6 Ways to Reduce Physician Turnover

Healthcare leaders put an enormous amount of time and money into physician recruitment, yet retention is often still an afterthought. If CFOs analyze the cost of turnover, they will likely find that millions of dollars are being lost due to poor physician retention.

Fortunately, correcting the problem isn't necessarily costly, though it does require building an accountable team and an action plan. Here's how Baystate Health in western Massachusetts tackled turnover and reduced it by a third in one year.

Baystate Health, a not-for-profit, three-hospital integrated delivery system serving much of western New England, identified physician recruitment as a key strategic need a while ago. On average, the system fills 60 physician slots annually, at a relatively low cost of $15,000 per recruit.

The organization's six-person in-house recruiting department has paid off when it comes to quickly finding and filling positions. But the team's success meant others in the organization didn't recognize another growing problem: physician turnover.

"We have a well-oiled physician recruiting team, so when we'd lose a doctor, we get a call saying basically, 'I want to order another physician,' says John Larson, Baystate's director of physician and advance practitioner recruitment.

In 2009, he says, "We're hearing about the physician shortage, though not yet experiencing it, and I'm thinking this situation has got to change. It's going to get harder to find physicians."

That year, Baystate's turnover hit 9.2%—far above the national average at the time, which was 5.9%, according to the American Medical Group Association. Even worse, says Larson, 39% of the physicians leaving the organization had been there for less than three years; the AMGA national average was 46% at that time.

"That was unacceptable. We did a cost of turnover analysis and we were losing a lot of money," he says. The Association of American Medical Colleges estimates organizations lose $115,000 when a general practitioner leaves and $200,000 for a specialist. However, Larson adds, "If you calculate the patients that leave when a physician does and other hard and soft costs, it can be as much as a $1.2 million loss to the organization for one provider."

For Baystate, "the future success of the organization meant we needed to make a paradigm shift in how we approached retention," he says.

First, Baystate pulled together physician leaders and practice managers at a retreat. The 20 attendees became the organization's retention task force. The group created six processes and guidelines for recruiting and retaining physicians. A major emphasis of these strategies was to  make providers feel valued and recognized.

1. Hire for cultural fit—Behavioral-event questions, which ask interviewees how they dealt with difficult situations, were added to the interview process to gauge how a candidate's personality and attitudes would fit within the department and organization.
2. Optimize on-boarding practices—The task force developed a pre-hire to post-hire checklist to ensure that new employees were guided through the first few months at the organization. Check-in and introduction meetings were made mandatory for managers.
3. Establish a buddy program—Rather than use a senior member of the team as a mentor, the task force decided that a buddy fit the culture of the organization better. This could be any member of the physician staff.

• Get to know the physician personally
• Set clear expectations
• Give feedback
• Provide recognition
• Listen
• Provide opportunities for the physician to influence and be involved in the work environment
• Hold the entire team accountable for effective on-boarding of new physicians
• Help the physician and their families adjust to new environments

Just a month after the retreat, Baystate Health enacted the retention plan. "These aren't rocket science and everyone was in agreement we needed to do this," Larson says. "But then we hit the next hurdle: accountability."

Larson and his team decided to do check-ins with new hires to see how the plan was working. "We'd ask the candidates if they received a welcome letter from their supervisor before they started; did they get the 30-day follow-up with administration; or even how was the CIS training. Then we'd go back to the manager, department head, or practice and point out the areas that needed tweaking. We wanted to make everyone accountable for this plan," he says.

The new retention strategy and accountability worked. Within a year, Baystate reduced turnover by over a third, from 9.2% to 5.7%.

But the struggle to keep physician retention down never ends. Larson says the next step is to bring the issue to Baystate's board and involve them in future activities to reduce turnover.

"[Retention strategies] require a cultural shift by all involved—some embrace it more quickly than others. We don't want this to be a compliance activity; rather it should be something people do because it's what should be done. We are looking to our board for more ideas on how we can move this program forward," he says.

By assessing organizational turnover and creating a retention strategy, financial leaders can potentially save millions and build a solid foundation for future growth. For more on recruitment and retention strategies, check out HealthLeaders Media's webcast next week.