The Exec: Medical Group President Grappling With Workforce Shortages

By Christopher Cheney

Workforce shortages are the primary challenge of managing Wake Forest Health Network, the president of the medical group says.

Russell Howerton, MD, is president of the medical group and senior vice president of clinical operations at Atrium Health Wake Forest Baptist. A practicing surgeon, he previously served as chief medical officer of Wake Forest Baptist Health.

Wake Forest Health Network employs about 500 physicians and advanced practice practitioners.

Howerton recently talked with HealthLeaders about a range of issues, including physician engagement, the challenges of serving as senior vice president of clinical operations at Atrium Health Wake Forest Baptist, and clinical care predictions for 2023. The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: What are the challenges of leading the Wake Forest Health Network?

Russell Howerton: Emerging from the pandemic, our greatest challenge has been the workforce at either end. Staffing the non-provider workforce and securing adequate resources for our teams to deliver the expectations we have of them has been a great challenge. At the other end, provider recruitment, retention, and burnout have been major factors.

We have learned a great deal and done a great deal to develop our pipelines and recruiting processes for the non-provider staff—clinical and nonclinical, front desk, and the backend. We have always had partnerships with those who produce that element of the workforce,  but over the past couple of years, we have had to redouble our focus and intensify our efforts to strengthen those partnerships. We are not the only healthcare entity in the market for those individuals—it is ferociously competitive. We are gaining ground, but we are not where we want to be.

HL: How have you risen to the challenge of recruitment and retention in your provider workforce?

Howerton: There are many components of recruiting physicians and advanced practice practitioners. Of course, striving to have market compensation is always a core tenet—it is necessary, but it is not sufficient. Today, it is our perception that meeting the needs of physicians to feel an appropriate balance of autonomy and being securely nested in a larger system that insulates them from some of the vagaries of business practices is the task. In either direction, you can go off the rails. Certainly, you can insulate them a great deal, but you do not want to become too controlling of their daily lives and clinical activities. We feel we are striking an appropriate balance.

We are not as fully staffed as we would like, and we continue to face challenges recruiting primary care physicians. There are many new entrants and new models in the market, not just our traditional competitors. We have all recently watched primary care models for CVS and Amazon.

Creating the work environment that promotes physician engagement is a retention strategy. We also want to be the best place to work.

HL: What are the primary efforts you have in place to address burnout?

Howerton: You need to ease the barriers to giving good care. As an analogy, part of leadership’s job is to make giving clinical care feel like a fish swimming downstream with the tide, not having to swim upriver against the tide simply to deliver the care that your professional standards call you to do. For better or worse, the complexities of modern care delivery and organizational structure manage to put a lot of obstacles in the way of giving clinical care. We are trying to address those obstacles.

HL: What are the primary elements of physician engagement?

Howerton: Listening is essential, along with conveying that something was heard. When you listen, you will often hear much more than you can address. Physicians express broad concerns from promoting world peace to not having the parking lot swept often enough at a practice. You need to listen, hear, and act whenever possible on as many issues as possible.

HL: You serve as senior vice president of clinical operations. What are the challenges of serving in this role?

Howerton: I am responsible for several business lines and subsidiaries. I help oversee Wake Forest outpatient dialysis—we are the eighth-largest provider of patient dialysis in the nation. We operate more than 20 sites around our part of the state. It’s an interesting business. It is like the hospital business in that it requires staff in place every day to care for the patients. Again, we have had an intense challenge of maintaining adequate staff to offer the services we need to provide, and the dialysis population is a non-elective population. They need to have their care whether you have staff or not.

Compared to the physician group, there is a much smaller pipeline of available individuals with knowledge in dialysis. We are using some of the same mechanisms used in large facilities but there are relatively few travelers in the dialysis world. We are actively recruiting overseas even though the lead time to onboard someone from an overseas environment is many months—it is still an overall more favorable investment than travelers.To rise to this workforce challenge at the dialysis centers, we have adjusted our pay scales and we have broadened our recruitment searches. There is a higher labor cost in the nation today to get dialysis in real dollar terms than there was pre-pandemic. We do not envision that going away. We seek to find efficiencies and improvements in other aspects of the model.

HL: Do you have any clinical care predictions for 2023?

Howerton: I believe we will learn how telehealth will fit into the long-term model of healthcare. It clearly has a place we would not have imagined if you had asked us in January of 2020 before the pandemic.

I predict that the end of the public health emergency and the variety of approaches to the waivers and regulations that have allowed us to adopt a care model during the pandemic will lead to confusion for a couple of years.

HL: You have a clinical background as a surgeon. How has this clinical background helped you serve in physician leadership roles?

Howerton: Surgery requires a leader of a team to get the rest of the team to work together toward a common goal. That leadership skill is generally translatable to administrative leadership roles. I have a personal belief that the currency of leadership is the confidence of those you help lead that you, the leader, has confidence in them to do the job. The daily work of leadership is to build this confidence in those you help to lead, so that when you need to draw upon it, you can, and everyone can succeed.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.