Group Practice: How to keep the new guy

December 15, 2006

More than half the physicians hired by groups leave in the first five years. Here's how to keep that from happening in your practice.

Not long ago, consultant Robert F. Priddy saw a young man sitting in an office where Priddy was consulting. He introduced himself and asked the man who he was. The man answered that he was the new doctor who'd just started that day. When Priddy asked him if anyone knew he was there, he replied, "I don't know."

The typical medical practice may not be that cavalier about greeting a new associate, but it's not uncommon for newly hired doctors to stick with the job for only a short time. According to a survey conducted by the American Medical Group Association and the physician-recruiting firm Cejka Search, close to 50 percent of physicians leave a practice within three years, and 60 percent exit by Year Five. Reasons include practice issues, compensation, location, and a spouse's dissatisfaction with the new surroundings. While some recruits undoubtedly know coming in that they only intend to stay for a short time, others would stick around longer if they felt valued, fairly paid, and knew the answer to the important question, "How am I doing?"

"Groups must be clear about what they require of new associates, and they should question job candidates to determine what they require of the group. This is an ongoing process that should begin during the initial phone interview, extend through the site visit and follow-up conversations, and proceed to a job-offer letter," says Kenneth T. Hertz, a senior consultant with the Medical Group Management Association Health Care Consulting Group in Alexandria, LA.

Hertz says that when one group of orthopedic surgeons was in pre-employment discussions with a potential associate, no one talked about expectations. "I don't mean the terms of the contract," he says, "but the unwritten provisos: Will the new doctor be responsible for promoting his practice? What level of control will the doctor have in running his practice? What do the partners expect of him, and he of them? What's expected in terms of covering satellite locations, practice governance, staffing needs?"

Call coverage requirements should be laid out, too. "New physicians don't want to be expected to handle the bulk of this burden," says Judy Capko, a practice management consultant in Thousand Oaks, CA. "Young doctors value family time and won't tolerate what was once the norm in terms of time dedicated to the practice."

Of course, it's essential to lock in the financial arrangements. Like marriages, many employment relationships founder over financial issues. "The practice employment contract may be vague on how compensation will be handled-particularly bonuses or incentive compensation after the first year," says Hertz. "The compensation deal should be included in the employment contract-along with specifics about benefits, workweek, and educational opportunities-and the details must be transparent for the employed physician. Trust is critical, and lucidity and sticking to a plan will help tremendously."