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High physician turnover needs early intervention cure
More than half of physicians leave within five years – many within five months. A few preventive steps can offer a big retention payback.
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Today’s 9% physician turnover rate leads to a lot of lost revenue and disrupted referral patterns. Yet practices could take some relatively easy steps to improve job satisfaction and ease the problem.
That is the key message that comes from The 2004 Physician Retention Survey by Cejka Search (a national physician recruitment firm) and the American Medical Group Association. Their survey showed that 29% of the physicians who leave do so within the first two years of employment and another 25% leave three to five years after being hired.
So why are so many physicians leaving? According to the survey, respondents cited the following:
- 31%, practice issues;
- 20%, compensation; and
- 13%, location.
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“Now we have a change in the supply and demand of physicians and they know about lots more opportunities,” Cejka Search president Carol Westfall told Orthopedics Today. “They have a lot more carrots being dangled in front of them in terms of job opportunities, so their tolerance for problems in the work place is less,” she said.
Of the 9% of doctors who leave annually, 71% of non-retiring physicians voluntarily leave practices, while 12% involuntarily left, she said. “A decision to leave that early represents a failure on both sides,” said American Academy Orthopaedic Association Leadership Fellows Program Mentor Stuart Hirsch, MD. “The frustrations may be highest at that point as accommodations have not yet had much time to be put into place and problems not enough time to be solved,” he told Orthopedics Today.
More than 250 American Medical Group Association (AMGA) groups received the survey and 67 responded. The 27% response rate represented more than 5000 physician responses, Westfall said.
What can practices do?
The solution: Westfall suggests that practices create a formal retention program – something beyond what’s being offered at most practices today. Seventy three percent of groups considered physician retention important enough to track it and 48% even had some retention initiatives, Westfall said. But when the survey drilled down further and asked the next question, “Do you have a written program in place?” and “Is there a formalized program?” it turned out only about 27% really did, Westfall said.
Practices should also form a retention team or appoint someone to ensure that plans get executed well. The goal: Make the new physician part of the team. Creative programs often include the following elements:
- family orientation;
- retention bonuses; and
- planned, periodical sabbaticals.
The first 90 days of employment, when new hires are most vulnerable, prove crucial to long-term success. She suggests giving extra attention during this period to help reinforce the employee’s decision.
Be up front
A straightforward practice may also fair better at keeping doctors. “Honesty, right from the beginning helps to avoid unrealistic expectations,” Hirsch, who is also an Orthopedics Today editorial member, said. “Medical groups should work under the premise that a physician being treated fairly will be more productive and a better member of the practice team,” he said.
As a new physician with the Denver Spine Center, Gary Ghiselli, MD, said that the fair treatment he receives at the practice keeps him happy. “I think that what happens a lot is that a lot of different spine groups or orthopedic groups… tend to cannibalize their younger partners and use them for a year or two years and sometimes even longer,” he said. “And at the end of that period, they want to erase the past and offer you a partnership,” Ghiselli told Orthopedics Today.
A new type of employee
The high turnover rate could also reflect a new generation of doctors. In the last three years, Westfall said that doctors are less likely to wait out “bumps in the road.” David B. Thordarson, MD, a medical resident director and vice chair of orthopaedic surgery at the University of Southern California, said that new physicians want more recreation and family time. “Actually, it’s an exception that I have a resident where they come through and they’re totally focused on orthopedics on being the be all, end all, for them,” Thordarson said. “So it’s actually a big change compared to the doctors of yesteryear,” he said.
Physicians hunting for jobs can make their search easier and increase their chances for job satisfaction by making a priority list. “It’s always about the location, the practice itself, the money…and then lifestyle issues that fold into all of those,” Westfall said. Good questions include, “What’s important to me?” and “What are my must haves?” she said. In addition to professional issues, doctors should consider family needs.
Finding a fit
Once goals are outlined, being proactive can also land physicians great jobs. “I looked for what would be the ideal position for me and then looked for that position,” Ghiselli said. “So, it wasn’t necessarily something that was advertised. There definitely wasn’t a recruiter that brought me to this practice. It was me figuring out what exactly do I want in a practice,” he said.
Job applicants should also compare their values with those of the practice, assess work demands and call schedules, Westfall said. ot
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