The Physician Retention and Turnover Challenge — Success Starts with Strategy
Nov.–Dec. 2007
As the imbalance in the supply and demand for physicians intensifies, physician turnover and retention remains at the forefront among critical issues that medical groups must address. The changing demographic picture of the physician workforce is another factor in play, as increasing numbers of practicing physicians retire while the number of graduating physicians remains unchanged.
To help highlight trends and strategies related to retention, Cejka Search and the American Medical Group Association (AMGA) assembled statistics and insights from 92 AMGA respondents whose groups collectively employ 16,833 physicians.
Respondents were asked to provide their answers based on the specific number of physicians with regard to demographic questions and those relating to trends affecting turnover.
In the report summary, a significant demographic shift among the reporting groups was exhibited from year to year. In 2006, female physicians accounted for 35% of physicians employed in the groups, compared with 28% in 2005.
On Average, There Is Virtually No Difference in Turnover between Male and Female Physicians
In 2006, there was virtually no difference in overall turnover between male and female physicians, but there was a shift among genders compared to 2005, with a significant increase in turnover among males and a decrease in turnover among females. The total average rate of turnover increased to 6.7%, compared with 6.4% from the prior year. Overall, turnover among male physicians increased to 6.8% in 2006, compared with 5.9% in 2005, and turnover among female physicians decreased to 6.6% in 2006, compared with 7.5% in 2005.
Statistically, the total average turnover reported in 2006 was within a band of 6.0 and 7.7% for the categories of responding groups, with the exception of academic groups.
Just Over Half of Responding Medical Groups Anticipated Their Turnover Rates and Deemed Them to Be “Acceptable”
Nearly six in ten (58%) respondents reported that physician turnover was close to their anticipated rate. Among the remaining groups, where turnover differed from what was anticipated, more than twice as many medical groups said turnover rates were “higher than expected” than those who said turnover was “lower than expected” (30% versus 12%).
Although a little over half (57%) of the groups stated their turnover rate was “acceptable,” 43% said it was “too high.” This indicated that — even among some who anticipated the turnover rate — there was a belief that it was still too high. No respondents in the survey indicated that turnover was “too low.”
The First Three Years Are Critical for Retention
As the number of experienced physicians moving on in their careers or toward retirement grows, the need to assess candidates for fit and the importance of focusing on retaining newly recruited physicians has become crucial for physician workforce stability.
Forty-six percent (46%) of those physicians who leave a practice are most likely to do so within the first three years of employment. The proportion leaving before the end of their first year of employment grew to 12%, compared with 9% in 2005. In aggregate, the respondents reported that 23% of the departing physicians had been with their practices for more than 10 years.
Based on the total number of physicians leaving, 57% were experienced physicians with six or more years of total practice experience, 34% had been practicing between one to five years, and 9% were immediately post-training. Notably, small groups reported that 61% of departing physicians had more than 10 years of total practice experience.
Fit and Family Are the Driving Forces in Turnover
According to the survey results, a lack of cultural fit with the practice and/or the community was a driving force in turnover. This data is consistent with past reports, stating a “poor cultural fit with the practice” is the single most frequently mentioned reason for voluntary separation (51%). In addition, “Relocated to find a better community fit” was mentioned 20% of the time.
However, family reasons that required
the physician to relocate were also strong contributors to turnover, with “relocating to be closer to own or spouse’s family” (42%) and “spouse’s job required relocation” (22%) revealing that moving for family reasons is a significant cause for physicians leaving the practice.
Retention Programs May Be Unwritten — but They Are Effective
Groups with designated retention programs collectively employed 6,010 physicians, a large enough sample for measuring turnover.
Forty percent (40%) of respondents stated they “have a designated physician retention program” and only one in five of these reported theirs as being a “written plan with identified goals and strategies.” Survey results showed that turnover was 6.0% among physicians working in a group practice with a designated retention program, compared with 7.1% for those without.
Additionally, group practices with a designated retention program were somewhat more likely to keep their physicians for at least 10 years. In groups with a designated retention program, the proportion of departing physicians was 73% leaving within 10 years and 27% leaving after their tenth year. In groups with no designated retention program, the proportion was 79% leaving within 10 years and 21% leaving after 10 years.
Succession Planning and Mentoring Programs Remain Primarily Informal
Leadership succession plans most often are a shared responsibility among a combination of executive leaders or the board of directors. Methods for identifying future leaders included observation of a physician’s participation with groups or committees and his or her expressed interest in a leadership role.
Among all respondents, 39% stated they have a leadership succession plan in place. But, among this group, fewer than half said they have a “written document with identified goals and strategies.”
Based on the total number of physicians employed by the responding groups overall,
it is possible to observe a significantly lower turnover ratio among physicians whose group practice assigned a mentor. Groups that assign no mentors at all had a 7.2% turnover ratio, compared with 6.3% for groups that assign mentors, and 5.8% for those who assign mentors from within the same department as their newly recruited physicians. Respondents agreed that the primary factor in the success — or failure — of a mentor relationship is the commitment level of the mentor. The limited availability of time to devote to the mentor relationship was consistently mentioned as an obstacle to success.
Retention Takes Commitment
Turnover is a fact of life and there are pressures beyond the control of medical group practice leaders. Demographic shifts include the growing number of retiring physicians leaving the workforce and the increasing ratio of female to male physicians. There is also a change with regard to the needs and expectations of younger physicians who appear to be increasingly focused on being happy in their work and family life. It will be up to medical groups to continuously explore creative ways to structure the practice to address the realities of these trends.
A first line of defense is carefully evaluating the influence of “fit and family” during the interview process. In the rush to hire, red flags in the candidate assessment are often overlooked. With pressures to ramp up quickly, the acculturation of a new physician may be shortchanged.
Participants in the 2006 retention survey offered further proof and testimony that strategies employed before hire, within the early stages of employment, and throughout the career cycle of a physician are worthwhile investments in long-term physician retention and stability of a medical group practice.
NOTE: The American Medical Association Membership Data, as of May 2006, reported that approximately 67% of physicians were over the age of 42. The Association of American Medical Colleges reports that 15,925 new physicians graduated in 2006, virtually unchanged from an estimated 15,000 to 16,000 physicians who graduated in 1980.
Source: 2006 Physician Retention Study, Cejka Search (www.cejkasearch.com) and American Medical Group Association (www.amga.org)
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