6 Ways to Decrease Physician Turnover

The 2010 Physician Retention Survey by the American Medical Group Association and Cejka Search reported that physician turnover in 2010 is up from the previous year, at 6.1 percent compared to 5.9 percent. For female physicians, the jump is even larger, at 6.5 percent in 2010 compared to 6.2 percent in 2009. In a time when physician shortages are projected to strain practices and hospitals, improving physician turnover is essential to keeping costs down and providing quality care. Here Gregory Stovall, MD, senior vice president of medical affairs at Trinity Mother Frances Hospital in Tyler, Texas, and Lori Schutte, MBA, president of Cejka Search, discuss six ways physician groups can reduce turnover.

1. Consider the cost of losing a physician. Dr. Stovall says one of the most important parts of increasing retention is acknowledging the negative financial impact of high turnover. A practice that does not value physician retention will end up spending significantly more money on recruitment, training and lost downstream revenue. "The cost of physician turnover includes three components: the cost of recruiting the physician, the cost of getting them started up into practice and the downstream benefit of the physician's practice that you lose when they leave," Dr. Stovall says. "We found it cost us about a quarter of a million dollars to recruit and start up a physician, and the downstream revenue average is around a million dollars." He says investing in retention strategies became very important for his practice, and reducing turnover by as little as 1-2 percent had a significant impact on annual budgeting.

2. Establish a mentorship program. According to the survey on physician turnover by AMGA and Cejka Survey, 74 percent of physician groups said they believed a mentorship program reduces turnover — yet only 56 percent of groups assigned a mentor. The survey also found that the average turnover rate for groups that had a formal mentor program was 5.3 percent, compared to 6.3 percent for groups that did not. "Mentoring in healthcare has been a bit of a lost art, even though it has a great history," says Dr. Stovall. "It takes a real commitment to develop a program of mentoring."

He says his practice has developed a program that assigns a mentor to every recruited physician and mid-level provider, an initiative that has proved successful in increasing retention. The mentors and new hires meet at least once a month to talk about the organization and any struggles the new physician is having, and mentors submit reports on physician progress at six and 12 months. "We discover problems early that we need to address," he says.

3. Provide flexible scheduling opportunities. According to Ms. Schutte, Cejka Search and AMGA have noticed over the last several years that more medical groups are offering non-traditional scheduling options. "If the medical group can provide flexibility in the medical practice, they may be more likely to keep physicians working," Ms. Schutte says. "The two fastest-growing physician workforce segments are younger female physicians … and older male physicians approaching retirement." Ms. Schutte says these two segments are also the most likely to want to work on a part-time basis, as younger female physicians may have family responsibilities and older male physicians may want to slow down as they approach retirement. She says some practices offer options such as a three- or four-day week, a shift from the traditional model that expected full-time work from a physician.

Dr. Stovall says to understand the importance of work flexibility, practices should view retention as a life cycle. "The values and needs change as the physician goes through their career," he says. "Ideally, you'd like them in the organization for their entire career." He says this may mean creating a practice where work schedules are tailored to the individual physician. He says creating a robust hospitalist program has been extremely useful for his own practice, as it gives physicians the opportunity to accept fewer call obligations and operate part-time without endangering patient care.

4. Recruit the right physicians up front. Recruiting great physicians and partners up front will benefit a practice in the long run, as providers are more likely to stay with the practice if it fits with their values and career goals. Ms. Schutte recommends implementing a robust screening that "looks significantly beneath the surface" of each candidate. Practices should also consider engaging the physician's spouse or significant other to determine whether the physician's family supports the move to the new practice. She says before joining a practice, every physician should be exposed to their colleagues and some support staff to give the visit a social aspect. The practice leaders should also be on the same page about the kind of provider they are looking for. "This is not just about skills, but about the type of personality, experience and communication style they are looking for," she says. "They have to be on the same page about what the ideal hire will be."

Once a physician has been selected to join the practice, Dr. Stovall recommends putting the provider through a thorough orientation. "That's where you tell the history of the organization, the mission and vision and how those were developed," he says. His practice uses a "partner profile" that covers the characteristics that make a great partner: collegiality, competence, character and commitment. "The partner profile has been a very valuable tool to pass along to new physicians, to let them know what it takes to be a great partner and what the expectations are," he says.  

5. Give physicians opportunities for leadership development.
Dr. Stovall says his practice has developed an appetite for leadership. "We have found that people who engage in leadership development are more likely to stay with the organization," he says. "They build a loyalty and a commitment there that is really significant in contributing to their retention." He says the practice has a variety of leadership development opportunities, from positions on lunch committees to medical directorships to department chair responsibilities. "The survey identified that people starting a new career are looking for participation in administration and a broad approach to leadership rather than a small, top-down approach," he says. "It's our culture that everybody is doing a little bit in addition to practicing medicine."

According to the survey, 76 percent of medical group leaders feel it is "likely" or "very likely" that physicians will be added to the executive team, and 66 percent believe it is "very likely" or "likely" that the number of physicians in other leadership roles will increase. Practices responded that they offer a variety of opportunities for leadership development, including committee assignments, external institutes and conferences, medical directorships, allocated budget for leadership courses, allocated time for leadership courses and mentoring assignments.

6. Implement EMR to improve access from home. Dr. Stovall says while increasing scheduling flexibility should improve turnover, there are several challenges associated with allowing physicians to work part-time. He says the practice still needs to stay financially efficient, and patient hand-offs still need to work smoothly and not disrupt patient care. Implementing EMR can help because it allows physicians to work from home, and patient records are readily available for another physician taking over the case. "If the physician needs to get home and take care of kids and then finish up their documentation or review lab results, they can do that at a later hour in the evening," he says. When a hospitalist can look at a patient's history, medications and recent lab tests electronically, problems with transitions of care should decrease. "The electronic record allows us to pass the information along much more readily," he says.

Read more about physician relationships:

-Survey: 45% of Physicians Expect Higher Salaries With Hospital Employment

-6 Tips for Improved Relations Between Hospital Leaders and ED Physicians

-Physicians Skeptical About Earning Shared Savings in ACOs

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