By Kurt Mosley, Vice President of Strategic Alliances, Merritt Hawkins
Though it is not listed that way in the dictionary, “retention” definitely comes before “recruiting” where physician staffing is concerned.
After all, in an era of pervasive physician shortages, it only makes sense to secure the doctors you have before you seek others. While doctors are not relocating at the rate they were before the economic downturn, physician turnover still is running at 11%, according to a new study from data base company SKA (for more information on this study see http://bit.ly/mUxmVF)
In many ways, retention and recruitment are two sides of the same coin, because the features that tend to retain physicians are the same ones that attract new doctors to a practice. Here are several guidelines to consider when developing a physician retention plan.
Walk in the physician’s shoes. Physicians are unique in the training they must complete and in the clinical, administrative, operational and moral challenges they must face. A great look into the mindset and priorities of today’s physicians is provided by a national physician survey Merritt Hawkins conducted on behalf of The Physicians’ Foundation. View the survey at: http://bit.ly/qf1awV Knowing and empathizing with the mindset of doctors is the first step in physician retention.
Pushed, not pulled. As much as we as recruiters would like to tout our ability to persuade physicians to leave one practice for another, the truth is that physicians usually leave because they are dissatisfied with some element of the practice, not because they have spoken to a silver-tongued recruiter offering a greener pasture. Therefore, you need to know how staff physicians feel about where they work and where they live.
Don’t forget to ask. If you want to know how physicians on staff feel about their practices, you have to ask them, both through formal channels, such as a staff survey, and through informal communication such as lunches, visits to the physician’s lounge, etc. A sample of a physician staff survey can be found in Merritt Hawkins’ book Guide to Physician Recruiting. You can order the book through our publisher’s web site at: www.practicesupport.com. A staff survey should reveal physician pain points, which must be addressed immediately to reduce the appeal of a recruiter’s siren song.
The primacy of the workplace. Like snowflakes, no two practices are alike. Frankly, some practices are more appealing than others, not necessarily because they are located by a beach or the mountains, but because they feature a practice style and a work environment tailored to what doctor’s today prefer. You cannot control the fact that you are not close to an ocean, but you can to some extent control the quality of the medical practice environment. Here are some ways to enhance the physician workplace:
- Maintain a qualified, appropriate nursing staff. A key irritant too many physicians is lack of appropriately trained nurses
- Improve physician access to patient data
- Enhance test turnaround times
- Ensure timely, efficient OR capability
- Ensure timely, efficient patient admissions and release
- Enhance ER triage/patient turnaround
- Implement a hospitalist/surgicalist/nocturnist program
- Provide flexible scheduling
- Use locum doctors during peak usage periods to avoid physician burn-out
- Provide convenient parking/access for physicians
- Maintain appropriate equipment/electronic medical records
Physicians are looking for environments where they can provide quality care to their patients – that is their first priority, and though it is not always easy or inexpensive to do so, it is important to maintain a premier physician “workshop.”
Employ the physician. Over the last year, 56% of Merritt Hawkins’ search assignments have featured hospital employment of the physician. The push toward more integrated delivery systems (including ACOs), and the desire of many doctors to seek relief from the burdens of private practice, are likely to accelerate hospital employment of doctors. Employing physician can cement the hospital/physician relationship and enhance retention.
Pay for ED call. ED call may be a part of the hospital employment agreement. If not, or if independent physicians are on staff, paying for ED call can be a good retention tool. The daily ED call rate for family practice is $300, according to MGMA’s On-Call Compensation Survey, while daily rates for neurosurgery are about $2,000.
Gain sharing/Joint ventures. Aligning physicians financially with the hospital has proven to be an effective retention policy. ACOs may achieve this alignment for some facilities, but they are unlikely to do so for all. Other avenues, such as gaining sharing outside of the ACO model, or joint ventures, can promote retention.
Good recruiting leads to good retention. Physician turnover often takes place because of lapses in the initial recruiting effort. If expectations regarding hours, group governance, and quality of care, financials and related issues are not clearly communicated on the front end during recruiting, misunderstandings that lead to turnover can result on the back end. Make sure to spell out in writing exactly what is expected of the physician, and make sure to accurately project the financial potential of the practice so that expectations are realistic. Keep in mind that recruiting new physicians can alienate existing ones, unless the recruiting effort is based on an objective, data-driven need for additional doctors. A community needs assessment plan can help convince staff physicians that new doctors are needed and that they do not have to relocate due to incoming competition.
Above all else, physician retention is a matter of communication. I recall checking up on a physician Merritt Hawkins had recruited some months earlier to see how he was fitting in with a new group practice. He informed me that he was leaving because the group had not put his name on the door and on other signage, and he assumed he was not wanted. A simple lapse in communication almost caused this group to lose a good doctor.
I’ll close with this quote from a health system CEO that further reiterates the importance of communication:
“When you need the goodwill of physicians, it is too late to create it. My advice is get ahead of the competition by having a really good relationship with your doctors.”
Kurt Mosley serves as Vice President of Strategic Alliances for Merritt Hawkins and can be reached at firstname.lastname@example.org.