Physician recruitment and retention: Factors affecting expectations and reality
By Alan Rosenstein, MD, MBA, Physician Wellness Services, Minneapolis, MN
Physicians are a precious resource. Some estimates project that by the year 2015 there will be a shortage of 75,000 physicians. There are many factors contributing to this shortage: increased healthcare needs of an aging population; manpower needs related to increased access from new health insurance exchanges; restructured health plan offerings; and external factors causing physicians to leave the profession prematurely. The ongoing physician shortage means organizations must not only recruit physicians, but also develop strategies to retain them. Successful retention strategies incorporate onboarding, physician support, training, and education.
Does it fit?
Successful recruiters don’t just fill positions with warm bodies, but attract physicians who provide clinical services needed for the organization and the community served. It is important to determine initial requirements, like training, skill sets, and documentation of clinical competency. Equally important is cultural fit, as one of the key factors affecting physician disposition and engagement is their feeling about the organization and their co-workers. Evaluating physician expectations and adaptability during the interview process should be a key component in the selection process. This will help to assess cultural fit and may predict how well a physician will acclimate.
Physician satisfaction is related to work relationships, feelings of trust and respect, and alignment of goals and priorities around patient care. Physicians want to be included in decisions that impact patient care and want to feel that administration has their best interests at heart. Recent surveys have shown that difficulties in cultural fit is a main reason why physicians decide to switch jobs, so determining cultural fit during the recruitment process will help with retention.
Support after signing
A consistent process for onboarding is critical after a physician signs. Acquainting new physicians with structure, processes, information systems, and medical staff responsibilities helps a new physician understand how the organization conducts business. Taking time to familiarize the physician with the corporate landscape and organizational priorities will help new physicians better understand their role in supporting these programs. During the onboarding process, the recruiter should take the opportunity to explain how the organization will support the physician.
After a successful recruitment, it is imperative to provide ongoing physician support. Recent surveys have revealed that up to 50 percent of the physician population suffers from stress, burnout, and depression. Some of these issues start during medical school and residency training, but much more occurs once the physician enters into practice. Causative factors include concerns about the economy, healthcare reform, a sense of loss of autonomy and control, the feeling of being overworked and underpaid, and a sense of loss of respect and appreciation for services provided. Surveys suggest that more than 15 percent of the viable physician population has left the profession prematurely though early retirement or switching to a different occupation.
Changing these environmental factors is difficult, so strategies must be geared toward helping physicians accommodate and adjust. Offering to provide physicians with administrative, clerical, or clinical support to assist them with non-clinical responsibilities and scheduling or on-call responsibilities will provide more free time helping to restore a more reasonable work/life balance. Providing support programs to help deal with stress and burnout will help restore balance, provide more realistic expectations, increase satisfaction, and leave the physician with more energy for their job. These types of services may be offered internally through human resources or wellness committees, through outsourced training/consulting firms, or as part of a formal employee assistance program.
When things start to go wrong
Effective and productive work relationships are a key to satisfaction as they impact workflow, communication, task accountability, and patient outcomes. Physicians want to be regarded as a “best practice physician” but are often unsure as to what that means. In some cases, one may encounter disruptive physicians who intimidate others, impede communication and collaboration, and negatively impact staff collaboration and process flow, which can adversely impact patient care. Some physicians may have more deep-seated behavioral disorders that need to be addressed accordingly. A much larger percentage of physicians suffer from a low level of “emotional intelligence” leaving them unaware of their impact on others. In today’s complex environment, physicians need to be taught that they are part of a healthcare team and how a multidisciplinary approach to care management will actually improve outcomes of care. It will also increase staff, patient, and self-satisfaction. Organizations that provide training in improving staff relationships and communication skills have noted significant improvements in both clinical and perceptual outcomes of care.
Physician intervention strategies are often necessary to keep a physician from leaving an organization. Providing general education programs on stress, time, and conflict management, diversity training, team collaboration, and communication skills is definitely a step in the right direction. But in some cases, it takes a one-on-one interaction to get the job done. Meeting with physicians can be a tricky issue as physicians are often unaware that something is wrong. If they do admit they’re under stress or are struggling with personal issues, the thought is that it is someone else’s fault or they can handle it themselves. There is an overriding perception that “non-physicians” just don’t understand their world. It is often best to take a more informal approach, asking questions such as: “How are you doing?” “Is there anything going on I can help you with?” “I noticed recently that you have...” Approaching the physician in a non-confrontational manner with the purpose of trying to help rather than punish is the key to this level of intervention. More difficult behaviors may require formalized recommendations for coaching or counseling. As a word of caution, a particular skill set is required for individuals conducting these types of interventions. Resistant, non-compliant physicians may require more intense administrative action.
Retain, retain, retain
Physicians are a precious resource. To ensure retention, take time to explain why things are a certain way and how the organization deals with issues. Invite physician input. Listen to and address physician concerns. Treat them with respect. Train them in organizational and relationship skills. Offer to help in a constructive manner. Thank and complement them for a job well done. Improved relationships and an improved sense of wellbeing will invigorate their energy, lead to increased engagement and productivity, and improve physician satisfaction and commitment to the organization. And when there is commitment to an organization, there will be physician retention.
Alan H. Rosenstein, MD, MBA, is a practicing internist and health care consultant in San Francisco, CA. Dr. Rosenstein is Medical Director of Clinical Efficiency and Care Management at ValleyCare Hospital in Pleasanton, CA, and Medical Director of Physician Wellness Services in Minneapolis, MN.