Workplace Culture Key to Keeping Docs

A new survey released today finds that the No. 1 reason why physicians leave their job is because they don't like where they work.

The 2008 Physician Retention Survey from the American Medical Group Association and Cejka Search found that 50% of physicians who voluntarily resigned last year cited "poor cultural fit" as a primary reason.

That may sound discouraging, but it's a great opportunity because improving workplace culture can be a cost-effective process that almost any healthcare organization anywhere and any size can do. Healthcare organizations can have a greater impact on workplace culture than on many of the other leading reasons cited by physicians for leaving that included money, proximity to family, poor community fit, or spouse's job relocation.

The survey was completed electronically from October through December 2008 by 50 medical group members from across the nation representing 9,985 physicians in AMGA. The respondents represent a mix of rural, suburban, and urban physician groups of varying sizes working in integrated, private, and hospital-owned practices.

Brian McCartie, Northeast Regional Vice President for Cejka Search, say cultural fit will become even more important in the coming years as the physician shortage worsens and as physicians move away from private practices and become employees. "The biggest opportunity that exists within the employed environment is for those organizations to empower the physician and make them feel special, because they are special. These are highly skilled people," he says.

The HealthLeaders Media Industry Survey 2009 found physician leaders primarily viewed a good work-life balance as the single-most important factor determining career satisfaction. But issues like autonomy, being valued and respected by colleagues and, of course, adequate income, also were significant drivers.

The AMGA survey found that physician groups reported average turnover of 6.1% in 2008. A further breakdown showed that there was no significant difference in turnover between men and women. The biggest variables were age and employment status. The biggest turnover came from part-time male physicians (39%) over 55 years old, and part-time female physicians (32%) under the age of 39.

McCartie says turnover will grow in the coming years as more physicians opt into employment models with high demand for their services, and fewer monetary incentives to stay in one place. "Because of the competition for talent and because the employers are often hospitals that are trying to drive revenue, the physicians that are accepting positions are accepting incomes that are more at the 80th to 85th percentile of what they'll totally make eventually," he says. "They don't have to build the practice to be given the same kind of money. In the old days there was a bigger hook. If you left the practice you'd take a large hit economically so you'd think twice about moving."

McCartie says the ongoing recession is a double-edged sword for physician recruiting. "First, it's driving more physicians to be employed. So, they are less likely to be in solo or small private groups due to the risk and the costs of operation, and they are more likely to join larger groups or integrated systems," he says. "The negative side is the inability of those physicians to sell their houses. A lot of physicians are upside-down, and they don't buy the small houses. They may be interested in relocating but they're not going to take a $300,000 hit. So they are somewhat restricted."

McCartie says there has been a growth in physician retention programs at healthcare organizations as the industry comes to realize—often through first-hand experience—the long-term implications of the physician shortage, the fierce competition for those physicians, and the expenses associated with replacing them. The AMGA survey for 2006 found that 40% of respondents reported having a designated retention program. In 2008, that number grew to 48%. The AMGA survey found that respondents with defined retention programs reduced the percentage of physicians leaving during the first three years to 44%, as compared to those without a defined program at 50%.

Common retention program financial incentives include signing bonuses, guaranteed income, moving expenses, medical school loan forgiveness, malpractice coverage, and even mortgage assistance and rental plans to help physicians trapped in overvalued homes. The financial incentives should be designed to tie the physician to the community. "Don't give them $200,000 to pay off their loans. Give them $200,000 over 10 years so there is an incentive to stay. It's setting the hooks that will keep them," McCartie says.

The details of a retention program are less important, McCartie says, than the message the retention program sends to physicians. "There is no gold standard," he says. "Having a retention program is more about a commitment to listening to the physicians."