By Lori Schutte, MBA, President, Cejka Search, St. Louis, MO
As the health care environment shifts from volume-based to value-based reimbursement, investing in efficient recruitment processes and effective retention programs will be crucial. Healthcare reform measures, changing demographics, physician shortages and advancing technology are challenges that present physician recruiters with the opportunity to build cohesive care teams to meet increased access to care.
Read on for five trends that can help you identify the areas where you can maximize your recruitment ROI and add measurable value to your organization.
- In 2012, physician turnover reached 6.8 percent, the highest rate reported since 2006.
This historically high turnover rate strengthens the relationship between turnover and economic conditions. As the economy improves, turnover will continue to increase as physicians proceed with relocation and retirement plans that may have been delayed due to depressed home and investment portfolio values.
Adding to the challenge, more than one-third of administrators (36 percent) expect retirement to increase in the coming year. The American Medical Association reports that 24 percent of physicians are over the age of 60, and an additional 49 percent are between the age of 41 and 59 years old.
- Turnover between the first and second year of a physician’s tenure with an organization averages 11.0 percent, followed by 12.4 percent between the second and third year – almost twice the average turnover rate of all physicians.
This staggering statistic may be due to a number of factors, including the rise of physician couples. A recent survey of residents and fellows reports that nearly one-third (29 percent) of physicians have a significant other who is also a physician. This could impact retention if one spouse accepts a position while the other is still in training. Turnover may occur when both spouses complete training if they decide to relocate to an area with personal ties.
The top controllable factor among all voluntary departures is lack of cultural fit, a variable that can be addressed during the hiring process with effective screening, onboarding and mentoring during the first year. The good news is that once physicians hit the five-year mark, they are much less likely to leave, with the average turnover rate dropping to 5.7 percent.
- 85 percent of health care organizations have an onboarding process for new physicians, but only 33 percent of those formalize the process with a committee or task-force.
A formalized approach to bringing new physicians into the practice is indicative of a culture that views retention as an investment and values the job satisfaction of the clinical staff. Onboarding and mentoring programs offer a significant opportunity to increase physician engagement in organizational culture. Though onboarding program components vary among organizations, it appears that those with a longer onboarding process have lower turnover during the critical early years of practice. In fact, health care organizations that have an onboarding program that lasts one full year report a lower turnover rate between physicians’ second and third year at 10.5 percent versus 17.4 percent turnover for organizations with just one month of onboarding.
Health care organizations report various best practices for onboarding programs, including:
- Assigning an experienced physician mentor committed to formalized meeting times and responsibilities.
- Training sessions for the organization’s EMR system and other technological applications.
- Scheduling regular follow-ups from mentors, committee members, medical directors, chief executive officers and others directly involved with new physicians.
- Since 2005, the total number of employed physicians increased 41 percent, and the number of female physicians increased 86 percent.
The increased number of female physicians is driving the growth of health care organizations and introducing new challenges for physician recruiters. For example, female physicians are more than twice as likely to practice part-time. Offering work/life balance for physicians has become an integral recruitment and retention strategy. The most successful recruitment offices of the future will fulfill existing patient access needs and meet growing demand for care by supplementing part-time and flexible physician schedules with electronic medical records, hospitalists and advanced practice teams.
- 76 percent of health care organizations plan to hire more primary care physicians, 61 percent plan to hire more physician assistants, and 67percent plan to hire more nurse practitioners in the coming year.
With the evolution of care teams, health care organizations need a ‘care quarterback’ to address new value-based reimbursement models, coordinate the care of an aging population, and provide access to a growing insured universe. There is greater pressure on health care organizations of all sizes to recruit and retain primary care physicians and advanced practice clinicians who will fit well within the group culture and work productively as a team.
Competition for clinical talent – amid an existing physician shortage – will be fierce. Ramped up hiring plans, along with increased retirements and demand for part-time work schedules, will challenge recruiters to use their investments wisely and find physicians who will stay for the long-term.
Armed with essential benchmarks, you can make a smart business case for implementing recruitment and retention best practices in your organization.
2013 Residents and Fellows Survey, Cejka Search
Benchmarks and Trends for Physician Retention, Cejka Search