively resourceful in identifying solutions to complex problems.
- Ability to create direction and movement within bureaucratic environments.
- Exceptional written and verbal communication skills.
- Understands the need for solutions to support all people in a community regardless of race, religion, gender, immigration status, or ethnicity.