The real cost of physician turn-over

Key thoughts:

• Physicians are the face of health institutions, are central to patient care, and drive much of their revenues
• While turn-over reflects the natural ebb and flow of career moves, it can have a devastating impact on an institutions performance and its public image
• Hiring and growing physicians aligned with a core mission is a better investment than trying to recoup losses from high turn-over

Employers have long grappled with the balance between rejuvenating the workforce, achieving high productivity, maintaining loyalty and containing costs. This balance is especially profound with employed physicians when considering the pace of change in our industry today. There are many forms of physician employment, from private practice groups, to hospital or health system employed, to academic practices. Although the goals and incentives may be somewhat different, the principles of "ownership" driving ambition hold true whether it be through financial ownership or of a common greater purpose. This also holds true for private physicians that are active at their local medical centers.

The real value of a physician to the institution includes direct medical service revenue, ancillary testing, and the operating margins from ambulatory and inpatient surgery and hospitalization. But physicians also guide referrals to other employed physicians in the group, which can ultimately convert patient loyalties to create a point-of-service for all their healthcare needs. Not to mention the important role of physicians in community-building, whether it is within their service, through interdisciplinary collaboration, or with the community at large.

Although turn-over may result from the natural ebb and flow of career moves, it may also be a reflection of an un-cohesive or discordant work environment. Nursing and support staff turn-over may also foreshadow physician dissatisfaction. It’s paramount to know your turn-over rate, the reasons for turn-over, and to recognize the lost opportunity cost when a physician leaves. The costs of recruitment are generally far greater than costs of developing and maintaining an optimistic work-force that can grow through their careers. Our greatest assets are people. And physicians need to be values at the highest level of our healthcare mission.

This column is part of a series devoted to clarifying and enhancing the physician-health system relationship. Dr. Ken Altman is Chief of Otolaryngology at Baylor St. Luke’s Medical Center in Houston, TX. He is also Secretary/Treasurer-Elect of the American Academy of Otolaryngology – HNS, and past-President of the American Laryngological Association.

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