Experts Discuss Impacts of PA/NP Onboarding on Organizational Finances

ACHE Webinar Helps Employers Understand Onboarding Best Practices

December 2, 2019

By Divya Williams

Effective utilization and efforts around PA/NP engagement are critical to employers’ financial metrics, access to care for their patients, and patient satisfaction. To help those involved in this process, the American College of Healthcare Executives (ACHE) hosted a webinar in October – How PA/NP Onboarding Impacts Organizational Finances, presented by Christopher Anderson, MBA, MS, PA-C, senior administrative director at Northwell Health – Lenox Hill Hospital and CHLM Consultant, and Andrea Lowe, MHA, PA-C, director, employer strategy at AAPA.

Structured approach to the concept of onboarding
Anderson shared that as we face an aging population, a physician shortage, and more than 10,000 PA job openings, it’s a “buyer’s market” for PAs. “We are long past the days where jobs are posted, candidates apply, we interview them quickly, and make a job offer,” he said. “We are also past the days that it’s maybe ‘an honor’ to work at certain organizations.” Since so many jobs are available, it can be difficult, as an organization, to fill them – so employers need to be more innovative to not only recruit, but to retain. “Providers may come for the initial salary jolt, but keeping them is more about culture, support, and growth,” Anderson said.

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Anderson emphasizes the importance of a strong onboarding program and provided several “onboarding necessities,” the first of which starts with recruitment. A strong relationship with your HR team is vital, as that’s the first interaction candidates have with the organization. Once a candidate is chosen and secured, Anderson outlines three orientations that should follow: a hospital/health system orientation, a PA/NP-specific orientation, and a service-specific orientation.

Attrition and Job Satisfaction
Lowe shared a few striking national trends regarding attrition and job satisfaction. The turnover rate in healthcare is increasing (20.4%), second only to the turnover rate in hospitality (31.8%). And in 2018, it was reported that 42% of PAs left their job at least once due to stress, burnout, or a toxic work environment, and 12.8% on top of that considered quitting for the same reasons.

Based on data from the 2019 AAPA Salary Report, the top three reasons PAs changed employers in 2018 were better work/life balance (16.8%), better management/leadership/environment (13.6%), and better compensation/benefits (11.9%). And based on data from the 2018 national summary of the PA and NP Workplace Experiences Survey Report, the top three considerations when accepting a position were the salary and benefits package (91%), the culture of the organization (70%), and being able to work at the top of their education, experience and training (56%). These numbers show that engagement is an important factor for this workforce and one that employers should prioritize.

Lowe said that in order to increase job satisfaction, employers need to encourage engagement by building career pathways, offering opportunities to serve on committees, and defining a leadership structure.

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Lowe also emphasized a few retention and recruitment considerations. Ask if your recruitment plan was made with this particular workforce in mind. If not, it’s likely worth a second look. Obvious boxes to check would include making sure salaries/benefits are competitive, but a lesser-known tactic is making sure PAs/NPs are visible on the organization’s website can also make a big difference.

Finances
When discussing profit/contribution margin, Lowe shared an example of a PA/NP making a base salary of $111,000 versus a physician with a base salary of $229,000. Both providers see 2,000 Level 4 New Medicare patients in a year, but with the 100% reimbursement rate for the physician versus the 85% reimbursement rate for the PA/NP, the PA/NP still makes a larger profit margin. Lowe reiterated that this is not to argue for PAs/NPs to replace physicians, but rather to emphasize the benefits of utilizing this workforce.

Lowe also shared examples of three organizations that highly utilize PAs and NPs and have reported their own PA/NP turnover cost for a single PA/NP. Cleveland Clinic’s is $225,000, Carolinas HealthCare System’s is $185,000, and University of Utah Health’s is $87-121,000. Keeping in mind these organizational costs and utilizing these tactics can help when building or restructuring your organizations recruitment, onboarding, and retention programs.

More Resources
ACHE/CHLM Leadership Institute
2018 PA and NP Workplace Experiences National Summary Report

Divya Williams is an associate in AAPA’s Communications Department. Contact her at communication[email protected]