UO Magazine > Mar/Apr 2007 > Physician Retention

Silver Cross administrators believe their efforts will retain existing physicians by strengthening their practices, winning their loyalty, and recruiting new physicians to growing practices in areas of identified medical need. They recently started the Physician Leadership Academy, a two-year program designed to help grow physician leadership from within and to secure the engagement of newer physicians as they enter their market.

The academy helps physicians develop critical skills about the business aspect of running a practice—or a hospital—and to develop capital and operating budgets. Additional skills include how to communicate effectively with physician colleagues and patients, how to improve customer service, and other practice-based skills, all the while providing participants with education credits.

Reducing Turnover

The battle for recruiting and retaining physicians has already begun to shake some of the inefficiencies from older, less formal programs. Practice administrators and consulting companies have experimented with a variety of strategies and tactics over the past decade and the field has matured to the point where there are “best-practices” for recruitment and retention.

A core aspect of any retention program is for the practice to take the time necessary to define carefully the job before interviewing even begins. It sounds deceptively simple, but far too many practices do not take the time to consider new realities, changes in best medical practices, opportunities for rearranging practice responsibilities, even the changing character of the next generation of physicians. “If you want them to stay, you have to have the job meet their needs,” cautions Marc Greenwald. “Make it one that is part of their life, not their life.”

Elements to be addressed cover a wide range of issues, including physician lifestyle, work expectations, including the hours and the intensity of the work, salary and benefits, the culture of the group practice, and fitting into the larger community. A failure to fully explore and understand these components can lead to disaster for both the employer and the newly hired physician.

Matching a physician’s needs and expectations with the demands of the job is as much art as science. But good scientific preparation helps. Once the job is defined and the expectations set, the interview committee’s job is to develop an artful interview protocol that ferrets out whether the match is one made in heaven or is doomed to a much warmer place—a job much easier said than done.

“At Fallon Clinic, we thought key physicians had to be behavioral interviewers,” Greenwald recalls. “They needed to learn how to get the right answers, not the answers they wanted to hear, but the true answers from the person.

“For example if you ask the candidate, ‘Are you a team player?’ everyone says ‘Yes, of course.’ On the other hand if you ask them: ‘Tell me about the last time you and at least two other physicians collaborated on a project, what was the project, what were the goals, how did it work out, and how did you feel about it?’ and then watch their eye contact, body language, facial expressions as they tell you about how they created clinical pathways, for example, you’re going to know by the end of that if they’re team players or not.”

Retention programs should be specific to physicians. “What physicians are saying is that we are an integral part of the health-care community, and we want to be respected and valued and part of the decision-making process that defines what good clinical care should look like,” says McKemie of LocumTenens.com.

The key here is to get physicians in the organization involved in defining what a good retention plan would be for them. For some it may be additional CME time, for others it may be flexible hours, or perhaps sitting on the board that makes decisions about clinical outcomes. This quality of good retention plans is known as targeting and it applies to practices both small and large. “We have a very targeted approach,” says Silver Cross Hospital’s Scroggins. “We have a retention calendar, so I can tell you for the whole year every given week what area I’m focused on.”

The targeted approach is key because it makes sure your key players are all on the same page in terms of priorities, strategies, and tactics. In the case of Silver Cross, its database gives exact numbers on every physician’s hospital referrals on a weekly basis. “I’m looking at the different specialties, to see who has increased their referrals and who has decreased and I’m going out and I’m seeing those practices and meeting with those physicians,” says Scroggins. These meetings are part of a critical feedback loop that the hospital uses to improve its retention.

And, no physician retention plan should be set in stone. One of the secrets to success is to constantly tweak the plan to balance the realities of the marketplace with the needs and desires of physicians. “With our recruitment and retention process and the medical staff development plan, there’s been a lot of tweaking as we go along,” says Scroggins. “It’s an ever-changing community and as we grow demographics change, and we may need to move something up or down in priority. Our physicians have been integral in that whole process.”

Carol Westfall, the president of Cejka Search, extends that principle to any size practice. “Some groups have used the same orientation program for 10 years. But really good orientation programs should be routinely revised to meet the needs of today’s physician. I think extending the orientation program through the first 90 days to six months, so that it’s more extensive, is the way to go. Find ways to get new physicians engaged in the organization early.”

Comprehensive orientation systems enable new physicians to gradually work into their practice, cultivate the lifestyle they need, insert themselves into their communities, and become part of the culture of the organization they’ve joined and know what they can expect from the organization for themselves. “The orientation to me is really how do we help this physician acclimate to the hospital and to the practice and what would that look like,” says Barlow of Corporate Health Group.

One much-hyped component of retention is mentoring programs. But, most experts agree that if not designed properly, this can often turn into so much window dressing. Many practices assign a relatively junior practice member to the new physician. That alone makes a statement that speaks louder than the proverbial welcome speech. Well thought out mentoring goes much deeper.

“It needs to be somebody who will introduce the new person to people, show them the ropes,” says Barlow. “The new physician should feel

comfortable asking the mentor some of the tough questions in a way that they can get a confidential and honest answer.”

“The process of attracting and retaining physicians is what in chemistry we call an endothermic reaction,” says Greenwald. “You have to keep putting energy in to make it work. The training, the coaching, the mentoring, the shadowing, the feedback, all of this has to become part of the culture by doing it consistently-every single time. The minute you stop doing it, or assume it’s going to happen, it stops.”

When all is said and done, is developing a retention plan worth it? Again, Dr. Greenwald: “You can call it an overhead cost. I look at it as an investment. There’s a return on the dollar. If you keep one physician, you save a quarter of a million dollars or more. That to me is an investment.”