So just recruitment assumptions, we'll kind of just talk through that really quick. Can everyone hear me now? Okay, good. So market share, we're, you know, kind of looking at our market share at TCO. And just kind of, so for those of you that didn't hear before, but some numbers for TCO, we have 131 physicians at TCO. We have 40 locations, 2,266 employees, and 13 orthopedic urgent cares. We hired 24 new orthopedic physicians, excuse me, 14 orthopedic physicians at TCO and 10 rheumatologists in 2023. So as you can see, market share, we are using that data and analytics to drive and look at zip code analysis of where patients are coming to see us from. That helps us look at what markets might be underserved. So where we might build new buildings, those kinds of things. First and third, appointment availability. So we're looking at from a provider standpoint, how many, how many days is it taking to get into their first appointment and then their third appointment? Template utilization, this is a valuable tool because when we go and talk to our service line leads, we'll, they'll, you know, we'll have to bring this data to them and say, you know, out of the two foot and ankle surgeons in the West Metro, you know, they're, they're packed. We're probably losing, we're losing patients to other, you know, to Alina or to other, other areas where we can't, we can't get them in. So when we are talking to the service line leads, we'll bring template utilization and that first and third appointment availability. We're also looking at patient demographics. I won't go into that one again, but additional services. I think as you're recruiting to highlight the good things that you have going on with inside your practice. We, we brought in 10 rheumatologists into TCO last year. They came from a health system and they all came together. Recruitment tactics, again, hired a dedicated physician recruiter. Current physician and leadership engagement is key. We have a strategic plan at TCO that we are executing. The board has signed off on it. And that also includes the, the direct number of physicians that we want to hire within that next year. You guys know it, you can't just hire a physician typically overnight. It takes time, depending upon if they're, if you're talking to them during the residency or if they're already in fellowship. We found the most physicians, once they're already in fellowship, they've already signed on with the practice. So you're too late. So to get to the physicians early and start building those relationships has been key. Residency program partnerships. So of course, we have some good connections with the University of Minnesota and other residency programs that are both local and outside of the state of Minnesota. We have a TCO fellowship program. So we have a sports fellowship program and a foot and ankle fellowship program. We have two sports fellows starting this fall and two foot and ankle fellows. That's the most we've had. Last year we had three, this year we'll have four. So that'll be a stretch for us. Recruitment events. We have different recruitment events throughout the year. Sometimes it's, you know, taking a group of residents to a game, just helping them get engaged and involving some of your existing physician partners to go to those games and start building those relationships. Really, it's all about, sometimes it's not just about the practice that they're joining, but recruits are looking for the right fit for them. You know, is it going to be, am I going to be well supported inside of this practice? And then we developed a new physician handbook. So that has everything from, you know, hard copies of what the, you know, our employment agreements say and contracts. We kind of run through the pay model with them and then highlight all of our services at TCO. So when we're recruiting a new physician, we typically spend about a half day with them. We'll start usually at two, three o'clock in the afternoon. We'll take them through a couple of facilities tours, have them see clinic, have them see therapy, have them talk to some therapists, and then usually a surgery center tour and then dinner with the physicians. That's sort of how we kind of have a recruiting event. And then a mentorship program. So myself and Dr. Ed Kelly, I'll go into this a little bit more. We developed a physician mentorship program at TCO. Some other physician differentiators at TCO is, depending upon how your practice is set up, you might have some investment opportunities. So to talk about, you know, investment opportunities to invest, if you have a surgery center, if you have real estate funds, if you have an MSO or any other investment opportunities, this is the differentiator between private practice and employed physicians. If you can help the physician understand that they are going to make more money down the road in their practice and have investment opportunities, these are things that they're not being told in, you know, in their residency experience. They're only getting the academic perspective. So when you can have conversations with them around what are the other ways that you can, you know, have a financial gain in your practice beyond just having a salary. Sports medicine coverage. So we at TCO, we have lots of sports contracts, both pro all the way down to club level. So sports physicians and really, I mean, our foot and ankle physicians, everyone's involved at some level of doing some sort of sports coverage. This is a good funnel to get those patients into your practice. And it's also good marketing as well. You know, obviously talking to the physician about call, we have our new physicians can pick up urgent care shifts, even our existing long-term physicians can pick up urgent care shifts. Our OUCs are staffed by PAs traditionally so that they can pick up our urgent care shifts. They get paid a flat fee instead of, you know, a salary or anything like that. So they get paid an hourly rate to pick up those urgent care patients and then they can keep those patients. Practice buy-in, ancillary participation. Again, just talking to them about how your organization is set up and if they, you know, at TCO, ancillaries go to buy down their half-day rate and how their participation and referring to, you know, our own scanners and PT and all of that, how that affects, you know, their buy-down of their overhead and helps them better understand sort of how the practice is set up. We have two models of payment at TCO. We have a guarantee that is just a flat guarantee we do it for three years. That was, it's not, I will tell you, not well received at TCO in terms of we've only had one new physician take the guarantee model. All the other physicians are on production. They have the greatest chance of ramping up their own practice on a production model that we've seen so far. So, yes. Do you put them on a production model right when they come out or do you give them a little bit of time before you cut? So, you mean after the three years? So, yes. Yep, yep. So, let's say they're making X amount. They're getting used to that nice salary. Well, once they come off production, if they haven't ramped up their practice, they're going to be in the toilet. So, it's, we always tell physicians if you, if you feel like you can bet on yourself and that you're going to, you're going to grind and you're going to be a hard worker and you're going to get out there in the community and build relationships and see, you know, open up your template. Let's say you're a foot and ankle surgeon. You're going to open up your template to see a bunch of body parts, probably not spine, but you're going to see maybe, you know, you're going to do some hips, knees, ankles, but you're, you know, you're probably not going to see the spine. But if you're willing to come in out of fellowship, you're already a general orthopedic surgeon anyway, this is the closest you're going to get to be able to build your practice that way. And eventually, if you can have the mindset of, hey, I want to be a foot and ankle surgeon solely in 10 years, you know, you have a better chance of obtaining that versus just coming out of the gate saying, all I'm going to do is foot and ankle for the rest of my career. So, it's a mindset and I don't know if anyone has anything to say about that or any questions, but that's how we tee it up because it's the fellows coming out of fellowship, they have to want to see other body parts besides just what their fellowship trained. Leadership and engagement opportunities, I would say, you know, and after your first year at TCO, if you are, you know, approved and approved partner and the board approves you to become part of the practice, that following year, you can be on the board. You can self-elect yourself to whatever region, if you're working in a region, you can elect yourself, say, hey, we're up for, you know, board elections. I can nominate myself and if my partners, you know, say yes, then I'm on the board. So, the leadership opportunities can come quickly. There's no waiting period in that. We have a mentorship philosophy. So, myself and Dr. Ed Kelly, he was my dyad partner in creating this philosophy. Really, it's a culture of support and to develop independent orthopedic surgeons and physicians who are new to the practice. I mean, as you can imagine, we all know new physicians coming into the practice, they have had a mentor their entire time. They've had it through residency, they've had it through fellowship, they've had someone walking alongside them in their journey to become an orthopedic surgeon. And so, when they come into practice, sometimes it can feel like a dump. I mean, I'm just going to be honest, where that's kind of like, you're just left there to the wolves, figure it out. There's, of course, there's people that will answer your questions, those kinds of things, but you definitely, I've seen over the course of the last year and a half of having a dedicated mentorship program that these physicians are much more engaged in the practice. So, obviously, it develops a cohesive physician partner. We try to assign a physician partner, obviously, that's in good standing. They actually have to be nominated by their service line lead. So, if it's a foot and ankle surgeon, the foot and ankle service line lead should be nominating physicians in that region to become a mentor. We also have them go through about an hour training. Dr. Kelly does that and kind of says the do's and don'ts of mentoring. And then that first year, I'll kind of walk through kind of some things that we cover, but really, it's a one TCO concept. So, creating that experience that attracts and retains new physicians and then creating those policies and procedures that align with all of our plans. So, the structure is, so at six and 12 months, all of our new physicians get a practice review. That practice review looks at their entire practice. So, we take into consideration, you know, how much work are they doing? How, you know, are they ramping up well? Do we need to do a little bit more marketing with them? We really take a look at the financials of how their practice has been performing over the first six months. And then we do it again at 12 months. And the physician mentor is present at both of those reviews. So, they're hearing the same thing and can help guide and direct. I'm at those meetings with my physicians. So, but again, we're looking at team utilization. And then also at that six-month mark, we start to look at, do they need a PA? We take a look at all of these surgeries that the physician operated on. If they had a PA, what would that reimbursement be back to their practice or even if they hosted their own clinic side by side with the physician? And are they, would they even, would they be break-even, let's say six months, nine months? Because sometimes the goal of the PA really is not to make a whole bunch of money. It's to provide a good service to the patient, have them see rechecks, I mean, in that global period. And then also starting to look at, you know, what they want to scribe. I would say just with how good technology has been, we've been probably moving away from scribes and doing more of a modal. We're looking at other AI tools and things like that. Scribes turn over very quick, very, a lot in our practice. They're typically med students. They're only there for us for, you know, nine months to a year maybe. So that is just, it's a heavy load on our clinic managers and our supervisors that are hiring for that. So I would say less and less scribes now over the course of time. But just, we also talk through our pay model. We're very transparent with our physicians and looking at, you know, are they ready for a service center investment? We talk to them about retirement. If there's any building funds, we kind of talked through that already. But, and then understanding collections and billing. I mean, again, residents and fellows, they don't have direct line of sight to sort of the inner workings of the business. So you have to help them navigate these new things. And having conversations with them and helping them understand and educate them really is the way to go about it. And then personal finance. You know, again, they're making a lot of money and sometimes they need a little help with directing on that. Dr. Kelly's pretty big on that and has a talk that he does with new physicians around just personal finance and sort of how to manage some of their dollars. We do, in terms of system navigation, when a new physician starts, we make sure that we have an onboarding. We have lots of onboarding that we do with them, but we have a whole orientation day where all the new physicians start together in the fall and we have a whole day kind of laid out for them. But part of their onboarding outside of the orientation day is we have site tours. We actually have them go to the hospital. Sometimes their mentor goes with them, tours them around the hospital, shows them where to park, they get their badge. These are all things that create a lot of anxiety for new physicians coming into the practice because it's new. We make sure that they have all the equipment and you know the trays and their preferences are their preference cards are all set up at both at the hospital and surgery center. And so prior to starting we host a new physician event. This is the first time we did this last year. So what we did was we had a whole day of orientation all day and then at the end of the orientation at four o'clock we did a happy hour. We had all of all the physicians that were in orientation and their mentors come in for happy hour and hosted just a new physician event and that was really nice. Everyone really appreciated that. We had appetizers and drinks and it was just a great time to kind of get everyone together. Collaboration. So important contacts we make we give them actually a book probably about this size and on the inside of the book it has all of our contact information in there. It has their surgery center contact information, my contact information, who their managers, who their manager contact information is just so they have everything in one spot because again they're new. There's a lot going on. There's a lot to keep for them to keep track of and if we can keep things as smooth for them as possible that'll be even better. And then just talk to them about what the chain of command is. What who sits on the surgery center board? Who are your board reps in your region? How is the board set up? How does voting happen? This is all information that they are going to need to know and they need to understand the structure of your organization. We go over that a little bit in their recruiting but we get down and dirty once they start. We really are transparent with all of that. We also I mean we have lots of different hospitals in the twin cities that our physicians operate out of so they need credentialing at multiple locations. That takes time. And the TCO onboarding tours, marketing. So for our marketing tactics each physician has their own web page. You can go out to our web page and kind of take a look to see how everything is set up. But our new physicians also can do a video where you know patient can click on that and kind of say oh you know I kind of resonate with that what you know with what that physician is saying and seems like seems like a nice guy or gal and I want to see them and make an appointment. And then just helping them navigate the hospitals and surgery centers. That's complicated and just takes some I think some hand-holding. And then we give them a new physician gift. This is kind of you know a nicety. You don't have to do this but we give them a TCO gift just to welcome them to TCO once they have signed their contract with us. That's all I've got. Do we have any questions for our speaker? Yes. You talk about all the things that you do when someone's on board. How do you how do you select those you want? Okay that's a good question. So we get lots of CVs through various ways right. We get we'll get a CV that comes to us through one of our physicians or someone that works at TCO. Typically our physician recruiter will you know reach out to those individuals. We have a whole set of questions that we review and ask of those physicians. We ask you know what kind of practice are you looking for? Do you you know are you looking at a private practice? Are you looking at you know an employed model? You know what's you know if you had to look five years down the road how what would you say would be the determining factor of a successful practice for yourself? Trying to gauge sort of you know we've already maybe figured out what the need is but we're during that interview process with the physician recruiter. We're trying to get sort of we're trying to dig a little bit deeper try to figure out what's their motive and why why are they choosing Twin Cities Orthopedics to have be of interest to them and their and their practice. I would also say that we keep a really nice list of all of our all the CVs that we've received and sort of where they're at in their process with us. And then you know once you receive that CV and if it's someone that we think we might have interest in let's say I keep going back to foot and ankle because that's service line I help oversee but we'll go to the I'll go to the service line lead and say hey Dr. Kammack can you take a look at the CV and see if it's a good fit for you? Dr. Kammack can you take a look at the CV? This is the region that we're thinking about for this physician. He usually will have some he'll weigh in on his thoughts you know he might say hey I'll reach out to you know I know their you know their fellowship director or you know their residency. I know I know someone at that residency program just kind of do some background check on that individual. Does that help? Okay. Not about recruitment but your session utilization. Are you guys used to Tableau for that as well? Yes yep yep we use Tableau, OBERD those are some big ones that are Leticia. Yes. Yep so I would say for the one solo orthopedic physician if you're adding a second one the second one's going to want to know what what kind of call am I going to be on? What's because the the burden is going to be higher the smaller your practice when it comes to call I'm just assuming that but when then I would I would I would recruit for that. I mean so if they're not taking call I mean from a financial standpoint you know that's a big part of how physicians get paid is call. So then if I'm the physician I would want to know how am I going to get paid if I'm not taking call are there other ways for me to make money? Probably someone who wants to who just wants to be on a salary. I mean I mean I don't know how it's set up with your practice currently with your one physician but you know I think you would yeah you would have to be on a salary. I mean I don't know how it's set up with your practice currently with your one physician but you know I think you would yeah you would have to post the physician that you're looking for you know a physician are you would you be looking for like a general orthopedic physician is that kind of general or sports? Yeah I mean I think yeah you have to you have to market it right and then you have to make sure that your one lone physician is 100 to 1000 percent on board with hiring because if because if once you're once you start recruiting if the vibe is that your physicians are not open to recruitment that new physician is going to smell that a mile away and they're not going to feel welcomed and they're not going to feel like they're going to be you know they're not going to have a good shot at being a part of your practice. Say that again? Yeah. Exactly. Yes. So all of our physicians that are offered a contract have to go before the board and the board approves that hire. Yes. Yep so we were really transparent we actually show like and we do like a a copy of our pay model and we'll just it's it's just like blinded numbers but one thing that I didn't mention in here that I think is really important is that after we've completed our like recruiting day or tour and all of that usually a couple days after we we set them up to talk to our CFO and Jay Hempe our CFO will kind of walk through and answer questions on the financial side but then he also will kind of do like hey this is where you're going to be at one year let's say it's a sports med doc one year three years five years ten years and that gives them a good idea over the course of time what what's possible of course it's going to depend on each individual but it gives them a sense of what they can achieve over the course of time. Yes. Yeah. No before that it was myself and two other people we kind of were just managing all of that but we got really busy with recruiting obviously 24 new physicians so we hired a dedicated recruiter. I can't speak on that I don't know if you guys have any experience with working with an outside recruiter but no nobody knows your organization better than you do and it's really I would think it would be really really hard to to use an outside recruiter that doesn't know your culture those kinds of things. Yes. I mean personally I handle it internally if you can unless you're just really strapped on resources but then you're going to be paying for that resource. I can say forever we stay away from recruiting one because they're very expensive. Number two for exactly what she was alluding to their job is to get that guy in place and they might not be a great fit for your practice but they're going to get their money. So for us we coordinate and just sell the residency route you know our doctors call back to us and I don't practice so many of the doctors that talk to the surgical team that work with the doctor and that's where we're offering residency because it's money. Yeah any other questions? How do you know when you're ready to hire somebody new like what what are your 12 inch marks that time you've been serving? So our board our board sort of decides number one we look at retirements we look at who do we have retiring in the next couple of years because we know that you know it can take some time to recruit and to backfill those retirements. Typically we'll hear of retirements two years ahead of time. Our physicians that retire actually get a price break on some of their overhead if they provide notice two years in advance so that helps. So we don't have a physician that says hey I'm going to retire in six months that doesn't help us a whole lot. So the benchmarks that we use are the when we're looking at new markets so we're using that zip code data analysis and then we're also using you know so that market share as well as our first and third appointment availability and the template utilization. First and third appointment availability so like at what point are out? So really we want again we want to win we want to win access so we win access by our orthopedic urgent cares and then we also win access to get our those patients who are coming in through our OUCs into us to see a surgeon. So let's say it's a it's a fracture that came into our urgent care and you know we want that fracture to be seen within a couple of days. If we have if we don't have any physicians that have availability within that market you know within those couple of days that tells us that we need to hire. So we're always sort of looking at that availability for our patients. Access is huge for us. Yes. Your urgent care and your doctors? You find, do you find many of the doctors say they have their urgent care and opportunity for technicians? They do because they they want to become partners that one year and they are they on the pay model I mean they have to they should be in the black or close to the black by the time they hit their one year mark. So one year. Yep. So they usually start in September the voting for the new new physicians to join as partners is usually that October so a little over a year. Yep. I mean that's that's a part of it right. If we have a physician that you know it maybe they're struggling and I've only ever seen maybe one or two that didn't sort of make partner at that one year it's kind of just varies from physician to physician but we want them to we want more than anything for them to be financially successful and so if we can provide them opportunities to pick up our urgent care shifts for a flat you know dollar amount and you know maybe they're maybe they can only pick up you know four hours on a Saturday morning or something like that we usually release you know our urgent care availability three weeks ahead of time so if our PAs you know our PAs take vacation so we always have some open slots for our physicians to pick up urgent care and then they get to keep those patients so if you know fracture patient comes in or you know whatever then they they keep those patients. Yes. We just we just kind of monitor them and work with them you know typically after about six months then you know they're they're usually where where they need to be. So I would so we only have one physician right now at TCO that has taken the salary guarantee all of our other physicians are in production. you

recruitment strategies

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Twin Cities Orthopedics

data analytics

market share

patient demographics

physician engagement