🔒Doc recruiting challenges leave small CT hospitals seeking help

In recent years, Sharon Hospital has been forced to shutter its sleep center and Yale-affiliated cancer center after failed efforts to find suitable replacements for physician managers who relocated or retired.

That's drained the 78-bed hospital's revenues, leading to financial troubles that spurred its parent company, Tennessee-based RCCH Healthcare Partners, to agree in September to sell Sharon Hospital to New York-based Health Quest, a nonprofit operator that owns three hospitals in the Mid-Hudson Valley.

The small provider in the state's rural northwest corner is far from alone when it comes to doctor-recruitment troubles. While smaller Connecticut hospitals offer a lifestyle that's appealing to some doctors, they typically have lower patient volumes, fewer resources and less exposure to doctors in training than teaching hospitals — all drawbacks in recruiting talent. Even being on call fewer nights of the week, often a benefit of a larger system, can be a deciding factor for some.

Hiring and retaining doctors has been a hurdle for smaller hospitals for years, but executives say the challenge has intensified as industry consolidation creates larger systems with more resources.

“Right now this is definitely a doctor's market,” said Dr. Ian Tucker, vice president of medical affairs at Johnson Memorial Hospital, which joined the Trinity Health-New England system early this year following nearly a decade of financial struggles. “We have fewer and fewer doctors to fill a greater and greater need.”

There are also fewer independent hospitals in Connecticut as Hartford HealthCare, Yale New Haven Health and the recently formed Trinity system gobble up hospitals and other facilities.

In the northeast corner of Connecticut, the 104-bed Day Kimball Hospital has long struggled with recruiting and retention, according to Chief Medical Officer Dr. John Graham.

When Day Kimball launched a physician group in 2008 to ward off an encroachment by ProHealth Physicians, there was hope that recruitment would improve and bring in added revenue.

”Unfortunately that has not come to fruition,” Graham said. “We've had some recruitment, but I'd say we're slowly slipping behind and we need to retain physicians.”

In the past few months, the hospital has taken a new tack, signing a contract with a recruiting firm to help it find doctors.

“Our strategy has to be more aggressive,” Graham said. “That costs money.”

Day Kimball's biggest competitor for doctors is Backus Hospital, 35 miles to the south in Norwich, but they lose even more of their physicians to retirement. The aging workforce is a national trend and nearly one-third of Connecticut doctors were 60 or older in 2014, according to the Association of American Medical Colleges.

Day Kimball and Hartford HealthCare were in affiliation talks but those ended in late 2015, and Graham said there are no current discussions happening with any potential acquirer.

Large-system edge

Joining a larger system often means smaller hospitals get help with recruiting and potentially become more attractive as an employer.

For example, Charlotte Hungerford Hospital in Torrington, which last month filed for approval to affiliate with Hartford HealthCare, is set to receive $3 million for recruiting and training programs.

Charlotte Hungerford has found it increasingly difficult to hire and keep primary-care doctors and specialists alike, it wrote in its filing submitted to the Office of Health Care Access.

Brian Mattiello, vice president of organizational development at Charlotte Hungerford, said compensation, unsurprisingly, remains an important factor for hiring doctors.

“It's hard in a market like ours to be paying top dollar,” he said. “It's definitely a struggle to match some of the more capitalized health systems.”

Matt Katz, CEO of the Connecticut State Medical Society, agrees that better capitalized providers have an edge in recruiting and retention, but even larger entities in the state encounter struggles.

He sees Connecticut's cost of living, certificate-of-need standards, malpractice insurance costs, and Medicaid reimbursement levels as negatives for attracting needed doctors to come to, or stay, in the state.

”We have huge issues,” Katz said. “If I'm a specialist coming into Connecticut, there are a number of issues causing me to say 'no.' ”

He also wants Connecticut to implement a loan-forgiveness program for medical-school graduates to incentivize them to stay here.

Financial impact

Recruitment challenges can have a direct impact on a hospital's bottom line.

In its merger application, for example, Sharon Hospital said that “consistent difficulties recruiting physicians” and numerous physician retirements, relocations and practice divestitures have resulted in declining patient volume.

The hospital saw a 16 percent decrease in inpatient discharges between fiscals 2013 and 2016, and a 22 percent decline in inpatient surgical cases since fiscal 2014.

During that time, the hospital was forced to shutter its sleep center after its medical director relocated out of state, and close its oncology service for similar circumstances — all tied to its inability to recruit and retain physicians to the rural part of the state.

Sharon, which until recently was Connecticut's sole for-profit hospital, is part of a larger system, but is isolated from its sister hospitals, the closest of which is in Ohio.

Sharon is now seeking to be acquired by Health Quest, which has a nearby presence over the border in New York.

The hospital would revert back to nonprofit status, which could be the first example of a reverse conversion in New England.

Sharon CEO Peter Cordeau said the hospital's struggles to recruit specialists have nothing to do with being a for-profit hospital.

“The problem is health care has changed,” Cordeau said. “I need synergies.”

One benefit of being a for-profit since 2002 is that Sharon isn't saddled with the long-term debt and liabilities cited by many nonprofit hospitals as reasons they need to be acquired by larger entities with more access to capital.

“Our challenge now from a viability standpoint is access to services so we can grow,” Cordeau said.

Changing dynamics

Charlotte Hungerford's Mattiello said he's seen recruiting dynamics change over the past six years. Physicians seem more willing to be mobile, even if that means leaving for another state.

“I think there was a time where people laid down roots for their practices,” Mattiello said.

Work-life balance has also become more important for doctors. Some want the flexibility to practice primary care several days a week and focus on another specialty on other days, which is more common at larger systems, Mattiello said.

Weekend staffing requirements at his hospital are more frequent than at some larger systems, which might require just one weekend every few months.

Technology has been another challenge. Some new doctors train on modern technology like robotic surgery machines, such as the da Vinci System — something Charlotte Hungerford can't justify purchasing because it won't draw enough patients for the service.

Despite the challenges, Mattiello isn't completely down on Charlotte Hungerford's prospects.

“We are still a very attractive setting for many reasons and we're still finding fits,” he said.

The hospital hopes the situation will only improve, should it become part of Hartford HealthCare.

Meanwhile, at Johnson Memorial, President Stuart Rosenberg said the hospital's recent membership in a larger system is a bright spot for future hiring.

Now, Johnson can sell itself in a new way. Job candidates will hear about how they will be able to collaborate with similar specialists within Trinity Health-New England — anchored by St. Francis Hospital and Medical Center in Hartford — as well as Michigan-based Trinity Health's broader network of approximately 90 hospitals in six other states.

“The retention factor is going to improve as we become part of the regional system,” Rosenberg said.