As physicians are leaving clinical practice at younger ages than before, health systems are adjusting their retention strategies through new call schedules, redefining full-time positions and more specialty hospitalist models.
Research published May 7 in The Permanente Journal found the mean age at which physicians left clinical practice was 48.1 years — nine years younger than a comparable cohort from 2008.
A separate study, published May 20 in the Journal of the American College of Surgeons, found surgeons with 10 to 14 years of experience were more than twice as likely to leave the profession than peers who have been practicing for five to nine years, a pattern the researchers called a “mid-career spike.”
Call coverage sits at the center
Rachelle Daugherty, chief administrative officer for physician enterprise at Renton, Wash.-based Providence, said the system is actively auditing call schedules across many of its facilities.
“Where typical call [ratio] might have once been 1-to-3 or 1-to-4, there are many areas where we are needing to adjust these to 1-to-5 or 1-to-6, as well as consider specialty hospitalist coverage models,” she said, adding that the specialties most often asking for these models are neurology and gastroenterology.
Kenneth Sable, MD, president of the acute care hospital division at Edison, N.J.-based Hackensack Meridian Health, said the pattern is straightforward.
“I think it comes down to being on call as one major thing,” he said. “As you get into your mid-40s, being on call and having your sleep interrupted multiple times over the night … you really like getting quality sleep.”
Hospitalist models absorb the gap
Hackensack Meridian, an 18-hospital system, has expanded specialty hospitalist programs — laborist, critical care and neurology — that allow physicians to shed overnight hospital calls while preserving their outpatient practices.
If you’re an obstetrician working all day in the office, “you don’t have to get out of bed to deliver a patient at 2 [o’clock] in the morning,” Dr. Sable said. “We have services for that.”
The laborist model has grown partly from recruitment pressure: The Journal of the American College of Surgeons study identified OB-GYN as having the second-highest annual attrition rate among surgical subspecialties at 5.9%.
There is no standard formula for building these models. Clearwater, Fla.-based BayCare Health System, which operates 16 hospitals, has found that call schedules must be tailored to each specialty’s case mix and volume. Neuro hospitalists can often rotate one week on, one week off, while OB hospitalists require more dynamic staffing given the unpredictability of deliveries.
Rethinking full-time equivalents
Providence is also renegotiating what a 1.0 full-time equivalent means inside shift-based groups — a structural shift playing out across the industry.
“Positions that, not too long ago, medical directors would not even consider to hire at less than full-time … are now being either crafted uniquely to meet the needs of an individual candidate, or even created with built-in flexibility that is touted in job ads to attract more potential candidates,” Ms. Daugherty said, adding that requests for reduced FTE are coming most frequently from primary care, psychiatry and advanced practice providers.
The rural gap
The structural redesigns available to large integrated systems aren’t always feasible for smaller hospitals.
JohnRich Levine, DNP, chief nursing officer at Reeves Regional Health in Pecos, Texas, said his system faces a different version of the problem.
“Surgeon retention is heavily influenced by case volume, access to resources, lifestyle considerations and the ability to practice at the top of their license — all of which we struggle to consistently make available,” he said.
Without the volume to sustain a laborist program or the physician supply to lengthen rotations, rural systems are leaning on softer levers.
“Retention often comes down as much to connection, trust and a shared sense of purpose as compensation,” Dr. Levine said.
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