Medical group practices that seek to hire physicians often act on the assumption that doing an effective job of recruitment is all that matters. Once a candidate agrees to join the staff, the thinking goes, leaders of the practice can refocus attention on other management tasks and medical matters.
But nothing could be further from the truth.
Greater attention should be given to physician retention at meetings of physician group practice executives this year. The first two years of employment are critical, as it is common for new physician hires to be recruited away, quit their jobs, or be asked to leave within their first 24 months.
Among the issues contributing to turnover are low productivity and revenue generation, disappointment with the practice environment, and a doctor’s inability to acclimate to the community.
A variety of costs are incurred when turnover is high. For instance, a practice with high physician turnover may have to spend enormous sums on malpractice tail coverage, particularly if the departure is voluntary. Tail coverage costs can add up to more than $100,000 per departing doctor, depending on the specialty and terms of the departure.
Add search expenses for filling open positions on the tab, and turnover has a major impact on the bottom line of a practice.
Some resignations or terminations may be unavoidable. However, often what a group does — or fails to do — after a doctor is hired can easily trigger a resignation. Ironically, while a group may devote lavish resources to recruit physicians, little or no effort may be made to keep them. The fact that such an effort is needed is not universally recognized in medical practice management.
Here are some key areas of focus that make significant differences in whether physicians are retained:
Aligning compensation with performance. Groups may guarantee a new hire’s salary for two years and perhaps offer a modest productivity bonus. That’s fine for the average physician. However, a star performer may be eager to be more productive faster. Groups that offer some flexibility in compensation for rainmakers are more likely to keep them on staff.
Mentoring. Groups may fail to assign a mentor to a new hire to ease the doctor’s assimilation into group culture. Others may assign mentors whose roles also include evaluating the doctor. This conflict inhibits the doctor from revealing problems and renders the mentoring relationship ineffective.
Orientation and training. Little may be done to ensure that a new hire understands the organization’s systems and processes — in other words, how to get things done. This oversight may contribute to the doctor’s ineffectiveness and stress. Even an experienced physician may not know the group’s coding procedures. The physician may then be unproductive and alienated for making avoidable mistakes.
Clear expectations. Many groups fail to inform a new hire about the evaluation process, as well as expectations for productivity and cultural behaviors toward colleagues, staff, and patients.
Regular feedback. Even when a new hire clearly understands the evaluation process and the criteria used for evaluation, there is often no attempt to give the doctor ongoing feedback on how he’s doing, so that if his or her performance needs improvement, there is an opportunity to change. An evaluation that comes as a shock may contribute to a doctor’s decision to leave.
Staff and support. A group may assign clinical and administrative staff to a new doctor without regard to the staff’s level of competence and personal chemistry. If the doctor is not quickly set up for success and is made to feel that he or she is part of an uncaring organization, that doctor may walk.
A nourishing culture. A group may do little to ensure that a new doctor feels welcome. He or she may not be invited to meetings or social events, or perhaps no one reaches out socially to the physician’s spouse or children. If the family is unhappy, the doctor’s tenure is at risk.
Carol Westfall is president of Cejka Search, a nationally recognized executive and physician search organization providing services exclusively to the health care industry for more than 20 years.