Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA, host of the MGMA Podcast Network. We're back with another podcast episode right now. And in this episode, we want to talk about some really critical issues in healthcare, and that is physician and provider recruitment. Thank goodness we have an expert in this field who can help us kind of examine this topic, dig deep into it, and hopefully provide some trends and solutions as well.

So our guest today is Doug Lewis. He's vice president of talent acquisition at Sentara Health. He's also a board member with AAPPR, and that's the Association for Advancing Physician and Provider Recruitment. Doug, welcome to the show.

Thank you, Daniel. My pleasure to be here, and I appreciate the invite.

Yeah. We have been going back and forth trying to get you or someone else from the team booked for y'all are busy. It's taken us, you know, about a month or two, but that's good news for y'all that you got a lot going on, and hopefully you can share some really good insights with us. So let's just look at what you do first. So where did the wheels turn, the light bulb moment, where you decided to get in into this aspect of healthcare and provider recruitment.

Yeah, absolutely. I appreciate the introduction and how I arrived where I'm at today. Interesting story. Earlier in my career, I was a recruiter and my next door neighbor who was a practicing OB GYN physician randomly knocked on my door one day and said, hey, you're a recruiter, right? And I said, yes, I am.

She's like, well, my healthcare needs a top notch recruiter. Would you be interested? And prior to that, I have recruited loosely in the healthcare industry, but mostly for organizations like Blue Cross, Anthem, so more on the insurance carrier side. And this would be my first launch into in house physician recruiting, But I had great relationships with my next door neighbor, she intrigued me about the opportunity to practice and look inside a healthcare system. So, story short, I went through a round of interviews and found myself being a physician recruiter.

I really love the ability to impact and affect not only the candidate, but the whole family. You know, most physicians, they are bringing in their families with them relocating across The United States to different locations. And so it was a very rewarding career that you get to impact someone's career projection, their lifestyle, and their financial well-being.

Yeah. It's so good that you brought in the family in this part of the discussion because I've had discussions about physician recruitment with people before, and they keep saying how important that is. We're going to be making a real life change, so to speak, if we're uprooting, moving maybe from an urban area to a more suburban area, even a rural area, or just a different location in a different part of the country. Because let's think about the physician. They may be busy a lot of the week.

Well, the spouse, if there is a spouse, kids, if they're kids, they may not be as busy. Is it a good cultural fit? Are there things, activities, are there things going on? I'm in Colorado here and you're in Virginia Beach. I mean, it that kind of lifestyle outside of work?

Talk about that, how that's evolved for you since you've been involved, and how do you include a spouse, a partner, kids, anybody else that may be a decision maker in this deciding if you want to take this job or not.

Right. Absolutely. It's incredibly important for health systems and recruiters to really think about the family and the impact that a potential relocation has on them. So absolutely, we include this spouse or the significant other, including their children in the interview process. And that could start earlier on when the recruiter asked, what's important to you?

What's important to your family? And we start getting into understanding what the impact on potential relocation, what are they really looking for? And that includes their community amenities in that community, school districts, private schools, churches, outdoor activities. So, you had mentioned, you know, Colorado. So, here in Virginia Beach, we like to sell the lifestyle.

Hey, you're five minutes away from the beach. Is that important? Is that relevant to you? We talk about different economic industries of their spouse or significant other are looking for a relocation of their job too. We try to make networks within that communities and make sure that it's a match, not just for the physician, but also their spouse significant other.

So typically through that interview process, we bring them on-site, we set them up with a community tour. We make sure that they get out and they look at the communities, cost of living, as well as available schools. We talk about commute times. So it's incredibly important to include the entire family when we're recruiting them from the beginning all the way up until that offer.

Yeah. In that recruitment and, discussion phase, do you have any do you have an anecdote, anything where you had that conversation and somebody just came back to you with something just so interesting, kind of painted outside the lines, you went, yeah. We've got right the place, the perfect place for you to go.

Oh, yeah. Absolutely. You you kinda have to be ready and and expect the unexpected. What kind of questions? When I was recruiting in Seattle, Washington, we were recruiting a fantastic couple, and I was thrown a curveball.

Asked, how is a chamber music scene in Seattle, Washington?

Okay.

There was a lot of homework I had to do. Yeah. Another question was, you know, how are the Spanish immersion schools? So, yeah, we do get a lot of these questions that require the recruiter to do some some legwork, some homework, make some connections in the communities, and make sure that we are including those important aspects and making sure that it is a match.

Okay. Now you have a lot of hands on experience at Centerra. Now you are currently serving on the board at AAPPR. How do you see your role there, and how do you use that real life experience so you can help impact the board?

I've had the pleasure to serve on the board for AAPPR the last six years. AAPPR, in its thirty two years, has really made a mission to impact health care access through education, research, and really elevate the physician provider recruitment industry. So my role is really acting on behalf of our members, what's in their best interest, what's important to them. How do we continue to build our network? How do we make sure they have the right tools to be successful?

So, in our board discussions, we talk a lot about what's next, what's coming down, what's relevant, what's important to them. And that can range from topics to what's going on in Washington, what's some of the legislation that's coming down that's going to have a huge impact in our ability to recruit physicians to their community. So, there's a lot of conversations we have both in the board and outside of the board. We have a yearly conference that all of our members have the opportunity to come together, you know, two and a half days of learning, as well as networking. So, can hear in real time how it's affecting their ability to recruit and their communities, and then bring that back to the board going, okay, how do we provide these new tools or resources to our members so they can be successful in their roles at their health systems?

Okay. Now, when I was sharing information with your team, trying to get resources so we could develop some questions for this. We were talking about trends and some of the trends that might be going on. First part of that question is, do the trends, as you've been in this field, are they they moving like at a glacial pace? Are they moving really rapidly?

And then, you know, just give us the speed of change and then give us some of the trends that are out there right now.

Some of the things that we have learned in 2025 that we're seeing move into a trend for 2026 is definitely the candidate expectations have sharply shifted from focusing on compensation to now they're really focusing on lifestyle, work life balance, the flexibility, looking for an untraditional role, moving away from that one point zero to is there flexibility? Can I work remote? Can I work telehealth? Instead of working at one point zero, is there an opportunity to work a point eight? Can I job share?

So, we're seeing a trend from the candidate themselves really changing their priority and what they're looking for in their next opportunity. We're also seeing kind of outpacing the hard to recruit specialties with tremendous pressure from recruiters and to partner with locums agencies to kind of help fill in that gap. And then we're seeing the change in policy really take effect as far as different specialties that's already hard to recruit or loan forgiveness or visa opportunities. And then, of course, the short and projections of the physician shortage that grows every year. And that number just seems unattainable.

And how do we fill that gap in that void? And so we're looking at different creative ways. At the end of the day, recruiters are being asked to carry a heavy workload and to face more complex issues in a multilayered facet that we see ourselves in today.

Right. And going back to the first part of that, did the big change did it occur during the pandemic when people really began to reflect and think about what do I want to do? I know the work I want to do, but maybe not the mode of the work that I want to do. Maybe it is incorporating the entire family's thought process, or I want to be closer to home, or I want to be somewhere where I'm near the mountains. So many things that incorporate work life balance.

Even like you were saying, I want to get the term right, was it job sharing, or what was that where you have multiple people perhaps working in that role? I'll let you fill in the gaps there for me.

Yeah, absolutely. COVID did play a pivotal role in how we see the changes in the projections today. So I think COVID really opened up a lot of different opportunities. Most health systems were looking at how do we get into telehealth. Fast forward to we have to be an expert in telehealth today to be able to provide patient access and patient care during COVID.

From that, I think physicians, especially those who are in training, really looked at what's important to them coming out of their training programs. That traditional model of practicing medicine at a one point zero in a brick and mortar, that really changed how we are now as health systems adapting to be able to offer those different flexible work models, such as job sharing. Job sharing for me and other recruiters really look at a point five. So, in primary care, I have to have a complement, So we have to be able to see a patient panel. If I'm job sharing with someone else, I have to be okay with that other provider filling in the days that I'm not there.

So if I'm committed to working two days a week, and the other providers commit to working three days a week, that practice administrator now has to figure out how do I fill that void and make sure that they are co sharing that patient panel. For recruitment, that's even harder because now we're looking for someone who's comfortable stepping into that role, working three days a week and co sharing a panel. Some love that opportunity because it provides them a lot of flexibility and others that's harder to comprehend that they are sharing now a patient panel and co managing them.

Yeah, it does seem like in the workforce, we're at a real unique time where we are provided and asking for flexibility. And for some people within that flexibility, they want to go, it might be flexible work hours. I want to avoid the traffic. So I want to get there really early, leave early, see the kids at the soccer match, whatever it might be. For others, it might be, as you were saying, telehealth, or other opportunities, job sharing as well.

I want to switch gears a little bit, because one of the most interesting things that I saw in the research y'all shared with me, that decision timelines are slowing down. And it seems that's at odds with where we are as human beings right now. We want something right now. And, if suddenly we're pushing back the time where these decisions are being made on hiring, that can be challenging. That could be some friction.

So first of all, what are the factors? What is causing this? And then how are y'all dealing with it? How are you building processes around it to make sure, those prospective candidates are happy? They know they're getting the touches they need.

They know that y'all care about them and you can't wait to onboard them, but it's gonna be a while. So how are you handling that?

So what we're hearing from our members and what you just spoke to and the data speaks to is the decision timeline has extended itself. And I think what we're seeing is health systems are really evaluating those roles and where they fit out in the organization. Is that someone that we need today? Or is this someone that we might be looking at in the next two to three years? And so, there's really a fine kind of scrutiny in governance and layers, making sure that every hire is adding to that bottom line, and that they're looking at the risk management lens as well, taking on a new provider.

What does that really mean when we look at compensation for that versus patient access versus the ROI for that. And so, are seeing a longer decision time. It's kind of that cliche hurry, hurry up and wait. And so, we, you know, we get that job order and we're out there, you know, hustling and sourcing and finding top talent, we bring them in, and then we're told by, you know, administrative leaders like, okay, let's slow down the process and make sure, one, I think it's the right fit, right? So, there's a lot of emphasis on culture and values.

Does that provider really resonate with what we're trying to achieve here? And then the second part is, are we making sure that we're making sound financial decisions for the health system? So, the speed and what you mentioned as far as how do we keep that candidate warm. And so, the recruiter has to really make sure that they're checking in with that provider, making sure they understand the timeline, what other questions that they might have, making sure they're meeting with the right people in that interview process. And so, although that timeline has extended, I would say that allows the recruiter to spend more and have a higher personal touch with that candidate.

So that's kind of how we're solving that in the moment. But yes, we do see generally that that time is taking longer to make the hiring decision. And then to your point, the onboarding comes into play as we've seen credentialing times hover around ninety to one hundred and twenty days. So, in that process, making sure that everyone in that continuum is engaging that provider and the provider's family. That gives them an opportunity to kind of finish out their training if they need to relocate, if they need to kind of find the community of where they're settling, and really help with their onboarding experience.

Okay. Another major aspect in hiring is compensation. So I've been in the workforce long enough where you went in that interview, you were looking to get the job, and then you basically maybe it was just me, but I've talked to enough people. It was back in the day, it was like, What's my salary? You had a number, and all right, that's my number, and now I'm going to go to work.

Compensation has evolved a lot, right? It's not just, here's the amount. There's so many other factors in there. Talk about how compensation strategies, packages, all of it are evolving.

Absolutely. I was told, you know, compensation is science, And then I was told compensation is an art. I think it's both to what you had alluded to. You know, health systems have to look at the compensation packages for physicians and APPs. It has to be sustainable.

We can't always outbid one another to buy talent. It has to be a sustainable model where the provider feels they have been taken care of, they are well compensated, and we have to make sure that the health system doesn't feel like they are being taken advantage of. So, is, you know, the way that we articulate whether that's a base salary, a base salary plus RBU, a base salary RBU plus incentives based around outcomes. It is really an art to it and making sure that when we're looking at that is completely transparent so the physician or the APP understands how they're going to be paid, and that they feel that they are fairly compensated versus health systems always competing and paying top dollar for talent.

One of the other challenges in the competition here, this was so interesting to me in looking at the research, I want to make sure I get this right. The hard to recruit specialties, they remain a major challenge according to the research, especially with locums rates outpacing permanent compensation. Talk about that. Talk about what health systems practices can do to compete in this arena. What what can they do?

What are their strategies here?

Absolutely. When we surveyed our our members last year, the number one thing that kinda continues to bubble up is the locum spin. And so, when we see locums as a reliance, it often reflects a deeper structural workforce challenge versus what the true market preferences. And so organizations really have to look at locums as a short term strategy. Why they're looking at how do we build a long term pipeline that is sustainable?

I think locums are always be with us to help fill in that the short term gaps. They definitely provide better access for our patients. So I think there's a healthy medium as far as a locum strategy, at the same time, making sure that they're not reliant on a long term locum strategy. Locums are here to stay. The organizations really do partner well with health systems, making sure that they are providing that access.

But we, as a health system, as recruiters, we really have to work hand in hand to understand what is our long term strategy and do better forecasting what our needs are. So it gives the recruiters, that ramp up time to start building that pipeline. And Locums kind of comes in to kind of fill in that gap until we're able to identify top talent.

Okay. As we're in '26, we are taking our steps here into the new year. What are you seeing as some major challenges or a focal point for you in this year, and how you can help facilitate physician strategies and bringing them on board, hiring them, retaining them? Where is your focus right now?

Well, we're getting tremendous pressure for a certain handful of specialties like hospital medicine, women's health, oncology, gastroenterology, urology. I can keep going down the list and physiology, radiology. So it definitely takes collaboration between recruitment and leadership and operations or truly understand and come up with a game plan to know exactly where we are going in 'twenty six, 'twenty seven, 'twenty eight, and really put forth a workforce strategy. So for myself, it's looking at a couple of things. One, recruiters still have that recruiting burnout just like physicians do.

So making sure that we are taking care of our recruiters, that we're focusing on their health and well-being. At the same time, we're looking at how do we standardize some of our processes? How do we bring in AI and leverage that to help with those huge workloads? At the same time, making sure that the recruiters are continuing to advance their craft, that we're developing them, we're providing them training to really give them the tools to be successful, to help keep up with the pace of of openings that we have.

Okay. Final question then. That was already one great piece of advice for those recruiters. What's another one? If they're going to do one thing this year in 'twenty six, where would you share?

What information would you give those people listening today? What advice can they take to have a successful 2026 in their physician recruitment?

I like that question. I'm going to add to it. What can leaders do? I think there's a beautiful partnership relationship that recruiters and leadership can have together to be successful. At the end of the day, we all want the same thing.

Recruiters want to hire top talent, and leaders want to continue to grow and fill those those requisitions and make sure that we provide greater patient access. So the one takeaway I would say is really how do you build that relationship with leaders, how do you make sure that the recruiters are sharing industry trends with their hiring leaders that we're collecting data and telling and sharing that data in a meaningful way that our leaders can understand and interpret that and help with some of the decision making, as far as. Are our workforce needs, so I think that's where I see us getting better and evolving is that partnership and moving away from just giving the requisitions of recruiters going, here's what our needs are, but more of that collaboration, as well as see the will be more successful as we continue this year and beyond is how do we again, attack it from both sides, from from both the recruitment lens as well as the leadership.

Okay. Well, Doug Lewis, thank you for joining us on the podcast today.

Daniel, it's been my my pleasure, and I I appreciate the questions and the opportunity to have this time with you.

Yeah. So everybody, I've been talking with Doug Lewis. He's with Centerra Health, and he's there with the talent acquisition side. He's also on the board of AA PPR. And I just wanted to let everybody know in the episode show notes, we're going to put a lot of resources in there for you so you can learn more about what Doug and other people in his shoes are doing these days.

Until then, thank you all for being MGMA podcast listeners.