Under the current, predominant fee-for-service payment structure, physicians are pitted to compete against each other. But as FFS gives way to alternative payment models and more physicians abandon their practices to accept employment agreements, retaining this ambitious workforce is quickly becoming one of HR's biggest challenges.
Hospitals nationwide are competing to recruit the best physician talent. The key to retention is to transform yesterday's Fight Club culture into a more professional environment. Four steps can help HR pros move closer to their physician retainment goals.
1. Remember their training
Human resource departments and hospital C-suite can learn a lot from one of the most disciplined and effective branches of the United States armed forces, the Navy Seals. The Seals have a saying: "Individuals play the game, but teams beat the odds."
Like Navy Seals, physicians endure rigorous training in a collaborative, team-based environment. Unlike Seals, physicians have traditionally been evaluated primarily on their skills with highly individualistic attributes—generating patients and revenue. These are efforts that lead physicians to practice territorial and defensive medicine instead of patient-centered, quality care.
"In a successful environment, part of the idea of a team is they are there to help each other. It's not a matter of just working alongside each other, but of colleagues collaborating for the benefit of the patient," says Thomas P. Flannery, Ph.D., a partner with Mercer HR Consulting.
"Today there is greater emphasis on quality of care, safety and satisfaction. As a result, people have to work together differently. Where you have high degrees of safety, patient satisfaction, and high levels of quality, and a team environment, that's where you see low turnover."
Setting expectations beyond the bounds of salary helps to create a more patient-centered and collaborative environment, says Rob Coulton, executive director in the Office of Professional Staff Affairs at The Cleveland Clinic.
At that organization all physicians are salaried and on one-year contracts, with professional annual reviews and no tenure. On an annual basis physicians go through a comprehensive performance evaluation process about their contracts with top leadership.
"That process not only makes the Cleveland Clinic decide if that individual going forward will continue with us, but it holds us accountable to the individual to make sure we're creating a practice environment that will have them stay," says Coulton.
2. Breed allegiance
"More organizations are recognizing that physicians are in many ways, unique," says Flannery. "They are scientists and researchers and they go into that profession not because they're interested in bureaucracy, but because they're interested in practicing medicine and working with patients. Organizations that miss that ambition are the organizations that aren't great to work in."
The Cleveland Clinic pays physicians a market-based salary, which is not directly tied to clinical revenue. The institution replaces monetary incentives with leadership development opportunities, allowing physicians to look at their practice through wider career lenses.
"If you create an environment where your only relationship is money, in any profession—not just medicine—then that money factor is quite easy to compete with. Someone could simply come in and buy your good people. But if you create an environment that promotes allegiance and collegiality and 'I can see the patients I want, I have a long-term future,' that in and of itself creates retention," says Coulton.
"That single factor of being competitive in the market place allows variability in practice. It allows people to look at their practice over a career, and hopefully move those practices," says Coulton. "They might focus on research or administration, and by nature, because of the salary model, their pay does not go down. We believe a broad-based career, in any profession, allows a person to feel more satisfied in their role."
3. Put physicians at the head of the table
Physicians at the Cleveland Clinic are encouraged to pursue educational and administrative roles, without it negatively impacting their salaries. According to Coulton, this is meant to encourage as many physicians as possible to achieve leadership roles in their organization, which he says helps to maintain Cleveland Clinic's future as a leader in medicine, because physicians are steering the organization's direction.
"So physician leadership is critical to our model and we are investing a lot in that," says Coulton. "We believe that model creates an environment that is hard to duplicate anywhere else, and that, in essence, is retention. You have to create an environment where someone has to think about leaving because they can't get all they can get anywhere else."
"Organizations with successful retention recognize that physicians are critical to the care delivery process," says Flannery. "No one wants to be micromanaged or told what to do, but when the expectations are laid out and the physicians themselves help to develop those expectations, that's when we see higher satisfaction and less turnover."
4. Step up human resource's role
The whole leadership team needs to be focused on creating a highly engaged work environment. You not only want happy physicians, you want happy social workers, case managers—happier everyone—says Flannery. Where you see highly engaged workers, that's where you see higher standards of care.
"Human resources are essential in creating that environment," says Flannery. "In many cases, physicians really never had human resource management and they never had that support. HR professionals have become much more sophisticated over the last decade, and they have a much more significant role they play in creating a positive working environment for physicians."
The objective is not to bend over backwards to accommodate every individual's wish, but to create a relationship between the organization and the physicians that is positive, productive, professional, and supportive of the physicians and treats them fairly," says Flannery.
Chelsea Rice is an associate editor for HealthLeaders Media.
