Physician Retention Best Practices

Bolster Your Physician Recruitment Success By Leveraging Physician Retention Best Practices

In updated statistical models presented to the Association of American Medical Colleges (AAMC) outlining Physician Supply and Demand over the next decade, the data is showing an increase in the projected shortage of physicians.  This revised shortfall now indicates a deficit of between 42,600 and 121,300 physicians by the year 2030.[i]  Primary care physicians still represent the largest deficit with a shortfall between 14,800 and 49,300. Another group that may be particularly hard hit are surgical specialists with a shortfall ranging between 20,700 and 30,500.

The primary driver of this increased demand for medical care is the aging of the U.S. population. Estimates in the AAMC Supply and Demand study project that the population over age 65 is going to grow by 50%.  The challenge facing healthcare systems and organizations around the country is that it will continue to become increasingly difficult to fill physician vacancies. Estimates show that the cost to fill a physician vacancy, including recruitment, onboarding, and lost revenue, can cost from $400,000 to $600,000.

Armed with this information, it clearly makes sense to ensure that your organization is proactively addressing issues that might lead to a physician becoming unengaged or even leaving.  In today’s competitive recruitment environment, taking the time to develop reasons for your physician staff to stay becomes as important as hiring the right candidates in the first place.

Here are eight retention strategies that every healthcare organization needs to practice.

Hiring for Fit

One of the best ways to give your organization a better chance at retaining the physicians you have on staff is to make sure you are hiring for fit and not hiring to fill.  Refining your recruitment process to target individuals who are already aligned with your organizational values will go a long way toward making sure the people you hire have the greatest opportunity to thrive and be successful.  If culture is not something that your leadership team has spent enough time thinking about, you will be battling turnover until you start affording culture and fit the significance it deserves.

As the cost of a physician vacancy mounts with each passing day, it can be tempting to “just fill the position,” rather than continue the search until you have found a candidate that is a good cultural fit. These types of short-sighted mistakes will end up costing you more in the long run.  It is better to continue your search and optimize your process.  Hiring physicians that display the cultural behaviors that are aligned with the organization, such as teamwork and being quality focused, will become valuable ambassadors for potential future hires.  Good hires will always attract more good hires as individuals prefer to work with others that have similar values and ideals.

Develop a Culture That Feeds Retention

We’ve already identified culture as a component of successful retention.  A toxic culture or dysfunctional work environment is displayed through constant conflict, breakdowns in communication, “old school” or authoritarian leadership, and power struggles.  In a Jackson Physician Search research study, when responding to the statement “Always treats physicians with respect” less than half of doctor respondents agreed in contrast to 78% of executives. The disparity identifies a gap in each group’s perception of their current workplace environment. If you can’t conclusively describe your organizational culture, take steps to begin an assessment today.

By fostering a culture of open communication, mutual respect, and collaborative decision making, healthcare organizations have a clearer understanding of the issues being faced by their physicians and are better positioned to resolve them before finding out through escalating turnover rates and hiring challenges.

Help Your Physicians Stay Engaged

When physicians and other staff are engaged, they are intrinsically more loyal to the organization, willing to work through challenges, and put forth more effort than non-engaged employees.  According to Gallup, fully engaged physicians generate more outpatient referrals and a striking 51% more inpatient referrals than those who aren’t engaged[ii]. Review the following five drivers for physician engagement and see how many are a part of your organizational structure[iii]:

  1. Executive team actions are in aligned with clinicians’ goals.
  2. Organization is open/responsive to physician input.
  3. Physician are interested in leadership opportunities.
  4. Physicians have autonomy in managing their practice.
  5. Organization is supportive of the economic growth and success of physicians practice.

Provide Personal Growth Opportunities for Physicians

According to Medscape’s 2018 National Physician Burnout & Depression Report, 42% of physicians report feeling burned out while 15% admitted feeling varying levels of depression.  As a healthcare administrator, it is critical to have your fingers on the pulse of your physician staff and provide them with opportunities to explore things that will help them combat burnout.  Supporting your physicians’ personal and professional growth can go a long way toward their well-being. From encouraging them to volunteer in underserved communities, to allowing them to pursue a medical mission overseas, give them the leeway to pursue things they are passionate about.

 Allow for Career Advancement Opportunities

Much like supporting your physician staff in their personal endeavors, it is equally important to allow them to pursue things that can advance their career professionally.  Knowing and understanding your physicians allows you to develop advancement opportunities to help keep them engaged.  Some may want to pursue research projects, others may want to spend some of their time teaching, they may want to serve on committees or boards, while some may be perfect candidates for leadership or medical director opportunities.  Sitting down and collaborating on a plan that affords them the flexibility to pursue their career goals will ultimately make them better doctors and result in better retention.

Promote Work/Life Balance for Your Physicians

The top two contributors to burnout cited in the Medscape report were too much bureaucracy in the form of charting and paperwork and spending too much time at work.  Additionally, almost 1/3 of respondents claimed that a lack of respect from administrators/employers played a role in their feelings of burnout.  Spending too much time at work isn’t healthy for anyone, and almost universally, physicians point to the inefficiency of Electronic Health Records as one of the reasons.

Addressing physician burnout and promoting a healthier work/life balance is going to look different for every organization. The Mayo Clinic utilized a collaborative physician-led approach resulting in a “Listen-Act-Develop” model to reduce burnout and involve the physicians in the mission of the organization. Communication and collaboration is an obvious starting point in identifying what is contributing to physician burnout, and also in developing the mechanisms that will help physicians achieve a better balance in their lives.

Compensation

In any career, compensation is always going to play a role in retaining your best employees.  According to the Kresser Institute, forty percent of medical school graduates finish with more than $200,000 in student loan debt[iv].  This financial pressure feeds into the stress experienced by physicians as they try to find the time to fit in more patients per day to earn enough money to help them pay off their debt.  Many organizations are proactively helping physicians with their student loan debt as an enticement to accept a job offer.  If your organization has avoided compensatory practices like this, consider the fact that 55% of physicians receive weekly job opportunities.  Student loan forgiveness is just one way organizations provide additional compensation to their physicians.

Many healthcare organizations choose to supplement physician income through the achievement of quality-based metrics. Promoting incentives that are tied to quality can achieve more for your organization than just keeping the physicians happy. Achieving reduced readmissions, improving patient satisfaction scores, or even improving medical record documentation helps to improve the reputation of the group practice which aids recruitment. Being able to promote organizational achievements in quality is also beneficial when the time comes to renegotiate reimbursement rates!

Encourage Time Off/Family Time

Similar to helping physicians achieve a better work/life balance, when asked directly what will help them the most, they respond that they need time off or more manageable work/call schedules.  The Medscape 2018 National Physician Burnout report asked physicians “What would reduce your Burnout?”, 31% of respondents cited a more manageable work schedule, 27% identified more paid time off, while 20% wanted greater flexibility in their schedule. Encouraging physicians to take time away from work helps them deal with the pressures of their job and allows them to spend time developing a healthy family life.

Scheduling and flexibility within the physician group is another natural situation where involving them is a common sense approach to developing a solution that works for everyone.  Any employee feels a greater sense of commitment to an organization when they are involved in decision-making and problem-solving.

Summary

There is no single magic solution to achieving physician retention. What is certain is that when retention is assumed or not actively pursued, money will end up being spent on avoidable vacancies.  A 2018 survey sponsored by The Physician’s Foundation found that 46% of physicians planned on leaving their current position within three years.  That information alone identifies how critical it is for healthcare organizations to ensure that they are openly communicating with their staffs and helping solve the issues that they are facing in the current environment.

Strong communication between administration and staff cannot be overstated.  As evidenced by a 2016 Physician Engagement Survey from Jackson Healthcare, there are significant gaps between actual physician engagement versus perceived engagement.

  • Organization delivers on what is promised to physicians. Only 45% of physicians believed that to be true while 66% of executives responded affirmatively.
  • If a problem arises, physicians can always count on a fair resolution. Executives responded with 70% affirmative with physicians only 36%.
  • Physicians are always treated fairly. Executives affirmed 68% as opposed to only 46% from physicians.
  • Physicians are always treated with respect. Executives responded at 78%, yet only 48% of physicians claimed that to be true.

These wide margins of disparity highlight a major communication challenge between physicians and administration.  Much of the key to physician retention is fostering an environment of engagement. Gallup identified four key practices that correlate to engaged physicians.

  1. Proactively address and provide solutions for physician problems.
  2. Promote effective communication between physicians and system administrators.
  3. Encourage physician involvement in organizational administration and ensure their opinions are heard.
  4. Go above and beyond to give physicians growth opportunities and provide new physicians with an experienced mentor.

As the physician shortage continues to impact healthcare organizations across the U.S., retaining the physicians you have on staff is going to be increasingly more critical to keeping up with the projected demand.  The question for healthcare executives is whether or not to spend the time, effort, and money on developing a successful retention program or on a continuous cycle of recruitment and hiring to fill avoidable physician vacancies.

[i] The Complexities of Physician Supply and Demand: Projections from 2016 to 2030 (2018 Update), Submitted by IHS Markit Ltd, https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[ii] What Too Many Hospitals Are Overlooking Gallup February 23 2015 https://news.gallup.com/businessjournal/181658/hospitals-overlooking.aspx

[iii] The Twelve Statements that Define Your Physicians Engagement Bill Heduc, June 25,2015, Advisory Board Company https://www.advisory.com/research/medical-group-strategy-council/practice-notes/2015/june/who-is-to-blame-for-physician-burnout

[iv] Kresser Institute, February 2018, The Epidemic of Physician Burnout, https://kresserinstitute.com/epidemic-physician-burnout/

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