By Carol Westfall
Changing demographics of the physician workforce are reflected in physician turnover trends, according to the 2006 Retention Survey published by the American Medical Group Association (AMGA) and Cejka Search, a nationally recognized physician and health care executive search organization. In its third consecutive year, this survey identifies the issues, strategies and best practices encompassing physician retention at AMGA-affiliated medical groups. The current report compiled from comprehensive input of 92 AMGA respondents, whose groups collectively employ approximately 17,000 physicians, revealed a significant demographic shift compared to data gathered in 2005. In 2006, female physicians accounted for 35 percent of physicians employed in the responding groups, compared with 28 percent in the previous survey. A major demographic shift is taking place in medicine. The current physician workforce is still dominated by male physicians age 42 and older. But this is changing. Women comprise half of the new medical school graduates for the first time in history. These trends will influence the way that medical groups recruit and retain physicians throughout their career cycles. The total average rate of physician turnover increased slightly to 6.7 percent in 2006, up from 6.4 percent in 2005. However, the survey revealed a significant increase in turnover among males and decrease in turnover among females. Turnover among male physicians increased to 6.8 percent in 2006, compared with 5.9 percent in 2005. On the other hand, turnover among female physicians decreased from 7.5 percent in 2005 to 6.6 percent in 2006.Retention efforts should address workforce trends and begin during the earliest stages of recruitment. For example, practices can tailor each interview to better match the generation and gender of a specific candidate. Today’s physician workforce responds well to a diversified interview team with a mix of experienced and newer physicians, including interviewees with similar professional and personal interests. Interview techniques specifically designed to assess cultural fit can help a practice to make a hiring decision with long-term retention in mind.
The study revealed factors, such as cultural fit and family, as driving forces in physician turnover.
Respondents to the survey were asked to report the most frequently mentioned reasons for voluntary separation given by departing physicians.
· Consistent with previous reports, “poor cultural fit” is the single most frequently mentioned reason for physicians to voluntarily leave a practice (51 percent). “Relocated to find a better community fit” was mentioned 20 percent of the time.
· Family is a strong contributor to a physician’s decision to leave a practice. Reasons that required the physician to relocate were “to be closer to own or spouse’s family” (42 percent) and “spouse’s job required relocation” (22 percent).
· “Leaving to seek higher compensation” was mentioned 32 percent of the time, with incompatible work schedule” and “excessive call schedule” each being mentioned 17 percent of the time.
Compensation and a desirable work schedule are typically discussed in great detail during recruitment. But a practice’s ability to clearly assess cultural fit and family needs is becoming even more important in determining if a physician will stay beyond those critical first three years with your practice.
Part-time and flexible work options are also growing in importance. The proportion of physicians, both male and female, who were reported as working part-time increased to 20 percent in 2006 from 13 percent in 2005. Flexible work hours or part-time options were reported as one of the top three ongoing retention initiatives that medical group leaders have found to be effective.
In addition to statistical data, the survey includes valuable insights about various retention initiatives that group practices are implementing.
Early Focus on Expectations, Retention and Fit
Respondents offered a consistent message regarding the effectiveness of engaging the candidate’s spouse and peers during the interview and the early employment period. “Peer interviewing” was rated as highly effective in assessing long-term cultural fit, followed closely by “including the spouse and family in the interview visit.” Timing is important. Between signing to start date, “providing clear expectations about compensation” was the most highly rated strategy for retention, followed by engaging the new physician in “personal interaction” with both leadership and peers. After the start date and through the first 90 days, “personal interaction with peers” received the highest score for retention effectiveness. Respondents also rated “mentor assignment” more highly as an effective retention strategy after the start date and through the first 90 days. When asked specifically about adjustment issues for newly trained physicians, respondents overwhelmingly reported that “coding” was the practice issue these new physicians were most unprepared to handle. Training, review and feedback on coding were frequently mentioned among the initiatives to help newly trained physicians most easily assimilate into the group practice.
Retention Programs May Be Unwritten – But They Are Effective
Forty percent (40 percent) of respondents said they “have a designated physician retention program,” and only one in five of these reported theirs as being a “written plan with identified goals and strategies.” The groups with designated retention programs collectively employed 6,010 physicians, a large enough sample for measuring turnover. Turnover was 6.0 percent among physicians working in a group practice with a designated retention program, compared with 7.1 percent for those without. Additionally, group practices with a designated retention program were somewhat more likely to keep their physicians for at least ten years. In groups with a designated retention program the proportion of departing physicians was 73 percent leaving within 10 years and 27 percent leaving after their tenth year. In groups with no designated retention program, the proportion was 79 percent leaving within 10 years and 21 percent leaving after 10 years. The top three individual retention initiatives reported as being effective on an ongoing basis were: “regular feedback and performance reviews,” mentioned 58 percent of the time, partnership/ownership opportunities” (51 percent) and “flexible work hours or part-time options” (51 percent).
Mentoring Programs Remain Primarily Informal
Among all respondents, 39 percent said they have a leadership succession plan in place. But, among this group, fewer than half said they have a “written document with identified goals and strategies.” Leadership succession plans most often are a shared responsibility among a combination of executive leaders or the board of directors. Methods for identifying future leaders included observation of a physician’s participation with groups or committees, and his or her expressed interest in a leadership role. Of all respondents, 61 percent reported that they “assign a mentor to new recruits.” Most mentors work within the same department and have an average of 5.3 years with the practice. Just over one-third of the groups that assign mentors have a structured program with written guidelines. Mentoring activities span a broad spectrum, to include guidance on policies and practices of the group, as well as orientation and social interaction. Based on the total number of physicians employed by the responding groups overall, it is possible to observe a significantly lower turnover ratio among physicians whose group practice assigned a mentor. Groups that assign no mentors at all had a 7.2 percent turnover ratio, compared with 6.3 percent for groups that assign mentors, and 5.8 percent for those who assign mentors from within the same department as their newly recruited physicians. Respondents agreed that the primary factor in the success – or failure – of a mentor relationship is the commitment level of the mentor. The limited availability of time to devote to the mentor relationship was consistently mentioned as an obstacle to success.
Staying in Step Throughout the Physician’s Career Cycle
Recruitment and retention efforts should continue to evolve as the demographics of the physician workforce change – particularly with the growing number of retiring physicians leaving the workforce and the increasing ratio of female to male physicians, and the reality that many younger physicians are focused on being happy in both their work and family life.
It will be up to medical groups to continuously explore creative ways to structure the practice to address the realities of these trends. Turnover is a fact of life, but practices can minimize their rate of turnover with proactive efforts by group leaders to understand the values, needs and expectations of their physicians across all generations.
The Cejka Search and AMGA 2006 Physician Retention Survey was distributed in October 2006 to 300 AMGA member medical groups. All survey responses (92) were compiled for this survey (31 percent response rate). The turnover rate was calculated based on the number of physicians leaving divided by the highest number of physicians present, over the same 12-month period.
Carol Westfall is President of Cejka Search.