Retaining the best talent is a key concern of all hospitals and practices. It costs an organization a significant amount of money to recruit a primary care physician. Replacing one primary care physician can result in $20,000 - $26,000 in recruitment costs, loss of $300,000 - $400,000 in annual gross billings, and the loss of $300,000 to $500,000 in inpatient revenue. The average annual turnover in medical practices is between 6-10%.

In rural and underserved urban areas, the challenges for physician retention can be even more difficult to overcome. Once a physician working through the National Health Service Corps (NHSC) has completed his or her contractual obligations, there is no compulsion to stay in a practice with low pay, overwork, and the lack of professional contact.

Factors in Physician Attrition

What causes a physician to leave a practice? Many times, expectations are not clearly communicated to physicians during the recruitment process. New physicians may not fit well with the environment and culture of the practice. Lack of two-way communication within the practice can cause frustration. In rural areas, a physician's spouse may be required to take a lower-paying or trivial job because of the lack of opportunity, and their children may have lesser educational opportunities. Finally, when physicians are not adequately rewarded and not included in the decision-making process, the physician may look elsewhere for work.

A recent survey by the American Medical Group Association (AMGA) found that 90% of medical groups track physician turnover, and 58% of the groups have put retention initiatives into place. By managing each of the factors that lead to physician turnover, the practice can reduce attrition and enhance the working environment for all employees.

Is This the Right Fit?

The first steps to ensuring a good working relationship is to make sure the physician fits the role, culture, and expectations. This starts with the information that the hiring practice can provide to the recruiter. The recruiter must be familiar with the role's duties, the education and experience qualifications, expectations, career path, and the culture of the hiring group. The recruiter then uses this information in presenting the right candidate, based on his or her knowledge of the candidate's skills, certifications, temperament, and professional goals.

An interview should unearth all expectations on both sides, such as patient load, work and call schedules, support resources, committee responsibilities, teaching responsibilities (if any), and the process by which the physician will become accustomed to the procedures and paperwork of the practice. The interviewer and the candidate should look for evidence that they click, that the physician is compatible with the practice. The right interview questions, such as ones that uncover previous challenges and behaviors, will give the interviewer a good indication about how the physician will respond in the future. Finally, salary, benefits, and perks should be outlined and all agreed-upon expectations should be put in writing.

Involving the spouse in the interview process is a smart way to ensure that the opportunity is a good fit and that the family experience will be a positive one. If the role will require the physician to relocate, the interviewer or recruiter should give the couple information about the new area, such as career opportunities, neighborhoods, schools, conveniences, and local lifestyle.

Welcoming the New Physician

Studies show that a new employee forms attachments and loyalty to an organization within the first weeks of employment, and those perceptions are difficult to change later on. The best way to ensure the physician feels part of a practice is to ensure that he or she is well-oriented and welcomed into the practice. Many times the simplest and inexpensive things make a big difference.

The Mayo Clinic provides welcome gifts and special nametags for new physicians. Other practices prepare welcome dinners or receptions for new families. One practice asks the physician to fill out a biography form including information about his or her family, and this information is distributed to the other physicians as a way to find common interests and help the new employee feel part of the medical group. A welcome package sent to the family, including information about the new area, restaurant gift certificates, health spa memberships, maps, etc., can help the entire family feel welcomed.

A new physician's orientation experience is key. The physician should be introduced to peers, support staff, and senior management. They should learn about the practice's strategies, market, managed care relationships, clinical programs, residency teaching, rotations, continuing education, research opportunities, risk management, and recruiting.

A mentor is especially helpful in walking the physician around the facilities, explaining the ramping-up process and daily procedures, and familiarizing the new hire with the community he or she will serve. Ideally, the mentor will also help provide acceptance, confirmation, coaching, counseling, friendship, and a good role model to the new employee. Physician-mentors help new physician to network with other physicians and to answer clinical and operational questions. In addition, the mentor can help welcome the new physician into the community.

During the first days on the job, the practice should ensure that the physician has all she or he needs to begin working. Items like lab coats, parking passes, office space, and adequate hospital retention plans computer training can ensure a new hire's effectiveness right from the beginning. A lack of these necessary items also produces a poor impression of unpreparedness and lack of planning.

Two-Way Communication

For the new relationship to become a successful and satisfying long-term placement, the physician and representatives of the practice must be able to communicate openly. There are many ways to foster good two-way communication. Arranging periodic forums allows physicians as a group to come together and discuss issues. Physicians should also have the opportunity to meet with key leaders and senior management to discuss issues and suggestions, as well as become informed about practice goals and business plans.

On an individual basis, physicians should be encouraged to keep in close contact with their immediate superior. Often an issue that is discussed early on is prevented from becoming a serious barrier to work, one that will eventually cause the physician to leave. The organization should therefore ensure that senior management has the appropriate communication skills and an open attitude to feedback, in order to foster honest communication. The hiring personnel, as well as the original recruiter, should check in frequently with the new physician during the orientation phase and should be responsible for troubleshooting any needs that the physician has.

By the same token, the practice should give clear, honest, and consistent feedback to the new employee. During the first weeks of hire, management should meet with the new physician at least weekly to discuss how well the physician is doing and ensure the expectations are completely understood. Constructive feedback, when delivered honestly and carefully, is a great gift to the new employee. When recognition is due, the physician should receive it promptly.

An Ongoing Relationship

Some practices do a fantastic job while acclimating the physician to a new role, but then the efforts slow down as the physician and practice settle into a daily routine. This is a dangerous habit. The feeling of being needed and appreciated fade if the practice is not consistent is valuing its employees. The practice should cultivate the mindset that this is a long-term relationship, and that valuable employees should be cared for.

Ongoing, consistent opportunities for discussion and feedback, such as continuing forums and practice-wide meetings, should be cultivated. Management should review the communication processes periodically to ensure that people are able to communicate freely and honestly. Physicians should be encourage to participate in making decisions, according to their roles. In large practices, regional forums and educational seminars can be a great way to learn from other groups and foster teamwork.

Recognition and reward are two critical factors to employee retention. The physician should always know how much management appreciates him or her. Exceptional achievements, when recognized, can also spur other employees to achieving more. While salary should always be commensurate with experience and achievements, smaller rewards, such as movie tickets, recognition plaques, or opportunities to mentor or lead others can be effective ways to engage and motivate physicians.

If the working relationship is not working out, and attempt to resolve problems have not been successful, the practice may still wish to retain top-notch physicians. In these cases, transferring the physician to a more appropriate role or more amenable location will prevent the physician from leaving the organization altogether.

Keep Your Best Employees

When a physician/practice relationship works well, the practice, individuals, and community all benefit. Practices naturally want to retain their top talent. However, when problems occur, an efficient process should be in place to resolve them. Open communication and a willingness to find solutions will usually take care of issues. An effective, consistent recruitment process will help.