Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep111: The physician engagement crisis, with Bill Heller of CHG Healthcare
Transcript
- 0:00 If you can engage your physician force, which is so important you've solved a lot of your problems, welcome 0:16 to off the chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians. Practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the Assistant Editor of medical economics, and I'd like to thank you for joining us today. Last month, CHD healthcare released its 2025 physician sentiment survey based on responses from more than 900 physicians across the US. The biggest takeaway is that while most physicians say they're satisfied with their current jobs, a much smaller percentage say they actually feel engaged at work. I got the chance to sit down with Bill Heller, the Chief Operating Officer at CHD healthcare, to walk through the report and break down what's behind those numbers. We talked about trust in leadership, communication, administrative burdens, economic pressure, and how engagement shapes whether physicians stay, leave or look for alternatives. We also discussed what the survey suggests the leaders can do now to improve engagement without adding major spending bill. Heller, thank you again for joining us. Let's get into the episode. 1:22 You Heller, thank you so much for joining me today. 1:28 Yeah, it's good to be here. Thanks for having me. Man, according to the survey, 1:31 75% of physicians are satisfied with their roles, but only 18% are highly engaged. Could you talk about what's driving that disconnect and what healthcare leaders should take from that data? 1:42 Yeah, I would say two things. One, you know that 75% satisfied is, you know, we shouldn't be too comfortable with that. You know, there's a hidden vulnerability there, because satisfied employees are still at risk to leave, you know, creating that turnover risk. I would say, you know, there's a lot of things, a lot of the garden variety, things that you would expect, that we hear, you know, time and time again, that we just haven't fixed. Things like, you know, two physicians are frustrated by spending too much time on documentation, on administrative tasks. They seem to be, you know, they're at the forefront of understaffing, whether it's understaffing of, you know, clinical support or understaffing of physicians, that is certainly a frustration that we're seeing show up and then it's communication. Communication is really important to physicians, and they want to have have more input, be heard more and so those are some of the things that are popping up relative to, you know, satisfaction. The data also shows 2:55 that physicians who feel highly engaged are much more likely to say that their leadership is transparent and communicate openly. And communicate openly. I mean, you talked about that, the importance of that communication. Could you talk about what kind of day to day behaviors actually build that trust? Yeah. 3:09 I mean, I think communication, you know, no matter what you know, industry you're in, or business, including, you know, the physician business or hospital business, you know, communication, it all starts there. And so I would start with communication in you know that day to day is physician again. Physicians want to be heard. They want to know that that administration is at least asking the questions of, how can you know? How can we make it better here. What can we do to drive patient care? How? How are you feeling about our protocols? And so I would say, more visible, you know, conversations. I would say physicians want to understand, just like all of us. I mean, physicians are people too. They want to understand the why behind decision making, if, if we're going to make a decision, and you know whether it's controversial or not, let's make sure we explain the why behind it. A lot of times when the why is more clear, it's easier to move people along frequent check ins. They're looking for more frequent check ins, on protocols, on staffing, on compensation models, all that stuff, and then feedback loops. You know, wanting to make sure that when they do ask for when administration does ask for input that the feedback loop is completed, whether it's the answer the physicians wanted or not, making sure that we close the loop on, hey, this is what we heard, and here's what we're doing or not doing, and why. And then, of course, you know, it's, you know, some. A that's an easy thing to do, or easier is to, you know, think about, how can we communicate and listen better the harder things get to you know, where you know, finance gets involved and margins get involved. And where you know, again, understaffing of support staff, understaffing of physicians, pulling away from, you know, what doctors want to do every day, which is patient care. Those are a bit more challenging. But again, if we start with talking and asking physicians have a lot of great ideas about all of those things, 5:40 and on that topic of trust, is a pretty clear divide with physicians who they tend to trust their direct supervisors a lot more than they do the executives and the organizations. What do you think drives that disconnect, and what's one thing that executives could start doing to close that distance? 5:55 Yeah, it's a great question. And again, it it's applicable, not just with physicians, but but in general, in business, almost anywhere you go, you know. But for physicians, certainly, proximity matters. They trust their supervisors. The trust levels, 57% of them in our study trust their direct supervisors, where 41% trust executive leadership. And so you can see the divide. I would say again, you can solve a lot with communication. You know, executives are oftentimes not just, you know, in in, you know, in the, you know, clinical world, but in business. Can be seen as tone deaf if you're not asking if you're not listening. Can be seen as detached from the day to day. And so you can see where you know that direct supervision could easily have, you know, high trust, because they're there at the day to day. They see more they're they're more involved. And so I think that's why physicians feel like you know that trust is more established with their direct direct or their direct supervisors and and, and I think that they have a general sense that their direct supervisor is just caring more and so again, if the if administration more visible, you know, checking in on on more of the day to day stuff, asking questions, doing listening sessions, humanizing themselves versus, you know, administrations over here, we don't see from them or hear from them, unless You know, things you know come down. I think humanizing administration is could go a long way. 7:46 Absolutely, I want to get into the net promoter score the NPS, it was negative eight, which means the physicians are unlikely to recommend their organization, and they would actually discourage colleagues from from joining the organization. What message should health systems take from that score? 8:04 Yeah, I think what I would tell you about Net Promoter Score is you typically in a in a challenging industry, you're typically going to see where internal NPS is often more challenged than external NPS, if the, if the if the hospitals would ask their clientele how they're doing, they'll get a better score on physicians. And they probably are grading this when they when they give their score, they're also thinking about how hard it is to be a physician in general, not necessarily just at that institution, but certainly that institution needs to, needs to think about it. I think, you know you want to drive net promoter. I mean, it is. It has become a really good indicator of loyalty and satisfaction and and, and. So while I said all those things that would make you feel less bad about a negative eight, a negative eight is that's a tough one to swallow on NPS, and so I think what I would say is, again, I'll go back to some of these things we talked communication, trust building is really important When you feel like you were in a trusting environment, you can that can go a long way. And about a third of the respondents in this, in the in this NPS rating were passives. And so that means they're not detractors, they're not promoters. They kind of sit in the middle like, yeah, I don't know if I would recommend a friend or colleague to work here or not. You know, focusing on getting a passive to be a promoter is is really good work, if you can do that. You know people that might be on the. Range of, well, I might, but then they pull back and say, I'm not really sure. So they fall into that passive category. There are things that we can do, like we're talking about today, that can take them from a maybe to a strong Yes. And so I think focusing on on those folks, and you kind of know who they are, focusing on that group, again, it's about 30 some percent of the cert of the survey respondents are in that middle group. How can we help them? With a little bit more communication, a little bit more trust, building a little bit more listening, a little bit more patient care that you know, putting them in a position for patient care, a little bit more support, a little bit more reduction of the administrative burden, can go a long way. 10:56 So most physicians also say they want to voice in decisions that affect their work, but only a minority feel like their input is actually asked for or used in those decisions. What's the simplest and most meaningful way that leaders can change that dynamic? 11:10 Yeah, you know, 72% of our physicians out there that we surveyed want input, and only 40% of them are saying they're asked for it. And then, you know, of that, 40 of that, 72% 44% say it's meaningfully Incorporated, if they're asked. And so, you know, I would tell you it's, it's the simple principles, it could be walk bys administration. There are lots of good examples out there where administration walks the floor, and it's the difference between, hey doc and walking by and hey, how you doing today? What's, you know, what's, what's your biggest challenge this week or today? And and really taking all that in and taking an active interest in that. And then it's more it's less simple things like creating, you know, interdisciplinary forums where, you know, we're talking about lots of different things, from protocols to patient care to other processes to administrative burden to AI stuff, you know, so everything from really informal to more formal, where you can get input and and for those that aren't doing that, you'd be surprised at how strong the input will be from your physician base. They have really good ideas. Some of them, just like in any company, you won't be able to, you know, do today or maybe ever. But lots of other things are actionable. And so I would say again, it is most of it goes down to dedicating the time to want to listen to the people that that make the hospital go round 13:10 based on the data, where do organizations often go wrong in trying to involve physicians in those decisions? You know, what does effective involvement actually look like when it leads to better policies or choices about technology, I know that was a big one, or compensation models, yeah. 13:26 I mean, I think you know if you're going to do it, do it meaningfully. If you're going to survey, make sure it's not just a token survey. Make sure that you're that you're really interested in what they have to say if you're going to consult on anything. Hey, we're considering a new EMR. We're considering a new, you know, software for this or that. We're considering a change to policy. Oftentimes it's, it's done too late, it's the decisions been made, or it's 85% of the way there. And so it's this late stage consultation, and it's pretty obvious the decisions have been made. Do it earlier, get their opinion earlier, to let you help inform that decision. And then again, it's about the follow through. It has to be if you're going to ask whether, whether the physicians are going to like the answer or not. Make sure you have a great feedback loop where, where you go back and you talk about, either you dig more on feedback, or you talk about the decision. You talk about the why behind it. You talk about the how you're going to move forward with it. And so again, it's not that different from most of what people expect from any employer they want. They want that. Ask me really listen to my opinion. Make sure. Is early enough, and let's have great follow through. 15:13 Hey there. Keith Reynolds here, and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow? Hack an employee engagement win or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds, at mjh, lifesciences.com with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. 16:02 You so 31% of physicians in the survey said that they're looking at work outside of medicine. 30% say they're considering moonlighting at the same time, only 10% of highly engaged physicians say that they're planning to change jobs, and 25% of everyone else says they are. What are those findings show about or what should health leaders take away, I guess, from those findings? 16:23 Yeah, there's a lot to unpack there. Yeah, there's certainly you can't talk about moonlighting and whatnot without you know, there's economic uncertainty out there, right? There's, there's uncertainty in the general economy, there's uncertainty with consolidation of hospitals, with public policy and, you know, healthcare policy. And so uncertainty creates those kinds of of thoughts. Well, maybe I need to, you know, make a little money on the side. Maybe I need to, you know, expand, you know, my opportunities to ensure that, you know any of this uncertainty, you know, if it does enter my sphere that I'm protected from, and I so, I think there's an aspect of that that is just economic uncertainty based, I think the other things that hospitals should take from this, when you when you look at, you know, well, 10% of, you know, highly engaged physicians would change jobs, but 25% there's a stark difference between, If you're engaged, you're locked in, you know, there while compensation and other things are really important that does make up some of that engagement, right? I mean, compensation is a part of engagement, but it's not, you know, it's certainly not all of it. And so it goes back to if you can engage your physician force, which is so important, one of the one of the top issues facing hospital administrators is attracting and retaining great physicians. And so if you can, if you can do a great job of retaining the ones you have through engagement, you've solved a lot of your problems, and you can move on to some of the other more important stuff. And so I think, I think that hospitals should take away from this, that engagement is important. It is a retention tool. It it does involve compensation and making sure that your compensation models work for you as well as for the physician, but it's much more than that. Physicians want flexibility, just like the rest of us are enjoying. You know, many of us are enjoying a new, flexible world over the last many years, physicians would like that too. Physicians want time with patient care, and so focusing on all of these things that are engagers to physicians will help you get that 25% that could be considering a job change down to that, you know, 10% that's a big deal. 19:16 Absolutely, yeah, I guess from for physicians themselves, rather than from the health system angle. I mean, you touched on the economic uncertainty. 65% of physicians are more worried now about the economy than they were a year ago. Obviously, they're considering different ways to protect themselves financially. We talked about moonlighting or maybe a different career path. What does that say about the role that engagement itself plays when the environment feels unstable. Yeah. 19:45 I mean, just like anything, instability and uncertainty causes people to start thinking and spinning and you know what, if and scenario planning? And so I think that you know, economic uncertainty, economic stress is high. 45% of those surveyed said economic stress is high. 64% are more worried than they were last year. And so, you know, you might think, well, physicians are, you know, physicians, you know they make a great living. They are immune from that, and but they're not. And so I would say that we have to consider uncertainty affects everyone, especially physicians. They're being highly recruited, right? Because, you know, almost everyone has an opening in just about every specialty, and so they're highly recruited. They're they're they've got lots of opportunity if they're willing to relocate and watch and so I think you've got, you got to pay attention to engagement. You've got to engage your physicians and know that they're just as human as everyone else, and the what's going on in the world affects them just like it affects your your front desk people, just like it affects your nurses, just like it affects administration. So I 21:16 want to get into some of those day to day pressures that are facing physicians, documentation and administrative work came through as major pain points in the survey, I think it was 50% of doctors cited documentation. 34% said administrative, administrative burdens, especially when considering things like staffing challenges or even just budget constraints and smaller and mid sized practices, when you don't really have much of a say over that, you know, you can't, you can't affect staffing or budgets. What leadership behaviors did highly engaged physicians report that actually made those pressures feel more manageable. Yeah. 21:54 I mean, I'll start with, you know, the stats that some of what you mentioned, you know, 45% of the respondents said they spend more than 15 hours a week on paperwork. That's a pretty stark number. And 35% of course, are citing under staffing, you know. And there's, there's, as you mentioned, there are things you can do about some of it, and because of other pressures on the business. There are things you can't do. I think the ones that what physicians would like, and what we've heard, not just in this survey, but in some panels that we've done and other things, is they would it's always great to start with just an acknowledgement they would love. They always appreciate when administration acknowledges, yeah, we there's a burden here, whether it be on staffing, whether it be on administrative functions, systems that are, you know, not optimized, processes that are not optimized. You know, starting with an acknowledgement is always good. A sincere acknowledgement, talking about the road map of just knowing that, hey, I want you to know that we're working on, you know, well, we talked about these five things. These two things are actually in flight, and this third one is something that is on our roadmap, and understanding that we are working on fixing this process, this protocol, this system dysfunction, that if we made these changes, could make everyone's life easier. And so I think acknowledging then talking about, you know, what's in flight a lot of the times, the physicians are the last to know. Oh, I didn't know we were working on that. So I think that, I think while we talked about Austin involving physicians in communication and listening, you know, that's great, but let's unburden them from unnecessary bureaucratic meetings that that are time wasters and so put them in the right settings where they can add value and where they can be heard, but try to unburden them from the things that are less important, more bureaucratic. Can, can one of them be there to represent instead of 12 of them, things like that? And then, of course, you know AI is upon us, and I know we're probably going to talk about that later, but you know, thinking about how AI can can help. And again, I'll save us. I'll save us times. I'm sure we'll talk about that. 24:44 Yeah, perfect segue. A lot of physicians in the report believe that artificial intelligence can improve efficiency and help with some of those challenges that we talked about, but far fewer think it'll give them more time with patients. Many of them worry that those gains will just turn into higher volume. They also. Say they want a real voice in tech decisions, and most feel excluded in that taken together, what are these findings suggest about how AI should be implemented if leaders want it to genuinely reduce burdens and protect autonomy, strengthen engagement? 25:14 Yeah, I mean, you hit it right on. Is that physicians are actually excited about AI they see the potential with AI to really help, and you're seeing it already in lots of areas of of health care. They're they're overly concerned about, or appropriately concerned about, that the AI gains will just lean to lead to more patient volume, and so, you know, they're where they're excited about it is, I can see these tools. I can see where this can really be an important part of the healthcare delivery process. What I want to get back from that is more time with my patients, greater patient care, you know, more time to spend, less churn and burn. And so there, you know, there's a little trepidation, because on one end, again, super excited about what AI can bring to healthcare delivery. On the other hand, worried that it won't be used. What the AI will be great but, but how it will impact the physician is more, more more, more more versus better patient care. And at the end of the day, you know, that's what, that's what they want the most out of anything is they went into medicine, and they stay in medicine to deliver great patient care and and all of the burdens have pulled them away, you know, little by little, and they're hoping that the AI will will give them some of that Patient Care time back, 27:01 if there's one message that physicians are sending through this survey that you hope the healthcare leaders really hear, 27:07 yeah, I mean, I think we it threaded through everything we talked about is they would like administration to be visible, to listen to, you know, act in ways that that reinforce the importance and the value of their physicians, their work allow them to have their input. Concern about their well being is important. You know, physician well being we've we've seen here and other things. I mean, the frustration is off the charts, the the burnout is off the charts. And so, you know, general concern for the well being of the physician, and then just giving them time to spend on on patient care, that's what they really want. Great. 27:50 Well, those are all the questions that I have prepared. Is there anything we might have missed from the survey, or anything else that that you want to share with the audience? 27:58 No, I think you know, despite all this Austin, what I would tell administrators is they're doing a great job, you know, in lots of ways, and they're balancing, you know, it's, it's a really hard balancing act to to run a hospital and to balance the finances, With the census, with physicians and nurses and all the things that go into running the hospital, and by and large, they're doing a really nice job. It's those little extra things that they can do a little will go a long way relative to physician and a and a happy, engaged physician workforce can solve a lot of those problems, or at least go a long way to solving some of those problems. So there's a lot to be gained by by doing some small things that can really lead to significant engagement improvement. 28:57 Great. Well. Bill Heller, thank you so much for taking the time today. 29:01 You bet that was super fun. 29:13 Once again, that was Bill Heller, Chief Operating Officer at CHD healthcare. My name is Austin Luttrell, and on behalf of the whole medical economics and physicians practice teams. I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week. Subscribe to our newsletters at medical economics.com and physicians practice.com off the chart, a business of medicine. Podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Latrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you. Of the.