Interview with Corbin Wilson, Executive Director and President, JPS Physician Group, Fort Worth Thomas McKeever, Jackson Healthcare’s National Sales Director

TM:  Mr. Wilson, at what point in your career did you realize that you sought to end up in the executive healthcare position that you now hold? 

CW:  Truthfully, that answer is twofold.  The first is, by education and background, I was originally a healthcare attorney for ten years, handling medical malpractice and litigation work.  Early on, I realized that they don’t call it the  adversarial system haphazardly.  It is extremely contentious and you have to be an adversary of someone to be a participant in the process.  My current position has given me the opportunity to use much of my education and legal background in healthcare without being immersed in the adversarial process.

Second, working as a healthcare attorney for a number of years, one of the highlights was getting to work with the physicians that I was able to represent.  I worked with them in medical malpractice situations, but I also worked in other healthcare matters—with medical treatment, clinical trials, ethics committees and contractual issues.  I really began to develop a significant appreciation for the physicians, particularly for those that worked here at our county facility treating an underserved population.  I was impressed with their heart for medicine and helping people who otherwise might not be able to get help.  I wanted to make that transition from the purely legal aspect of healthcare to full-time administration, medical group management specifically, where I could represent physicians in a whole different way day in and day out, and to help facilitate their patient care and their passion to practice medicine.

I really liked the interaction that I had with doctors.  So I came to a place where I made the transition to purely medical group management.  Working here, I’m very glad I made that decision, and feel a tremendous sense of appreciation from the physicians here.  I feel my background has given me the opportunity to more fully care for the needs of our doctors and the group in general.

TM:  That’s a pretty impressive story, Corbin.  Going from the legal aspect where the issue at hand is brought to you after the point where you can have an impact, to a position where you’re brought into the situation and can ask, “How can we avoid scenarios that we don’t want the physicians to get into?”  You could almost look at it as a preventative form of medicine.

CW:  There is a lot of that, Thomas; certainly that goes on.  And also, there’s much greater opportunity to walk directly with them through the entire process instead of getting in on things at the tail end.  So it’s been something I have really appreciated.

TM:  That’s quite interesting, and I am sure that as you have gone from the legal aspect to the administrative side with the physicians, you probably see different surveys that talk about physicians no longer encouraging their children to follow their footsteps into the clinical side of medicine.  Based upon what you’ve seen in your current role, do you echo that same sentiment?  Would you encourage your four children to follow your footsteps into either an administrative or even a clinical medical profession?

CW:  I don’t know that I would subscribe to that view or that line of thinking.  In fact, I’ve told my wife a number of times that if I had to do it over again, I would find significant satisfaction in going into medicine myself.  It’s the running joke in my household that I’m telling my kids that they need to be Interventional Cardiologists …and I work with doctors who think they should have gone to law school.  I guess there are always “the grass is always greener” scenarios, depending on where you are.

The thing about being in this role that has significantly impressed me is the ability my providers have to reach out and provide comfort and help people, and the need is growing more and more.  I believe our responsibility as citizens, together with our government leaders, is to figure out how to continue to encourage people to go into the medical field and to make that a lifelong passion and profession.  So yes, I would definitely encourage my own children in that direction, and believe the physicians here practice medicine for what I call “the right reasons.”

The doctors that I work with have gone to medical school and want to practice medicine, not run a business.  I try to create an atmosphere in our physician group where they don’t have to worry about the corporate side of medicine.  We take care of the billing, contracting and regulatory issues and let the doctors get down to the “nitty gritty” and do what they are trained to do and are passionate about.  So I think most of our physicians here would probably not subscribe to the trend of the national surveys and would likely encourage their children and others to do first, what they are passionate in doing…but would not discourage the practice of medicine at all.  We work hard to maintain a very significant work/life balance within our group and hospital system.

TM:  That is a wonderful dynamic--encouraging your children to go into medicine, and what you say about Cardiology is certainly true.  One of the macabre realities is that as we live longer, we might be done in by some sort of cancer or heart disease, making the choice of Cardiology an excellent one.

To change the focus a bit:  What are some of the biggest issues facing the contemporary healthcare administrator today?

CW:  That’s a complex question.  I would say, in no particular order, some of the biggest hurdles that I will likely be dealing with over the next few years are the following:  first, what appears to be a trend toward diminishing reimbursement.  None of us wishes to have to deal with any sort of reduction of compensation or lifestyle change in any way.  Trying to figure out how we’re going to tackle the scenario of expanding healthcare to those who can’t pay much and still be able to compensate our physicians in a way that is equitable to their time, dedication and the training and education that goes into being where they are--but yet deal with limited resources in regard to reimbursement--is a big issue.

Along that same line, another issue is trying to maintain a work/life balance like I mentioned for those doctors.  As reimbursement decreases and the population of patients increases, there are fewer physicians out there—at least in the short term—and it’s going to be significant to continue to provide the physician manpower available to a sick population to care for them…and at the same time, allow our doctors to go home at a reasonable time and not have to see patients until 9-10 o’clock at night.  We’re already significantly expanding our outpatient clinic hours to meet the demands of a dramatically increased patient base without hiring significantly more physicians, because the resources to pay for those doctors are shrinking as well.  Trying to balance all of that in an equitable manner given the different variables in that equation is going to be a significant challenge for physician practice administrators.

TM:  Absolutely.  That’s an excellent answer because you have hit on things that appear throughout our series of healthcare executive interviews.  Billing and reimbursement is the #1 answer to that question.  But to follow up on that and talk about the quality of life as it relates to the physician population, I think that’s an answer we have not heard yet.  So it goes back to your discussion and topic points to the alignment of administration here at this facility with the physician staff.  It’s important not to create an adversarial environment for them to work in.  As you retain your medical staff and add to it, that’s certainly something you can expound upon.  Quality of life is certainly more important today than it was 20 or 30 years ago.

That also ties into physicians encouraging their children to go into medicine.  They look on a lifetime of having fewer hours to spend with their families.  They look back at 80-90 hour work weeks and the quality time they’ve missed. 

CW:  And I think a lot of physicians in various practice situations and environments do deal with hours like you mention and would definitely discourage that for their children.  It’s definitely important to me and this group.  We keep physicians who are excited about coming to work and treating the patients…and we do our best on our in-hospital teams to keep our patient volumes down to 15-16 a day rather than 30-35 as some are seeing.  It keeps our doctors excited about coming to work.

It’s also significant to see with the change of administration here at JPS Health Network, where most of our providers work exclusively, there has been a shift in trying to reach out to the medical staff to create a practice environment where they have greater participation and meaningful contribution to the practice environment and processes.  However, trying to balance that with the patients’ perception of care and having the manpower to meet the needs of a growing patient population is not an easy balance to reach.  Our System’s administration is trying hard to reach a balance and is dedicated to both of those things…and is doing a very good job under our new CEO, Robert Early.  His top administrators are doing a great job of working with our doctors and really listening to the patients here and what their growing needs are.

TM:  That’s good to hear, especially from the perspective of patients. You look at an administration that wants to listen to its medical staff and also wants to listen to its patient base in terms of what services and initiatives need to be taken to arrive at the quality outcome in terms of patient care that we all want to see.  As you look at your business day, where would you say your time is spent both least and most productively?

CW:  Looking specifically at our group and the mission to serve the underserved population here in Tarrant County as well as the commercial, Medicare / Medicaid and self-pay patients, we have a significant problem at times keeping our clinics staffed both with support staff as well as the medical staff. If a doctor is not available, it’s going to have a significant impact on the support personnel there keeping the clinic open.  I would say there is a significant portion of my day spent on trying to fill all of those holes that open up.  (Jackson & Coker is great in providing us with locum providers at times to piece the schedules together.) 

Also, unique to our practice is our physicians who have frustrations concerning their immediate practice: issues with support personnel, getting test results back at convenient times, and interacting with patients when they really don’t have a lot of control over their practice environment.  This is at times a frustrating situation for me because I don’t, as administrator of the physician group, have responsibility or control over those practice issues.  So I will try to represent the physicians—facilitating meetings and interactions with the facility and health network to address these issues, but often times don’t feel like I am fully effective in finding solutions.

The most efficient portions of my day revolve around a couple of different elements.  One is the recruitment aspect—making sure that we have the physician manpower to meet the growing needs of our community and patient population here at JPS.  I want to be very proactive and even forward thinking by having providers already interviewed and on the road to recruitment before a need is overwhelming in a particular service line or area.  So we try hard to stay ahead of the curve in making sure we have to provide manpower here and available to meet the needs of the community.

Secondly, it’s important to work with our providers to ensure that they are aware of the benchmarks and best practices within their service line so that they are as effective as they can be as providers…and that they are working within their clinics to be sure that their patients are being scheduled and attended to in such a way that their practice runs efficiently.  To accomplish this, there is data that continually has to be gathered, analyzed and evaluated in order to ensure that we have productive physicians and productive environments to best meet the needs of a growing population.  Providing this feedback to our department Chairs and physicians is an important aspect of my job.

Lastly, being available to my doctors to hear their needs and do the best I can within the system we work in to address and meet those needs.  It is a real privilege with most of my physicians to be available to them and to work to meet the various issues, needs and questions that come up for each of them.  I would say, looking at all the totality of the work that I do, those would be some of the most significant, productive aspects of my day.

TM:  When you look at our concern as recruiters to have an impact throughout a process as opposed to have something handed to you when it’s already “a mess” – it’s better to have a preventative problem role as opposed to problem solving in the end.

When you talk about the medical succession plan that you have, certainly it’s important to address key issues now rather than being stuck with a bigger problem in 12 months.

CW:   Exactly.  For the most part, that doesn’t make the most fiscal sense because you at time spend dollars to recruit and bring on board physicians before there is an overwhelming need for them.  But it definitely makes for a healthier population and better care.  I see more satisfaction from my current physicians having help when they need it, as well as the patients having better access.

Certainly the impetus of that point is succession planning regarding recruitment, but the retention piece is also a significant element of that process.  Many times administrators don’t see the impact that if a physician is lost tomorrow, what the corollary impact is on other physicians within the practice.  You’re taking physicians that already have busy schedules and now you’re going to provide additional pressure points and stress to their day.

TM:   We’ve seen certain administrators finding themselves in a difficult position as a result of that thought process.  Corbin, if you can provide one bit of advice to a new administrator, what would that be?  Or maybe several pieces of advice they need to be cognizant of as they step into their new position.

CW:  One thing would be to focus on communication—not only with your providers and physicians that you serve, but also in the larger realm with the various administrators in the facilities where they practice.  When we make a hiring decision here, we work hard to bring in and include the various administrators at the facilities where the doctors will be working…even the clinic directors and managers there to make sure that we have complete participation and support from the beginning…this is in addition to all of the other providers in that service line.  That’s just one example where as an administrator, it’s a lot easier just to make an executive decision and to move forward with that and not to take the time to get the feedback, buy-in and participation through an intentional community.  I think it’s imperative for success of any kind, particularly in a medical group, to have open minded and intentional communication with your providers as well as the administrators within the facilities where they work.

TM:  That’s a fantastic answer, and I think it goes back to another common thread that we’ve found in our discussions, which is administrators aligning themselves with the medical staff.   Despite differences here or there, you’re going to find everyone arriving at the same result when there is that alignment.

CW:  And like you said, that same goal is similar across those lines…and often times the means to get there is a matter of better understanding both sides.  As an administrator of a medical group, I feel I can bridge that chasm between where the hospital or administration is going and the desires and directions of the actual physicians or midlevels and where they want to go.  Without a doubt, it’s crucial to have direct and hands-on involvement with patients so that providers have a compassionate perspective toward patient care. Furthermore, it’s important for us to continuously reach out to the providers and promote their participation in all the activities, initiatives and processes involved in running a facility.

I’ve learned from the physicians I’m privileged to work with that they know a lot about a lot of things.  And sometimes administrators don’t really take the time to slow down enough or are too engrossed in their own plan to think they need input from others.  If anything, I probably go in the other direction to a fault—at times wanting to empower my providers to be able to deal with situations in the ways that they see best. 

One example involves our cancer center.  We recently hired a new medical director for our hematology/oncology center.  It’s remarkable the initiative he has already introduced into that program regarding the specialization of the different oncologists as they relate to primary care providers in regard to different types of cancer and disease states they have to deal with…not to mention the expansion of other areas such as clinical trials, research and being proactive in screening and other areas that oftentimes administrators are less concerned about….or don’t make the most sense from a fiscal perspective.  He’s been remarkable in a number of those areas.  It is part of my responsibility to get him the tools and empower him to continue to assess the needs of patients and draw on his experience of being an oncologist for twenty years to know what are going to be effective programs and processes to meet the needs of his patients.

TM:  Corbin, you’re an excellent resource to have here because of your legal perspective in seeing what physicians had to go through and now trying to be a part of the proactive solution…the bridge between an accounting P&L chart and a patient chart.  How do we put those two together?  How do we look at those two different ideologies and find the bridge between them?

In terms of your job role and what makes it exciting and how you impact the medical staff and the actual delivery of care of the local patient population, where do you see the next evolution of your career in the next 5-10 years?

CW:   Without a doubt, this is an area where I have found significant satisfaction and feel that I am fulfilling a need for our physicians as well as the patients that they serve in a very significant and meaningful way.  A happy, satisfied physician is going to have the ability to provide better care in a lot of ways.  And I do the best that I can and feel that I have a variety of life experiences to prepare me—everything from education and prior experiences working for the hospital system, even to the way I was brought up in my own family to value and give deference and importance to others, specifically our doctors here and try to create job satisfaction in them that is going to spill over into the type of care that they deliver…and to help facilitate an environment where they are working as efficiently and productively as possible.

TM:  Given what are certainly interesting economic times--and will be for the foreseeable future--are there any marked recruitment trends you see developing? 

CW:  One trend is evident in the fact that we have over the last 1-2 years had an easier time identifying and bringing candidates in. For one thing, our own providers are a great resource for bringing in new candidates, and promoting our Group to relatives and colleagues.  Also, in these uncertain times, the security of working for a larger, multispecialty group that has the responsibility for a defined, government-supported patient population is something that providers see as securtiy for them. 

So that, in line with what I mentioned before, we shoulder the headache and burden that private practice physicians have to deal with by managing the business aspects of practicing medicine, such as monitoring different regulations through so many different initiatives by CMS. To have someone else--rather than the private physician—monitor these changes in reimbursement headaches…as the government takes more of an active role in how healthcare is delivered…means there’s going to be more security in coming to an environment like we offer.  That’s the primary area of change that I’ve seen.

TM:  Absolutely.  That’s a good point in terms of your providing and creating an environment where a physician can be just that…a physician that focuses on patient care and quality outcomes rather than having to ask, “Does one hour of patient consultation result in one hour of paperwork that I have to somehow find time to take care of?” 

Is there one common thread or common concern that is notable as you talk to other hospital administrators?

CW:  Contemporaneously, it’s what has been going on in Congress and Washington and what we as medical practices can be doing to begin to prepare for that as well as the expansion of integrated care by health systems.  That’s never fun, when from a dollar-and-cents perspective, you begin cutting back in a lot of ways.  Your physicians will frequently have great angst over the preparations you have to take.  If I were to identify another concern, it would be the processes and structures associated with the new government initiatives such as PQRI reporting and electronic medical records that I mentioned earlier.

Concerning hospital and facility relations with individual providers and our physician groups, that is always a delicate balance trying to create a stable and aligned working relationship there.  We have a significant advantage being a physician group that was actually created by a health system working as a completely separate entity.  Our mission is aligned in many ways within the JPS health network facilities that we serve. 

TM:  Absolutely. What are some of your strategic initiatives to address a looming shortage of physicians?

CW:  We’ve prepared for that in a couple of ways.  We have over the last two years grown by nearly 50%.  It’s definitely not been a small undertaking, but something that has proved necessary and very effective in caring for the population that we have to care for.

The other thing is being proactive in listening to physicians to develop a benefit and compensation plan that is equitable to what others in the area are offering--yet accounting for the revenue that that physician, working in our system, is able to generate for the group.  It’s also critical to strive to promote as efficient a practice as possible.  Oftentimes, many of the underserved patients that we have here have significant transportation issues and don’t have access to different technologies such as telephones or e-mail or the Internet to remind them of appointments.  So we have a lot of “no-show” issues as well. 

We have been trying to work with the hospital as well to promote clinics that will run as efficiently as possible so as to minimize the idle time of our providers and also to work on physician compensation that will reward those providers that try very hard to maintain a full and efficient schedule—seeing patients in an effective and efficient way.  We’ve also worked significantly within our hospitalist program to develop a hospitalist schedule that takes into account both work/life balance, but also provides the best continuity of care to our patients by having a minimal amount of turnover from day to day within our hospitalist team and provide continuity allowing the hospitalists who admit through the night and day to keep those patients rather than handing them off to others.  Therefore, they can dispose of patients much more quickly through different care models and scenarios.  We have also dedicated providers to our observation unit to manage timely discharges.

Those are the primary areas.  I’m sure if I sat down and thought through this question, I would have other areas for you also.

TM:  One of the points that you bring up that is too often overlooked from time to time is the basic access to care, such as concerning transportation.  Clearly, basic communication means that we take for granted aren’t available to all the patient population.

CW:  As far as initiatives go, we are working with our hospital to try to manage an environment where there is a limited number of providers to be proactive in trying to keep our patients out of emergency and urgent care units by giving them access to primary care doctors to promote “well care” rather than dealing with problems on the back end, which takes more time and money to address.  So we are striving to develop transitional clinics for patients leaving the facility who don’t have a primary care physician or can’t easily get an appointment.  Additionally, there are other methods and processes that are going to be important to focus on due to the fact that most providers may not be easily accessible.  Our aim is to focus on keeping our patients out of the ED and urgent care centers…and more regularly in their primary care offices.

TM:  Absolutely, giving more focus on preventative medicine which, as you alluded to, promotes healthier lifestyles and really trying to lead the patient population down that path rather than being a “repairer of social ills.”  That gets back to the point of communication:  How do you communicate that to the patient population so that you have more effective healthcare delivery?  If preventative healthcare were stressed 20 or 30 years ago, we wouldn’t be seeing some of the problems we are seeing today.

CW:  That’s exactly right.  As mentioned, that’s what our Director of Oncology, Ely Choufani, MD, and many of our providers are trying to do--get patients in for observation and well care.  Starting different initiatives to screen for various cancers, and also be proactive in performing endoscopies and other procedures.

TM:  If you were to give one bit of advice to recruitment firms, what would that be?  As you use those service offerings, is there anything that we could do as a company or industry to better serve you?

CW:  It is very significant for me to have one particular recruiter or two at most that are dedicated to truly learning our facility and practice and are able to, as well as myself, inform a potential candidate about the practice environment and  the benefits of practicing for our particular group in our facility and even in our area.

It’s a tremendous benefit to have one or two recruiters who are familiar with the practice, the patient population, and the environment so that they can adequately make a representation that is going to be appealing without overstating or misstating the facts.  It’s very frustrating to bring a candidate in for an interview and have to clean up….

TM:  …the false pretenses that were established.

CW:  …exactly. The other thing that I so appreciate is that when I get a candidate from a reputable agency that the candidate is going to have enough accurate information about me that if during an on-site interview I were to offer them a job, they would accept my position.  That is very significant as well:  if I’m going to spend the money to get them here and dedicate an entire day for an on-site interview process to know that that is a candidate that would likely take a job if it were offered to them.

TM:  It sounds like communication has come back and plays a critical factor.

CW:  Yes, it’s definitely a factor.  The other bit of advice is for an agency to definitely communicate from their expert perspective what is going to be required in order to secure a particular candidate…and the timeline that needs to be followed in order to fill a particular position or to maintain the interest of a particular candidate.  On the other hand, once that is communicated, respect the processes of their client, the physician group, and the timeline that is going to be taken…not push or rush a situation that could ultimately end unfavorably if a candidate is rushed through and all of the steps were not taken on either end to ensure it’s the best fit.  What could result is a recruitment “fill” that only stays a number of months. 

TM:  Those are certainly excellent talking points. Part of the training we give our recruiters centers around a day in the life of an administrator.  Recruitment is a mission-critical project for them [administrators], but it’s not the only critical project on their desk.  Our recruiters are trained that just because administrators haven’t returned your call or e-mail within 24 hours, it’s not a fire-and-brimstone scenario.  It’s just the weight of what a hospital administrator has to go through in terms of the number of initiatives on their desk on a daily basis.

CW:  While the recruiter gets to focus solely on the recruitment project at hand, I don’t have that luxury.  So that’s a good point.

TM:  As we wrap up, what do you find most rewarding about your career in healthcare administration?

CW:  I would say it has allowed me to be a problem solver, which is something that I very much enjoy.  Oftentimes our physicians are not either equipped from an administrative or experiential standpoint, and they just don’t have the time to think through solutions with consideration to all factors or interests. And so I am really able to intercede for them in a lot of ways—both from a business and administrative perspective even to patient care delivery in terms of facilitating communication with the facility and support staff that supports the providers to solve the problems and issues.  And it has allowed me the opportunity to be very creative and to come up with particular answers and potential solutions and resolutions…and be able to hone a particular hypothesis or direction where we’re headed that will ultimately lead to a successful outcome that meets patients', providers' and a community's needs. 

Having the ability to bring satisfaction to my providers in regards to their occupational goals and to equip them with the practice environment to best meet the needs of their patients, has been tremendous.  And also facilitating, like you said, that very delicate relationship with a hospital or health system administration and working to be a “Yes” person to foster those relationships with our different providers, trying to figure out ways to make it work, rather than just take the “No” or the easy road…to figure a way to align goals and incentives so that everyone benefits—it is all critically important. 

TM:  Certainly.  That’s a very important point.  Well, Corbin, I want to thank you for your time and thought-provoking insights.  I’m sure our readers will benefit from your perspectives.