Division Float Provider in Primary Care: A Novel Approach to Access Coverage in Primary Care

Background

A significant challenge in General Internal Medicine is coverage for leaves of absence and unexpected provider attrition. Patient satisfaction suffers as access to care becomes constricted, thus leading to an increase in patient complaints. As providers leave the workforce or reduce clinic time, remaining providers bear the brunt of the increased workload leading to resentment, burn out, and disengagement from the workplace. To address these concerns, the Division of Internal Medicine at Cooper Health and Cooper Medical School of Rowan University implemented a Float Provider to cover absence.

Cooper General Internal Medicine provides primary care to a large area of South New Jersey and four subacute/nursing home facilities for a total of 72 providers and 12 primary care offices. The Division Float is a 0.5 clinical full time equivalent (cFTE) physician who provides coverage for our primary care clinics and nursing home/subacute facilities. In the clinic setting, the Float Provider schedule will book 12 patients per four-hour session and templated for sick visits, hospital follow ups, and annual wellness visits. Float Provider workdays will vary from month to month based on the needs of the division but never go over the expected hours for 0.5 FTE. Although, the division primary care providers have Saturday hours and nontraditional hours in the primary care clinics, the Float Provider is scheduled for only traditional workdays (Monday through Friday) and traditional hours 8am-5pm. The provider is required to manage their own in-basket and forward results to the PCP for further management and follow up. Physician compensation is based on RVUs which includes a quality portion at risk that guarantees our Float Provider will be a good citizen to help capture patients with overdue quality metrics during the visit.

Our division Float Provider is an experienced physician who was at an exit point in their career. This individual was not ready to retire completely from patient care and needed schedule flexibility. A Float Provider does not need to be seasoned or at the end of their career; but, the key qualities that make them successful is a willingness to be flexible with their clinical hours from week to week and a comfort in working in different or new clinical sites. Unlike per diem providers, the Float Provider was contracted to work a 0.5 cFTE which guaranteed a baseline quantity of access for our clinics.

We have had the division float position for three years. In 2023, we had a total of 33 weeks of leave of absence from Physicians and Advance Practitioners in the division. We had a total of one full time provider lost to attrition in 2023. The float physician provided 108 hours of clinic coverage and 16 weeks of nursing home coverage. The Float Provider generated approximately 3,600 RVUs in 2023 which aligns with RVU productivity metrics expected for a part time primary care physician. As compensation was based on RVUs, the position did not require additional financial support from the division. We did not replace every session that was lost through a leave of absence or attrition as that was too great for our 0.5 FTE Float Provider to fill. We found that adding one or two sessions per month in a clinical space experiencing attrition or leave of absence provided enough of a relief valve for patient access that the providers felt it made a positive impact.

The float position was an overwhelmingly positive intervention. Physician and Advanced practitioners in the division expressed their satisfaction and appreciated the “decompression” of the workload by this provider. We were also able to maintain patient access in the face of provider attrition. Thus, a Division Float model is a sustainable strategy to meet the continual challenges of provider leave and shifting cFTE.