How to improve provider satisfaction in the emergency room
Evaluating people & processes + improving the practice environment
By the very nature of its purpose, the Emergency Department is a uniquely challenging part of any hospital, and the demands for and on the physicians, who make it tick are ever increasing. Creating and maintaining positive provider morale requires ongoing commitment to strong ED leadership, appropriate staffing levels, a financially and operationally strong practice environment, work-life balance, and consistent demonstration that the hospital values the people who make up its emergency medicine team. Fostering this kind of culture will breed not only Physician and patient satisfaction but also physician and patient loyalty—aspects no hospital in today’s healthcare environment can afford to ignore.
In this guide, we explore four areas which can impact provider satisfaction:
PART 1:
Recruitment and Retention
How to acquire and keep the best doctors
PART 2:
Medical Directors
The vital role they play in provider satisfaction
PART 3:
Hospital Leadership
Fostering a positive practice environment for better retention
PART 4:
Work-Life Balance
Strategies to address physician burnout
Part 1: Recruitment and retention
Now is a great time to find employment as an emergency medicine physician. But for hospital administrators trying to recruit and retain highly qualified candidates, times are tough. A 2018 study by the Association of American Medical Colleges showed that by 2030, the projected physician shortage for specialties including emergency medicine, anesthesiology, radiology, neurology, and psychiatry is between 20,300 and 36,800.
These projections persist even with moderate increases in APRNs and PAs, delayed Physician retirement, and changes in payment and delivery. In 2018, the American College of Emergency Physicians also reaffirmed their belief that there is a significant shortage of physicians appropriately trained and certified in emergency medicine.2 Add to that an aging baby boomer generation, a growing overall population, and an increasing shortage of primary care providers, and we have more patients than ever turning to Emergency Departments for help.
A shortage in physicians can mean more stress on the existing team, longer hours, more overtime, and general provider dissatisfaction with work. Lest you think the future is all gloom and doom, there is good news. Recruiting and retaining enough EM doctors to run an efficient EM program improves overall morale—and it’s not only possible but also uniquely within your control.
Three steps to recruit and retain the best ED doctors
Step 1: Examine your recruitment and retention strategy
Your hospital or recruiting partner should have a defined and trackable recruiting process in place. Begin evaluating its overall effectiveness by asking the following questions:
- Is your recruiting process generating enough quality candidates and doing so in a timeframe that meets your ED’s staffing needs?
- Alternatively, is your ED relying on temporary staff, such as locum tenens, for longer than is financially feasible?
- Are you meeting your goals for quality, consistency, community involvement, or ED team cohesiveness?
- Are the doctors you’re trying to recruit turning down your offer and going elsewhere? If so, why?
Step 2: Revise your recruiting processes
If it appears that the weakness lies in not closing the deal with a model candidate but in finding suitable candidates at the start, it’s time to back up and evaluate your recruiting processes. To begin making changes, ask questions like:
- How deep is the physician database your recruiter or recruitment partner utilizes?
- Has the database been cultivated over the course of years, or better yet, decades?
- Does the database include physicians nationwide yet allows the recruiter to identify those who were raised, attended medical school, or fulfilled their residency near your hospital or in your hospital’s state or region? How often is the database updated?
- Something else to consider: How well-versed is your recruitment team regarding the differing priorities of EM physicians and their practice environment needs? And, are EM physicians just one of a number of specialties for which they recruit?
You may find that your current process or recruiting partner simply isn’t capable of delivering upon your staffing needs. Don’t underestimate the impact an investment in a reputable staffing partner can have on not only recruitment, but also hospital process, your bottom line, and overall employee satisfaction.
Step 3: Factor retention on the front end
Many organizations make the mistake of assuming that retention begins only after an individual has signed on to your ED team. In truth, successful retention starts at the initial recruiting stage.
Essential to the process is to determine not only the kind of asset he or she would be to your ED, hospital, and community, but also how much of an asset those entities would be to him or her.
Would working in the area allow the candidate the opportunity to move near family? Perhaps your hospital serves a segment of the population about which he is truly passionate. Or maybe the ED offers a clear path to a leadership position she seeks, such as medical director or hospital administration.
In today’s employment climate, successful recruiting and retention are less about selling your hospital or ED than it is about listening carefully to the candidate’s particular desires and determining whether or not your facility and practice environment can comply. Therefore, in addition to understanding what makes each candidate tick, your recruiter’s ability to understand and communicate your hospital and ED’s culture and priorities are essential to making a good match with candidates. Properly aligning the two before contracts are signed will reduce the risk of dissatisfaction or turnover in the future.
Part 2: Medical directors
The role of the medical director in physician retention
Recruiting outstanding, well-aligned physicians to your hospital’s Emergency Department is one thing; keeping them is another. As long as the number of opportunities across the U.S. outweighs the number of EM physicians, your EM team will continue to receive calls about other opportunities throughout their tenure. While you can’t prevent the calls, you can give your doctors enough reasons to stay so that leaving isn’t something they would seriously consider. As such, hospital administrators, along with the ED leadership team, must put as much priority on retaining top-tier talent as they do in recruiting them.
The tie between medical director leadership and physician retention
Your ED Medical Director bears the greatest responsibility for the success of the Emergency Department, not only operationally and financially, but also regarding the quality of care and patient satisfaction. Because of the intense focus these areas demand, it’s possible for Medical Directors to lose sight of the linchpin that makes success in these areas possible: the physicians themselves.
For emergency medicine physicians to work safely and efficiently, and deliver excellent, patient-centered care, they must have a Medical Director who can lead effectively—someone who can combine broad vision with strong clinical, managerial, and interpersonal skills
Is your medical director up to the task?
- Operationally, does your ED have reasonable throughput and wait times?
- Does the Medical Director monitor operational and financial metrics, champion improvements, and motivate the team as a whole?
- Does he/she help develop and implement protocols that support good patient care and a well-oiled practice environment?
- Do complaints arise from patients, physicians, or the nursing staff?
- Does he/she instill a sense of collaborative practice within the ED and extend it to other groups and specialists?
Ideally, you want an ED Medical Director who can create and maintain the kind of environment that is as beneficial for physicians as it is for patients.
Supporting your ED medical director
Before making a judgment call, consider the caliber of your support by asking these questions: • Are you providing your Medical Director with the tools and metrics they need to skillfully monitor and guide the day-to-day operations and performance of your ED and its physicians?
- Are you giving them access to ED-specific leadership training?
- What about ongoing education and training opportunities to advance their practice of medicine and ED management skills?
- To whom are they accountable?
- Who is guiding your ED Medical Director?
Regarding the last question, it should be someone with both clinical and management experience in emergency medicine who can mentor your Medical Director in the leadership of a cohesive EM Physician team and high-functioning Emergency Department.
Part 3: Hospital leadership
Administrative leadership’s impact on ED physician retention
As recruiting and retaining ED physicians becomes increasingly competitive, it’s increasingly important that hospital leaders foster a healthy practice environment. When it comes to physician retention, practice environment is often cited as the most influential factor in a physician’s satisfaction at work.
An EM physician is like any other professional: If he likes where he’s going to work each day, he’ll be less inclined to look elsewhere.
New opportunities will come calling, many with bigger paychecks and grander promises. While you can’t prevent that, you can ensure your ED physicians are working in the kind of practice environment they wouldn’t risk giving up, regardless of the perks being offered. Aside from supporting the Medical Director, there are other factors you can impact to create a better practice environment—namely, ensuring adequate coverage, engaging and empowering the team, and keeping communication lines open.
Ensuring adequate coverage
Engaging and empowering the ED team
Keeping communication lines open
- Does the current provider-patient ratio allow your EM physicians to spend adequate time with patients, or are both patients and doctors feeling excessively rushed?
- Is the current nursing and secretarial or department support adequate for all shifts?
- If adding another physician isn’t affordable, is it feasible to add a nurse practitioner, physician assistant, or a scribe to high-volume shifts?
- Also, along with examining day-to-day operations and metrics, pull back and look at the big picture through a physician’s eyes as well.
- Do your ED physicians feel valued?
- Are they recognized for jobs well done as often as they receive suggestions for how to improve?
- How are decisions made in the ED—by consensus or directive?
- Are ED physicians granted a voice and an opportunity to share ideas and experience before you make decisions affecting them?
- Is someone accountable for acknowledging or rewarding good physicians and working with or removing those who obstruct the harmony of the practice environment?
- Are you checking in with ED physicians in person to gauge their satisfaction?
- Do you have an objective, non-supervisor in place (such as a scheduler) who frequently communicates with physicians? Are you leveraging that person to help make you aware when physicians or the practice environment are struggling?
Part 4: Work-life balance
The truth about emergency department burnout
Burnout is a problem for all physician specialties, but it’s particularly significant among emergency medicine physicians. Since hospital administrators ultimately bear the burden of ED stability, installing safeguards against burnout is vital.
A 2015 Medscape Physician Lifestyle Survey of 7,000 physicians revealed that:
- 52% of EM physicians experience burnout
- EM physicians experience 3X the burnout as the average doctor
- 10% of EM physicians said they are so burnt out, they consider leaving medicine
Top 3 burnout causes (according to Medscape)
- Too many bureaucratic tasks
- Spending too many hours on the job
- Insufficient income
These factors affect physician well-being and lead to poor performance, lower patient satisfaction scores, increased errors, alcohol and drug abuse, and even thoughts of suicide. To retain the best EM providers, hospital administrators must make preventing burnout a priority. To do so, commit to providing strong ED leadership, appropriate staffing levels, a supportive practice environment, and perhaps most importantly: work-life balance
Three keys to healthy work-life balance
Balance work schedules
While you cannot control who walks through the ED door or when, you can ensure your ED team is ready. A humane physician work schedule that allows for adequate balance with a doctor’s life outside the ED is a great starting point.
- Ensure EM schedules don’t require flips from night to day and back again
- Avoid lengthy and unsafe shifts
- Monitor patient volume to ensure the ED is adequately staffed for swings in patient load
- Ensure all physicians share responsibility for working nights, weekends, and holidays Striving for fair and equitable scheduling goes a long way in promoting a stable, team-centric practice environment.
Offer value beyond income
Simply raising a physician’s rate isn’t a magic bullet. The reality is that raising ED physician pay above the market rate for your region may not be feasible for your hospital, or even fruitful. Long-term physician-hospital commitments tend to be more strongly fortified by those things money can’t buy:
- Shared values
- Capable leadership
- A supportive practice environment
- A collaborative ED team
That’s not to say money doesn’t matter. Signing bonuses and relocation reimbursements are often valuable draws for younger, less experienced physicians with minimal savings post-residency but face daunting school loans. For more established, experienced physicians, signing bonuses and relocation money may not be as important as what they want or need in a practice environment, culture, Medical Director leadership, or team.
Lighten the load with support staff
The push to develop and deploy EMRs and the need for more detailed documentation has forced providers to spend extra time during and after patient visits capturing and entering data—impacting both time at the bedside and at home. A solution to help lighten the documentation load is the use of medical scribes or a speech-to-text EMR dictation resource. Scribes work as on-premise or virtual assistants—responsible for entering information into the medical record with the doctor’s oversight. Scribes can also look up details, such as: what’s in old records, nurse’s notes, medications the patient is taking, and things the doctor can’t readily recall. The scribe takes notes in real time as the doctor interacts with the patient and alerts the doctor to questions he or she may need to ask, such as social or family history. Scribes help boost provider satisfaction with:
- Increased efficiency and productivity
- Better bedside manner
- Improved surge volume management
- Adequate shift coverage
- Reduced wait times/LWOTs
- Rural hospital assistance
- Enhanced patient satisfaction
As the industry evolves speech-to-text EMR dictation tools are quickly becoming the resource of choice for provider documentation. This allows the provider to speak directly into the computer when documenting patient encounters. It is important for hospitals to support methods that improve provider efficiency, productivity, and documentation. Notes entered during the actual episode of care means fewer required entries at the end of the day for the physician.
The first step is to take a closer look
Improving provider satisfaction can be a seemingly daunting task. Simply evaluating your existing recruitment and retention strategies and capabilities of hospital leadership will give you a healthy step in the right direction. With a proper understanding of your facility’s challenges, you can take small steps towards a more positive practice environment and ultimately, happier, more productive emergency medicine providers. Regardless of the steps you take, making a conscious effort to support your providers during work and protect their personal time outside of work will show you value your physicians and take the problem of provider morale seriously. This positive culture will not only benefit your physicians by reducing burnout, but also your Emergency Department’s overall care quality.
