Global Recruitment Trends for Advanced Practice Providers in Spine Care

Nicola Hawkinson, DNP, RN, FNFA discusses changes in the health care employment industry.

Peer Reviewed

SpineUniverse spoke with Nicola Hawkinson, DNP, RN, RNFA about challenges and trends in health care employment that affect how patient care is administered in spine practices today. Dr. Hawkinson also provides her insight on innovations in recruitment of spine professionals as well as evidence-based recruiting.
Collage of people in a globe illustrated on a smartphoneThe health care industry has undergone significant change, and much of that change has stemmed from what was once the Affordable Care Act and resultant influx of millions of patients into the health care system who formerly didn't have access to health care.Q: How has the health care employment industry changed, where has the change come from, and how does this change affect spine care practices?
Dr. Hawkinson:
The health care industry has undergone significant change, and much of that change has stemmed from what was once the Affordable Care Act (ACA) and resultant influx of millions of patients into the health care system who formerly didn't have access to health care. In addition, the aging baby boomers have contributed to this increased demand for health care services.

The supply of physicians has not been able to keep up with the demands from these patients, hence the increased number of nurse practioner (NP) and physician assistant (PA) programs in medical schools, as well as the increased hiring of NPs and PAs nationwide. U.S. News & World Report has ranked NPs and PAs as the number 2 and 3 best jobs to have in 2017.1 Specifically within the spine care profession, more patients with spinal deformity, herniated disc, or low back pain are seeking care, and physicians who are accepting of ACA Marketplace insurance are seeing a higher volume of patients. In order to counteract this increase, these physicians are using physician extenders—NPs and PAs—more often.

Q: What are current trends and innovations in recruitment, particularly in spine care practices?
Dr. Hawkinson:
In the past, spine practices, like many other practices, recruited talent by word of mouth or by placing an advertisement. However, candidates are now less likely to respond to ads, and trends in recruitment methodology show that a more active approach of reaching out to candidates via a phone call or social media is preferred in order to recruit the best talent possible.

Q: What is evidence-based recruiting?
Dr. Hawkinson:
In the past, physicians would interview a candidate in their office and say, “I’ve got a good instinct or good feeling about this person.” They might not go through the appropriate screening processes or methodology needed to make sure that the candidate is the right hire, such as checking references, running a background check, doing a panel interview, and having other staff in the office meet the candidate.

With evidence-based recruiting, the employer needs to consider what the candidate’s salary is going to be and compare it against benchmark data of what salaries are nationwide. In addition, the employer needs to define the training period and orientation, and what types of benefits, mentorship, career growth, promotion guidelines, and strategic incentives will be offered to the candidate.

Furthermore, the employer should define the desired skills and behavioral competencies needed to fulfill the job description, and may choose to use behavioral assessments, which are highly correlated with job performance.

Q: Do bundled payments have any potential effects on staffing in spine care centers?
Dr. Hawkinson:
Bundled payments are starting to affect other areas of orthopaedics, and it is expected that these payment plans will affect the spine care industry, requiring spine surgeons along with many ancillaries—such as the hospital, physical therapists, and pain management specialists—to all draw from the same pot. This movement will change and affect the way spine surgeons practice medicine.

Before bundled payments, spine surgeons were not concerned with whether patients tried conservative therapies, like physical therapy, for 6 versus 12 weeks. However, with bundled payments, spending extra resources on conservative therapies that do not improve patient outcomes will reduce the payment to the spine surgeon when that patient eventually ends up in their offices for treatment. In a sense, there will be fewer resources in the pot for spine surgeons if conservative therapy is unnecessarily prolonged.

Updated on: 03/20/18
Continue Reading
Bundled Payments in Spine Surgery: Lessons Learned
Nicola V. Hawkinson, DNP, RN, RNFA
Adjunct Clinical Professor
New York University College of Nursing
New York, NY

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