Early Focus on Physician Satisfaction Is Key to Retention
July–August 2005
Results of a recent physician retention survey conclude that early preventive care taken to maximize physician satisfaction can play a key role in preempting physician turnover. Cejka Search, a national leader in physician and health care executive recruitment, and the American Medical Group Association (AMGA) conducted the survey. The study highlights the issue of turnover costs and provides an initial baseline from which medical groups can compare their turnover. Over recent years, as the physician shortage has become more critical, the attention is shifting to include not only how to recruit physicians, but also how to keep them.
Early Detection Is Key
A key finding of the survey shows that more than half (54%) of physicians who leave their medical groups do so within the first five years. “It should also be noted that sometimes, the decision to leave is often made as early as the first three to five months,” says Carol Westfall, president of Cejka Search.
Joseph Scopelliti, M.D., executive vice president of clinical affairs at the Guthrie Clinic in Sayre, Pennsylvania, and AMGA speaker on the subject of retention, endorses the urgency of evaluating physician satisfaction at the onset. “The most fragile time for physician retention is in the early stages of employment when physicians are learning about a medical group’s culture and are looking for their own fit,” he says.
Cejka Search and the AMGA hope that the survey will serve as a benchmark in monitoring physician turnover, and alert employers about the importance of monitoring a new physician’s adaptation to a medical group. “The information from the survey implies that physician retention — just like the medical care they provide — requires preventive and early treatment for the best outcome,” she adds.
Turnover Misconceptions
Another key finding is that physician turnover is actually higher than perceived by medical groups.
According to Westfall, a commonly held belief among medical groups is that turnover is around five percent. The survey found, however, that the average rate of turnover was reported at 9%.
“In the business world, a turnover rate of 9% may not be cause for concern. In the medical profession, however, given the physician shortage and costs involved in replacing one, that 9% can be unduly burdensome,” Westfall says. “Not only is there the loss created by undelivered services and changes in referral patterns due to shifts in patient loyalty, but there is also the additional cost of recruitment and getting a new physician through the learning curve,” she adds.
Reasons for Turnover
The survey also found that compensation and practice issues are among the top reasons for a physician to leave a medical group. According to the survey, practice issues cause physicians to leave approximately 30% of the time and compensation causes separation approximately 20% of the time. Other factors contributing to the issue of voluntary resignation for physicians include location (13%), spouse’s career (10%), and the pressure of clinical practice (10%).
In addition, physicians leave due to disappointment over what they consider to be “broken promises,” such as patient volume falling short of expectations at hiring, or partnerships not becoming available when the physicians perceived they would be.
The Costly Effects of Turnover
With its experience of completing more than 600 assignments a year, Cejka Search estimates an average cost of $3,000 per physician candidate and spouse in interview expenses. Lost productivity from an unfilled position, replacement costs, and the cost of the interview team’s lost time and productivity contribute to the total cost of turnover.
According to the survey, 73% of the responding medical groups expressed concern about their ability to retain physicians. This concern was also expressed as a potential problem for the future. Approximately 68% of those surveyed predicted that physician turnover would continue to increase on a national level over the course of the next two years.
Despite the cost and concerns surrounding turnover, only 27% of the respondents reported that their group had any kind of written or formal retention plan. Westfall warns that this is extremely unwise. “Unless groups allocate necessary resources to invest in formalizing and implementing effective physician retention programs, turnover rates are likely to increase in the same proportion as the projected increasing rate of physician shortages,” Westfall says.
Better Recruiting Means Better Retention
Practical strategies and recommendations to improve retention include better managing physician expectations, starting with the initial interview. Groups that improve communication during the hiring stage and include realistic details about potential income beyond the guarantee period may avoid unrealized expectations and subsequent separation.
“Groups that are successful with retention make recruiting the lifeline to their organization’s success,” says Westfall. “They actively involve senior leadership in the recruitment, interview, and follow-up processes with physician candidates.”
A good recruitment process is key to ensure retention, according to practice managers. Darrell Stremler, CEO at DuPage Medical Group in Glen Ellyn, Illinois, says the process involves first developing a practice culture that emphasizes patient care, but also includes a collegial environment, personal responsibility to solve problems, willingness to go the extra mile, and group contribution to success.
“What happens in that environment is that so many people are choosing to become part of our culture, they help to make it even more of a reality once they get here,” Stremler says. “Our success is attributed to the careful selection of not only qualified physicians, but also those who will fit into the group’s culture; then the careful mentoring and acclimatization of physicians within their first couple years.”
As a result, DuPage has very little voluntary turnover. Some doctors retire and some are terminated each year, but most of them are in their early forties and choose to stay with the practice.
Common Recruiting Methods
A majority of the groups surveyed reported using several methods for physician recruitment, including full-time or part-time in-house recruiters, contingency firms, and/or retained firms. According to the survey, recruiting over the past year has particularly focused on internal medicine, dermatology, gastroenterology, cardiology, and family practice. The survey predicts that rates for these and other difficult-to-recruit specialties will place pressure on currently employed physicians to consider more lucrative opportunities and locations.
Survey Methodology
The survey was distributed in August 2004 to 251 nationwide AMGA-affiliated medical groups. Of the 251 medical groups, 67 responded, ranging in size from less than 50 physicians to more than 150 physicians. The survey breaks down information by specialty, group size, and regional locations, along with information on turnover tracking and retention practices. To obtain an electronic copy of the Cejka Search and AMGA Retention Survey, e-mail retentionsurvey@cejkasearch.com.
Source: Cejka Search and AMGA. In order to obtain an electronic copy of the Cejka Search and AMGA Retention Survey, email retentionsurvey@cejkasearch.com.
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