INDUSTRY PERSPECTIVES

INDUSTRY PERSPECTIVES Proactive Strategies Help Leaders Recognize the Signs of Physician Burnout Leland Roberts, Associate Director, Delta Locum Tenens the 4th Quarter 2017 January 17 - December 17 PHYSICIAN BURNOUT IS A COMMON STORY ACROSS FACILITIES AND SPECIALTIES, IMPACTING PROVIDERS OF ALL AGES AND TENURE. WHILE YOU MAY NATURALLY CONCLUDE THAT BURNOUT ONLY HAPPENS AFTER DECADES INTO A CAREER, RESEARCH FROM THE ADVISORY GROUP S MEDICAL GROUP STRATEGY COUNCIL SHOWS THAT 33.3 PERCENT OF PHYSICIANS WHO HAVE BEEN ON THE JOB FOR LESS THAN A YEAR SAY THEY EXPERIENCE STRESS AND BURNOUT. IN ITS REPORT, COMBATING PHYSICIAN BURNOUT, THE MEDICAL GROUP STRATEGY COUNCIL SURVEYED U.S. PHYSICIANS ACROSS PRIMARY AND SECOND- ARY CARE DISCIPLINES TO CONCLUDE AN UNWELCOME REALITY: PHYSICIAN BURNOUT IS INCREASING. WHILE WE CAN T ELIMINATE BURNOUT ENTIRELY, WE CAN RECOGNIZE THE SIGNS AND TAKE A PROACTIVE STANCE TO MITIGATE THE NEGATIVE IMPACT TO PROVIDERS, PATIENTS, AND HOSPITALS. FIVE STEPS TO PROGRESS By the time a physician expresses burnout, the damage is already done. At this point, he or she may already be ready to leave the facility, the profession, or be unmotivated to change. Because burnout is such a widespread issue, mitigating the impact is a high-level priority for 90 percent of the medical executives interviewed by the Advisory Group. But how? And after consulting with stakeholders in the field, the Medical Group Strategy Council outlined five insights that could help combat the problem: recognize it might not be who you think; listen (via group forums, one-on-one conversations, or executive rounding); give physicians a choice in operational initiatives (ask them to weigh in on organizational priorities or to help solve problems); balance negative and positive feedback (use quantitative and narrative data); and offer emotional support (via off-center retreats). These insights can be part of a proactive strategy designed to create awareness before burnout becomes a reality. THE NEED FOR TIME OFF While most providers begin their careers enthusiastic about the demands of the job, it s imperative to understand that the reality of the work may prove more taxing than they expected. Identifying when a physician has accumulated an abundance of personal time off (PTO) hours can be a sign that they don t feel they can take a vacation or spare time away from patients. In these instances, it s incumbent upon hospital leaders to recognize the need for providers to take a break. And it s where locum tenens providers can become invaluable. Locum tenens providers can fill in for a day, week, month or longer. By providing a way for physicians to have PTO, locum tenens professionals help to combat physician burnout. In doing so, these providers not only fill a temporary need, but assist with the ongoing quest to provide excellence in patient care. of physicians who have been on the job for less than a year say they experience stress and burnout. of medical executives put mitigating the impact of burnout as a high priority. THE PHYSICIAN RECRUITING

PLACEMENTS & INTERVIEWS Candidate Sources PLACEMENTS & INTERVIEWS Placement Data by Specialty This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average Job Boards 26% days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty. Average Average Days emarketing 46% Networking 24% Starting Sign-on Bonus Potential From Interview to Placement Family Medicine $231,664 $24,516 $278,318 22 1 Family Med.- Obstetrics $222,334 $52,000 $310,299 23 60 Fastest Days-to-Fill Other 4% Data indicates sources of candidates for placements and interviews from January 2017 through December 2017. The information contained herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. No one should act on such information without appropriate counseling and thorough examination of the particular situation. For more information regarding specific specialties, regions, or trends, contact Eric Sasser, VP of Advertising, The Delta Companies at (800) 521-5060 x4600 or Placements by Population 45% 36% Surgery Primary Care Sub - Specialties Internal Medicine $223,750 $20,000 $201,000 25 71 Obstetrics/Gynecology $302,500 $20,000 $329,167 33 13 Pediatrics $209,583 $20,909 $256,500 12 63 Psychiatry $238,586 $43,737 $268,500 25 8 Orthopedic Surgery $553,680 $58,333 $681,447 27 116 Surgery - General $408,333 $45,000 $435,556 33 24 Surgery - Cardiothoracic $460,000 $30,000 $700,000 15 163 Urology $422,500 $22,500 $530,000 10 65 Critical Care Medicine $300,000 $25,000 $425,000 13 73 Neurology $422,500 $22,500 $530,000 10 65 esasser@thedeltacompanies.com. Subscription information and an archive of previous versions is available at www.thedeltacompanies.com/standard. 19% Hospital Based Emergency Medicine $333,878 $16,667 $381,150 22 5 Hospitalist $261,533 $21,000 $301,827 28 4 2017 The Delta Companies Pediatric Hospitalist $232,500 $26,000 $243,500 18 116 Subscribe online @ www.thedeltacompanies.com/standard Data indicates the percentage of placements made from January 2017 through December 2017 by the population of the search facility s metropolitan area. Data reflects averages from placements and interviews by Delta Physician Placement from January 2017 through December 2017. Potential data reflects average yearly compensation at full production excluding benefits. Average Days data does not include off-contract placements. Average Days Total Placement data is calculated from profile to placement.

MARKET DEMAND LOCUM TENENS Nationwide Search Distribution 4.3% Days Requested - Top Specialties 2.1% 4.9% 5.6% Surgery (Gs, Cts, Ors) 9.5% 8.9% 11.8% 3.9% 5.3% 4.3% 3.6% Emergency Medicine Urgent Care 8% 6% 7% 26% Other 6.9% 4.6% 7.2% 1.3% Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from January 2017 through December 2017. Primary Care (Fp, Im, Ped) 15% 24% Hospitalist (hosp + Ped Hosp) Specialty Demand Comparison 4 th Quarter 2017 4 th Quarter 2016 1. Family Medicine Family Medicine 2. Anesthesiology Internal Medicine 3. Internal Medicine Family Medicine - Obstetrics 4. Neurology Pediatrics 5. Psychiatry Surgery - General 6. Urology Obstetrics/Gynecology 7. Pediatrics Urology 8. Emergency Medicine Emergency Medicine 9. Family Medicine - Obstetrics Geriatric Medicine - IM 10. Hospitalist Otolaryngology 11. Cardiology - Interventional Psychiatry 12. Gastroenterology Allergy/Immunology 13. Gynecology Gastroenterology 14. Hematology/Oncology Hospitalist Search Specialty Distribution Hospital-Based 13% Surgery Sub-Specialties 18% Primary Care 55% Data indicates the percentage of searches initiated by specialty grouping between January 2017 through December 2017. Candidate Placements Top 5 States Providers Have Taken New Opportunities 1. Wisconsin 2. Pennsylvania Data indicates the top specialties by days requested from January 2017 through December 2017. Nationwide Physician Distribution Advanced Practitioner (np + pa) 5.3% 1.4% 2.0% 9.4% 5.1% 5.9% 8.2% 9.8% 5.7% 7.1% 7.2% 3.5% 4.9% 1.4% 7.7% 4.8% 10.6% 15. Occupational Medicine Medical Oncology 3. Iowa Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the fourth quarters of 2016 and 2017. 4. Arizona 5. Minnesota Compares all states for the top 5 candidate placements as initiated by Delta Physician Placement from January 2017 through December 2017. Map represents the percentage of licensed physicians by region working with Delta Locum Tenens.

INDUSTRY PERSPECTIVES The Rise of Telemedicine and Why You Don t Want to Be Left Behind Molly Mettauer, Marketer, Delta Healthcare Providers MARKET DEMAND Nationwide Search Distribution Specialty Demand Comparison TECHNOLOGY HAS MADE IT POSSIBLE FOR HEALTHCARE PROVIDERS TO SUCCESSFULLY TREAT PATIENTS VIRTUALLY, OPENING UP A WORLD THAT ENABLES GREATER EFFICIENCY AT A LOWER COST. THANKS TO TELEMEDICINE THE USE OF TELECOMMUNICATIONS TECHNOLOGY TO DIAGNOSE AND TREAT PATIENTS FROM REMOTE LOCATIONS PROVIDERS AND PATIENTS NOW HAVE AN ADDITIONAL CHANNEL OF COMMUNICATION TO DELIVER AND RECEIVE RELEVANT, COST-EFFECTIVE MEDICAL CARE. THE APPEAL OF VIRTUAL VISITS From a provider savings perspective, telemedicine often makes sense. According to Modern Healthcare, 71 percent of organizations adopted telemedicine last year (up from 54 percent in 2014), and 29 percent have seen 20+ percent in cost savings. For patients, telemedicine can translate into savings of $126 for an acute care visit, according to American Well. And when you consider that a nonemergency in-person visit to a doctor s office typically costs $100, or $160 at an urgent care clinic, as opposed to a $45 telehealth appointment, it s easy to understand the appeal. LESS TIME, MORE EFFICIENCY Across the nation, the acceptance of telemedicine is on the rise. American Well reports that after surveying 2,000 consumers, 64 percent approved of telemedicine. This is largely because of the convenience factor. Professionals with busy schedules, people who have difficulty traveling, parents with a sick child (ear infections, colds, and other conditions easily diagnosed), and those located in rural areas benefit from the convenience of telemedicine. THE HEALTHCARE RECRUITING Providers also see the efficiency advantage, which helps to buoy a 57 percent acceptance rate, according to Becker Hospital Review. Because patient issues are resolved 83 percent of the time during an initial telehealth visit, for many (like stressed out parents or overwhelmed providers), the choice to leverage telemedicine rather than log minutes in person has great appeal. STAFFING FOR TELEMEDICINE As more patients and providers leverage telemedicine, the demand increases, particularly for the expertise of registered nurses (RN). Within just 26 days, Delta Healthcare Providers (DHP) successfully completed a telemedicine RN placement with a provider who has 20 years of skilled experience. The community she now works with has less than 30,000 people. Approximately 7 million patients are expected to utilize telemedicine this year, and about 70 percent of employers said that telemedicine is or will be a part of their benefits package. As such, the demand for telemedicine providers is on the rise. Telemedicine offers the opportunity for small or rural hospitals to connect to a greater number of patients and provide expanded services. Because of telemedicine, facilities have the potential to realize significant cost savings while continuing to focus on the delivery of high-quality patient care. of organizations adopted telemedicine last year. Amount of time it took for DHP to successfully complete a telemedicine RN placement. of the time patient issues are resolved during an initial telehealth visit. 5.4% 9.9% 13.0% 20.4% 6.2% 4.1% 1 2.3% 2.1% 6.5% 1.1% 4.5% 3.4% Map represents searches initiated by Delta Healthcare Providers on behalf of healthcare facilities from January 2017 through December 2017. PLACEMENTS & INTERVIEWS Placements by Population 38% 29% 19% Data indicates the percentage of placements made from January 2017 through December 2017 by the population of the search facility s metropolitan area. 4 th Quarter 2017 4 th Quarter 2016 1. Physical Therapist Registered 2. Registered Physical Therapist 3. Practitioner Data compares the top 5 most requested searches initiated by Delta Healthcare Providers in the fourth quarters of 2016 and 2017. Years of Experience 27% 25% 34% < 2 Years 2-5 Years Practitioner 4. Dentist Dentist 5. Occupational Therapist Medical Lab Technician 6-10 Years > 10 Years Data indicates the average years of experience of candidates for placements and interviews from January 2017 through December 2017.

PLACEMENTS & INTERVIEWS Placement Data by Specialty This data represents average statistics of placements and interviews by Delta Healthcare Providers over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented is an indicator of the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty. Nursing Allied/Other Extenders Rehabilitation Starting Average Sign-on Bonus Student Loan Repayment Relocation Reimbursement From Interview to Placement Data reflects averages from placements and interviews by Delta Healthcare Providers from January 2017 through December 2017. Average data reflects average yearly compensation for each position listed above. Average Days data does not include off-contract placements. Average Days Total Placement Occupational Therapist $85,750 $7,571 $30,000 $4,000 5 61 22 Physical Therapist $83,665 $10,667 $22,667 $4,691 10 68 2 Fastest Days-to-Fill Speech-Language Pathologist $83,704 $7,600 $15,000 $4,083 6 106 21 Physical Therapy Assistant $70,000 $2,500 - $2,500 3 74 1 Practitioner $144,600 $18,984 $43,288 $9,515 11 73 1 Physician Assistant $111,000 $7,666 $28,000 $5,500 7 52 14 Dentist $174,292 $20,667 $52,500 $9,500 11 91 1 Diagnostic Medical Sonographer $61,620 $37,500 $6,500 $6,250 4 59 148 Licensed Clinical Social Worker $71,914 $6,250 - $3,250 14 80 26 CRNA $153,000 $48,750 $25,000 $4,500 31 319 255 Registered $79,497 $10,036 $17,714 $8,286 4 57 3 Director of Nursing $78,000 $2,000 - $5,000 2 121 121 Manager of Surgical Services $90,000 $4,500 - $2,000 4 40 40 Candidate Sources STAFFING The data below is comprised of travel placements made by Delta Healthcare Providers over a three-month survey period. Facility Demographics 20% Home Health emarketing 61% 30% Outpatient 22% Skilled Practice Settings 23% Mixed Job Boards 26% Cold Calls 7% Referrals 4% Websites 2% Data indicates sources of Delta Healthcare Providers permanent candidates for placements and interviews from January 2017 through December 2017. 5% Inpatient >200 34% Candidate Placements Compares all states for the top 5 candidate placements as initiated by Delta Healthcare Providers from January 2017 through December 2017. 100-200 23% Number of Beds <10k <100 43% 50-100k >100 10-50k 51% 21% Top 5 States Providers Have Taken New Opportunities 1. Alaska 4. Nebraska 2. California 5. Kansas 3. Wisconsin Community Population Years of Experience Recent Grads < 2 Years 2-5 Years 6-10 Years > 10 Years 2% 20% 42% 15% 21% Data is compiled from assignments placed by Delta Healthcare Providers from October 2017 through December 2017.