The scene is all too familiar. A physician in the medical group suddenly leaves or develops an extended illness. An atmosphere of panic pervades the clinic. Who will see that physician’s patients? How quickly can we get another physician? Where do we recruit? What do we do in the meantime?
All medical groups face these situations on a routine basis. Having consulted with many medical groups across the country over the years around the issues of physician retention and recruitment, here are some strategies and tips that you may wish to consider for your group.
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1. Develop a Medical Group Charter
If your medical group does not have a charter, it should be developed. If your group has a charter, it should be regularly revisited and updated as part of the group’s strategic planning.
A medical group charter defines the ideal physician for the group in terms of the group’s mission, vision, and values, as well as acknowledges the cultural issues, both overt and covert, that exist within the group.
The cultural piece needs to be discussed openly and frankly amongst the providers. For example, does the group culture expect high productivity/high compensation amongst its physicians, or does the group “set the thermostat” at a lower workload/lower pay expectation?
These cultural norms and mores are critical to discuss, especially as one considers the compatibility and ultimate longevity of future recruits. The charter becomes an integral part of not only your physician recruitment and retention strategies, but also of the compensation and incentive program for the medical group, as those physicians who most embody the spirit of the charter should be the ones most rewarded in the compensation plan.
2. Develop and Implement a Recruitment Strategy for the Medical Group
Ideally, this plan should be in place BEFORE the process has to be implemented. Several factors must be considered as part of the ultimate development of this plan. Importantly, the recruitment strategy must tie to the overall needs of the group and must be an integral component of the group’s strategic plan. There are several key issues to consider.
The group must first determine which services/specialties are needed within the group as well as the costs and benefits of providing such services. Then it must be determined if there are specific needs within those services.
There are multiple issues to be considered: the desired/ideal panel sizes for primary care, productivity assessments for all current physicians, geographical or office coverage issues, and the potential for growth, to name a few. These factors determine the ideal number of physicians for each specialty both for the group as a whole and within a given geography. The group can then objectively determine if there is a gap and whether recruitment is even necessary.
The recruitment plan, like the strategic plan and group charter, is a living document and will change over time with the dynamics of the group. Each of these strategies should be periodically reviewed and adjusted as the physician recruitment and retention needs of the group evolve.
3. Retention is Rule #1 of a Recruiting Plan
Turnover has a considerable cost in terms of lost patient visits, lost time in diagnosis and treatment of patients, increased workload for remaining physicians, and the time-consuming and expensive process of finding a physician and inboarding that physician to the group. As a rule, turnover should be minimized first and foremost.
However, one must acknowledge that some turnover can be good—not only if a physician has a quality or competency issue, but also if that physician does not fit in with the culture of the group or is incompatible with the values of the medical group charter.
The huge cost of turnover must be recognized by the medical group. Physician retention is the best way to minimize the need for recruitment. What is being done by the medical group to encourage the good physician to stay? Ideally, recruitment should be reserved for medical group growth or physician retirement, while retention should be the foremost of your strategies.
Many medical groups routinely assess the satisfaction of the physicians and adapt accordingly. Your group should strive to be the ideal place to practice medicine in the community. Are you creating an environment where the good physician wants to stay? Are symptoms of burnout promptly recognized and addressed? Are there long-term benefits and incentives in the compensation program that make a physician want to invest an entire career with the medical group?
4. A Physician Leaving Does Not Mean a New Physician Is Needed
A recruitment plan is not a glorified replacement plan. Despite the chaos that can ensue with a sudden physician vacancy, an opportunity now exists for the group to reevaluate the need for recruitment. Do not get cajoled into thinking that just because a physician has left, there is an automatic need to recruit another. There may be other options for the group to consider, such as redistributing patients to other, less busy physicians. This is an opportunity to reconsider whether those services are necessary going forward given the ever-changing environment of health care.
5. Develop and Implement a Standardized Process for Recruitment
As new physicians are added, the group needs to develop a consistent methodology that optimizes the recruitment of the best physician available. It is imperative that the recruited physician have a reasonable understanding of what will be expected by the group.
Compatibility with the group charter is essential. Group expectations in productivity, on-call, and work/life balance must be clearly articulated upfront. It is important to have as many members of the group as possible personally meet and evaluate the applicant.
Likewise, the applicant should have the opportunity to interview as many of the physicians in the group as possible. Both parties must honestly assess the situation and make the best decision objectively. It is OK for either party to disagree and walk away. And if that is the case, it is much better to do so now rather than later!
The worst-case scenario is not the absence of the physician, but rather the “mis-hiring” of an incompatible physician. The inappropriate hire can be considerably costly and have long-term adverse effects for the group.
6. Leaving Is the Final Step in the Process of Dissatisfaction
What are you doing to recognize physician dissatisfaction early on, and what are you doing to address it? Many times, retention and recruitment strategies overlook the fact that appropriate intervention can obviate the need for the physician to leave. There is a great opportunity here for “preventive medicine” before differences become irreconcilable, especially following COVID-19.
Book a Presentation on Recruitment and Retention
I have found these six tips and strategies useful in the process of physician retention and recruitment and leveraged them to great effect throughout my consulting engagements. If you’d like to improve on your medical group’s track record on recruitment and retention, contact SMB Health Consulting to learn more or to inquire about speaking engagements. I offer presentations on avoiding provider burnout as well as consulting services to guide medical groups toward the path to physician satisfaction.