Tuesday, May 31, 2022

Rural health care challenges go beyond a lack of doctors

People living in rural areas have long had difficulty accessing health care, a situation usually attributed to a lack of nearby care providers. But a new study suggests the problem also lies in the financial, cultural and interpersonal challenges many rural residents face when they seek care, especially for chronic conditions.

A team of researchers reviewed 62 studies involving more than 1,350 patients with cancer, behavioral health problems, HIV/AIDS and diabetes living in rural areas. Their goal was to study and synthesize the patients’ experiences when it came to accessing health care services.

The authors found four major “analytic themes,” and accompanying challenges, associated with the patients’ attempts to obtain care for their chronic conditions. They identified these as:

  • Navigating the rural environment: This category included challenges such as the need to travel long distances for routine health care services while experiencing poor health, having to to rely on spouses and other caregivers for transportation, and the belief that the care available nearby was worse than that in more-distant locations.
  • Navigating the health care system: Problems in this category included delays in getting care due to limited availability of specific clinicians, barriers to maintaining a continuous relationship with specific doctors or organizations, inadequate communication between different providers, and frustration with inflexible scheduling and long in-clinic wait times—often followed by what they felt was inadequate time with their clinician.
  • Financing disease management: In half of the studies analyzed, patients said that living in a remote area meant they had to bear costs of transportation, overnight lodging and childcare to obtain needed care. Many patients also cited low pay and overall economic hardship in their communities as challenges in financing their care.
  • Rural life: While many participants said they liked living in a close-knit community with high levels of social support, they also cited the accompanying lack of privacy as a barrier to obtaining health care, especially for stigmatized conditions such as AIDS or mental health. Others complained of a lack of cultural sensitivity and stereotyping of rural residents among health care professionals and clinic support staff. Native Americans in particular, the authors say, “characterized western practitioners as paternalistic, condescending, and openly skeptical of tribal healing practices.”

The authors note that despite the overall growth of telehealth during the COVID-19 pandemic, it has been used less for patients in rural settings compared with those in urban areas. They recommend that future researchers explore how telehealth services affect the experience of care access for rural patients with chronic health conditions.

The study, “Rural Patient Experiences of Accessing Care for Chronic Conditions: A Systematic Review and Thematic


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Friday, May 27, 2022

4 Tips on physician practice succession planning

Succession planning is essential for private practice owners, especially since ownership transition can be necessary at a moment’s notice due to unforeseen events such as illness, death or retirement. Unfortunately, many physicians have not contemplated succession planning or do not have a comprehensive succession plan in place. This widespread lack of succession planning can lead to major obstacles for both private practice owners and the continuity of care for patients. An increasing number of physician owners are expected to retire within the next decade, which will create an extremely competitive market for medical practices looking to sell to new owners. Private practice owners who want to secure the future of their medical practice need a solid succession plan in place to ensure a smooth transition from ownership to retirement. There are several options available if you are a private practice owner looking for advice on how to establish a succession plan. Here are four tips on getting started:

1. Select a designated successor


The first step to medical practice succession planning is deciding who will inherit your business. You can select an individual physician, a group of physicians, hospital, another practice, or a private equity-backed management company (“MSO”).The intent, of course, is to have someone who will continue to care for your patients and also maintain good relationships with referring physicians and the community as a whole. Many of your patients and referring physicians may come to your practice because of their relationship with you. Choosing the wrong successor can lead these patients and physicians to seek care elsewhere. As an aside, if you decide to select a family member as your successor, be it a relative or child, make sure they want to run your medical practice and have a passion for the business side of private practice.

2. Create a buy-sell agreement


Once you have decided your successor, you need to ensure your private practice succession plan is legally protected. There are several legal arrangements you can make to plan for succession, and one of the most popular is creating a buy-sell agreement. A buy-sell agreement allows you to make provisions that govern what will happen when you decide to leave your practice. You can state who will own your practice, how shares will be allocated if there are multiple owners and at what price to sell shares. Even if your retirement is more than 10 years away, creating a buy-sell agreement is a good idea. Buy-sell agreements can determine what will happen if unforeseen circumstances, such as bankruptcy or personal injury, force you to leave the practice of medicine earlier than expected. This will ensure your chosen successor (or successors) are legally able to transition into ownership when you step down.

3. Prepare your successor (and yourself) for success


Once you have finished your private practice succession planning, chosen a successor and taken care of the legal arrangements, you will need to train your successor to successfully run your medical practice. I cannot stress enough the importance of this step and yet it so often is overlooked after the attorneys have drafted the legal documents and departed the practice.Even if your successor is passionate about your practice, you should set up a training plan that exposes them to every area of your medical practice so they can learn the critical management tasks that you may take for granted. In addition to training your successor, you should also plan your own exit strategy. Give your successor room to learn and grow while you are still in a place to offer advice, but be prepared to start giving them more control as you approach retirement. This can prove to be difficult for passionate private practice owners, but it’s essential to gradually let go and allow your successor to take ownership when you’re ready to depart.

4. Communicate your succession plan


The last thing you want to happen as you create your succession planning is for rumors to spread about your departure. Rumors can become misunderstandings if you are not clear about who will be running your medical practice and when the transition will take place. You risk patients leaving and referring physicians sending patients elsewhere if they are concerned about the stability of your practice. Once your plan is in place and the time is right, make sure to tell your patients and referring physicians and assure them that your successor will provide the same level of service they have come to expect while working with you. Communication is also essential with the person you are eyeing to be your successor. Don’t let them jump ship for another job without communicating that you are considering them as the eventual head of your medical practice.

Private practice succession planning can take years, so it is essential to get an early start. Make sure to involve an experienced consultant at the outset as they can walk you through the strategy and also can coordinate the other needed professionals such as an attorney, accountant, and financial advisor.The earlier you get started, the better chance you have at ensuring the transition to your successor is as smooth as possible.


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Thursday, May 26, 2022

Managing millennial physicians

As the physician shortage gets worse, experts say the health care system needs millennial physicians to shore up the workforce. At the same time, as millennials are seeking changes to the day-to-day operations of the system, they’re driving a much larger conversation about what health care should look like.

Ted Epperly, M.D., president and CEO of Family Medicine Residency of Idaho in Boise, sees the millennial generation of physicians as a way to refill the ranks but warns that all physicians aren’t equal. It will take more than one millennial to fill the hole left by a retiring baby boomer doctor, he says.

“The data on this is that for every retiring boomer physician, it’ll take about 1.7 millennial replacements,” Epperly says. “And the reason isn’t that they’re not as capable. It’s that they’re not willing to put in the 80-hour workweeks.”

Andrew Hajde, CMPE, assistant director of association content at Medical Group Management Association in Englewood, Colorado, says the health care system is reaching a point where millennial physicians are becoming the only ones left to pick up the slack of retiring boomers and Generation Xers before Generation Z comes of age. “I think you have to learn to work and integrate (millennials) into your system,” he says.

Millennial physicians are simply different from the generations of doctors who have preceded them, and that can pose challenges for physicians seeking to fold them into their practices as doctors. These challenges include different attitudes toward work-life balance, technology and mentoring.

Work-life balance and purpose


While some pundits may decry millennials’ love of avocado toast and their shunning of certain industries, Epperly says he believes they are bright and creative physicians who aren’t afraid to put in the labor, though their philosophy is diametrically opposed to his own generation’s views on work. “They want to do (the work) quickly, efficiently and effectively, but then they want to hand it over to the next capable and accountable person so they can then get to” the rest of their lives, he said.

A survey of final-year medical students performed by national physician search and recruitment firm Merritt Hawkins found that new doctors are taking their desire for more free time into account when evaluating employment opportunities.

Natasha Bhuyan, M.D., is a family physician and regional medical director with One Medical in Phoenix and is a millennial. In her role with One Medical, she speaks to many millennial physicians, and what sticks out to her about the cohort is their desire to be fulfilled by practicing medicine.

Unlike previous generations, though, millennials don’t base success on hours spent in the office or number of patients seen, Bhuyan says. “They’re measuring success based on fulfillment of purpose, based on developing meaningful relationships with patients and having time to connect with patients, improve their behaviors and see health results and outcomes change,” she says.

The millennial physician is less interested in starting their own practice and prefers employment with a physician organization aligned with their values, according to Bhuyan.

Hajde spent years managing group practices. He says this move from starting a practice may be due to the increased emphasis on avoiding burnout. “They see some people, not just physicians, but those with different jobs and careers across the board, struggling with burnout and other things when they try to take on too much at one time,” he says.

Millennial physicians are less interested in being the prototypical “cowboy” doctor, seeking to take care of all a patient’s needs, and more interested in being members of a team in which each member has their role, with the combined goal of offering the patient high-quality care, Bhuyan says.

Technology


Experts say millennial physicians are more comfortable with technology than other generations.

Cristy Good, M.P.H., MBA, CPC, CMPE, a senior industry adviser with Medical Group Management Association, says that technology is a key marker in the generational divide in practices. Whereas some older physicians may be reluctant to use newer technology or have resisted technology in general, the millennial is looking for tools that increase communication. She says where older physicians may have stuck with paper charts and were used to discussing things in staff meetings, the millennial physician was using an EHR in medical school and believes communication among colleagues can be handled in quick emails and text messages.

With many millennials not having experienced a world without the widescale integration of the internet, Epperly says the younger physician is extremely tech savvy and isn’t even going to look at working at a practice where the technology isn’t current.

Bhuyan says that while millennial physicians are indeed looking for better technology integration, they aren’t seeking technology just for the sake of it; they’re looking for technology that allows them to practice at the top of their license without getting burned out. “We want technology that enables us to have a career that’s professionally rewarding and takes out all those inefficiencies and administrative burdens in the system that tend to drive that burnout,” she says.

Hajde says that millennial physicians must be cautious, as too much communication technology can turn patients off because of the lack of personal contact with their physician. “I think that as newer physicians come into the field using technology, we have to be really careful to kind of maintain that relationship with the patient,” he says. “They need to look at them when they’re seeing the patient and not stare at the computer screen.”

Feedback and mentoring


Epperly says the key things millennial physicians are in need of are feedback and mentoring, which are different from the needs of Gen Xers. “They see the value of picking a senior person’s brain to help them be more efficient and more effective.”

Bhuyan says that millennials have also changed the forms that feedback and mentoring can take. The model is no longer just a senior physician transferring everything they know to the junior physician. “I like to think of mentorship more like coaching: How do we coach physicians to reach the top of their potential and beyond? How do we push people beyond what they think is their best?” she says.

Bhuyan adds that millennial physicians should have a hand in guiding their own development and mentoring, and practice managers should be willing to place them into higher roles within the practice.


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