By Carol Westfall
Competition for physicians in key specialties – among them cardiology, dermatology, hematology/oncology, neurology, neurosurgery, orthopedics, otolaryngology, and radiology – is becoming more intense than ever.
Cardiology is just one example of a specialty with eye-opening statistics related to physicians in practice. There are currently 21,305 cardiologists in the United States, according to the American Medical Association. But nearly two-thirds of them are over age 45. Many cardiologists will retire or leave the profession within the next 10 years. Nor will a sufficient number of new specialists be available to replace retirees. In 2002, only 499 new cardiologists entered the specialty. In 2003, just 540 new cardiologists entered practice.
In addition, movement of clinicians into management positions, early retirements and career changes resulting from frustration over everything from malpractice rates to working conditions will continue to impact the medical labor market. The situation increasingly will force physician groups and hospitals to strengthen their recruitment strategies if they have not already done so.
Organizations destined for the greatest success with physician staffing, however, will devote at least as much attention to retention as they place on recruitment. With every month that an open physician position remains unfilled impacting the bottom line, effective retention will be essential to each organization’s financial stability.
As an example, consider the American Medical Group Practice Association listing of an internist’s gross annual productivity (professional charges). At the 90th percentile annual productivity is $596,377; median productivity is $392,430.
This means that monthly lost physician professional charges for an internist would be $49,695 at the 90th percentile and $32,702 at the median productivity level. Additional negatives on the financial side include lost patient referrals that could have been generated via a physician in place, and the risk of failing to meet managed care contract terms.
Also, a practice with high physician turnover may have to spend enormous sums on malpractice tail coverage, particularly if the departure is involuntary. Tail coverage costs can add up to more than $100,000 per departing doctor, depending on the specialty and terms of the departure. Add recruitment expenses to the tab produced by a physician resignation, and the total cost has a major impact on the organization’s bottom line.
Effective Retention Begins with Screening of the Eventual New Hire
Somewhere in a group of candidates who apply for an open position may be an individual who in the future will be an outstanding colleague and contributor to your organization. Promptly returned phone calls and informative answers to questions about the search status will help keep that candidate – whoever he or she may be – interested.
Internally, keep the screening process moving so that candidates are not left for long periods of time wondering whether they will be interviewed. Doing so will help ensure that the best candidates will still be in the pool when you are ready to begin interviewing.
When speaking with candidates, provide brief information about your organization and the local community, including income range for the open position, benefits, typical living costs, schools, lifestyle amenities, etc. This information also should be discussed with the candidate’s spouse during the phone screening stage, as part of a discussion of what the spouse is seeking in a new community.
If you are using a search consulting firm, let the firm’s recruiters address salary, benefits and other issues with candidates prior to scheduling interviews. The search firm can help encourage candidates to realistically assess what they are seeking, increasing the likelihood that they will respond favorably to offers from organizations that match their priorities.
Once interviewing begins, following these guidelines will help your organization present itself to top candidates in its best light:
Plan a thorough itinerary for each candidate and the candidate’s spouse. The candidate should meet with a variety of people within your organization who can explain its strengths most effectively. The individual who can best explain benefits, and buy-in and partnership opportunities and the potential income resulting from them should be included, since these are among the most popular incentives for physician hires and can be valuable tools for retention. This individual should explain with clarity all contract elements applicable to new physicians joining the organization, including financial details, expectations, incentives, etc. with clarity.
If there are aspects of your organization or local community that may be perceived as negatives by some candidates, choose one interviewer only to discuss these issues with each candidate. The individual should be honest, but also able to address how other physicians on the staff have overcome or compensated for any disadvantages. For example, if the local school system is weak, alternatives utilized by current physician families could be explained.
The candidate spouse itinerary should include meetings with spouses of physicians on staff and a meeting with a local real estate agent. Also, as appropriate, plan meetings with local school administrators, contacts related to potential jobs for the spouse, etc.
The Transition from Candidate to Colleague
If you believe that your organization will make an offer, ask the candidate at the end of the interview, “If we extend an offer to you, would you accept it?” This will reinforce in the candidate’s mind the belief that your organization has a strong interest in him or her.
Once an offer is made to the candidate, keep in mind the following. A mentor appointed to assist the candidate as he or she prepares to join the organization and during the first year can have a strong impact on retention. This individual should be a physician with at least two years of experience on your staff. After the new hire accepts the position, the mentor should contact him or her to discuss any questions about the organization, and see if the new hire and his or her family need any assistance related to the community or the move process.
An orientation program should be planned to begin once the new hire is in place. The program should be spearheaded by someone with strong overall knowledge of the organization, who will ensure that the new hire is given all needed information, and is made aware of all organizational resources, etc. to perform effectively. The new hire should learn who within the organization should be consulted for everything from supply needs to insurance-related questions.
Make plans to introduce the new hire to other physicians in the community, especially those in his or her specialty.
Competitive Compensation, Ongoing Communication Are Key
Certainly, there are instances in which any physician may pass up a higher-paying opportunity to accept a position with lower compensation in an organization perceived to be a better fit for his or her work priorities or professional goals. Success in both recruitment and retention still depend in large part, however, on ensuring that compensation is competitive.
Organization leaders should stay abreast of compensation trends nationally, regionally and locally – a challenging task as trends may change very rapidly. In 200l, for example, the starting salary for a hematologist/oncologist joining a large multi-specialty group averaged $200,000. In 2002, it was $300,000 – a 50 percent increase.
Positive responses to changing candidate expectations about work/life balance issues also can be strong retention tools. Many physicians, for example, respond positively to flexibility on issues such as work hours, call schedules and job sharing. In fact, a growing number of physicians are interested in alternatives to working full-time. By being open to job-sharing or other part-time arrangements for some of their physicians, organizations may be able to hire strong candidates who are likely to become loyal employees.
A new physician hire should experience regular opportunities to communicate not only with his or her mentor, but also with the organization’s executives who will be evaluating his or her performance. From the beginning, make clear to the new hire what to expect in terms of the evaluation process, expectations for productivity and preferred cultural behaviors toward colleagues, staff members and patients. Based on these standards, give the physician ongoing feedback so that if her performance needs improvement, she has an opportunity to change. An evaluation that comes as a shock may contribute to a decision to leave.
Ensure that a new doctor feels welcome in every way within the practice, professionally and personally. Make sure that he is invited to both meetings and social events. Encourage other physician families to reach out socially to the new hire’s spouse and children. If the family is unhappy, the doctor’s tenure is at risk.
By planning both recruitment efforts and retention tactics in a strategic manner, organizations can enhance their effectiveness in both areas, with good financial results.
Carol Westfall is president of Cejka Search, a nationally recognized executive and physician search organization providing services exclusively to the health care industry.