Why physicians leave: Fit and Family

Changing demographics of the physician workforce are reflected in physician turnover trends, according to the 2006 Retention Survey from the American Medical Group Association (AMGA) and physician and healthcare search firm Cejka Search. In its third consecutive year, this survey identifies the issues, strategies and best practices encompassing physician retention at AMGA-affiliated medical groups. The full report can be downloaded from the Cejka website.

Key Findings:

• 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%). "Relocated to find a better community fit" was mentioned 20% 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%) and "spouse's job required relocation" (22%). "Leaving to seek higher compensation" was mentioned 32% of the time, with incompatible work schedule" and "excessive call schedule" each being mentioned 17% of the time.

"Compensation and a desirable work schedule are typically discussed in great detail during recruitment," said Scopelliti. "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% in 2006 from 13% 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.

"A major demographic shift is taking place in medicine. The current physician workforce is still dominated by male physicians age 42 and older," said Donald W. Fisher, Ph.D., AMGA's president and chief executive officer. "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% in 2006, up from 6.4% 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% in 2006, compared with 5.9% in 2005. On the other hand, turnover among female physicians decreased from 7.5% in 2005 to 6.6% in 2006.

"Retention efforts should address workforce trends and begin during the earliest stages of recruitment," said Carol Westfall, president of Cejka Search. "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."

"As the demographics of the physician workforce change, so will recruitment and retention efforts," said Joseph Scopelliti, M.D., president of The Guthrie Clinic in Sayre, PA. "Turnover is a fact of life, but practices can minimize their rate of turnover with proactive efforts and a commitment to recruiting a physician whose needs match the needs of the practice."

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% of physicians employed in the responding groups, compared with 28% in the previous survey.

"In addition to statistical data, the survey includes valuable insights about various retention initiatives our members are implementing in their medical groups," said Fisher. "We hope that this survey will encourage today's healthcare leaders to understand the values, needs and expectations of their physicians across all generations."

Recruiting a physician is not the same as recruiting other staff for your practice. The physicians - new and tenured - are the "face" of the practice. It's disruptive when physician leaves in many ways that ripple across the practice - patients needing a new physician (who may or may not stay with you), questions as to why they left (as in "what's wrong with this practice) and so on. The interview time is the critical time. Never, ever hire someone based upon one interview. Have them meet with your support staff without current physicians present. Finally, bring the family in as well and meet with them on a social basis - try to introduce them to other people, including non-physicians, with whom they might share interests. For both parties, take the time to learn more about each other in different settings. All too often, the responsibility for a bad hiring decision rests with the employer.