Hospitals and health care organizations don’t do enough to keep physicians. A new book discusses how to change that.
Healthcare organizations invest significant time, energy, and money into hiring physicians. But according to Douglas Farrago, MD, the author of ‘The Hospital Guide to Physician Retention,’ very few organizations invest adequate resources into keeping physicians. Farrago, a Family physician, became interested in the topic from his personal experience as an employed physician. “I wrote this book to help companies improve their physician work environment, so that doctors don’t want to leave.”
Farrago says that increasing retention efforts can save organizations money and improve quality care. “It costs a lot to hire and train a physician,” he says. “Lowering your turnover rate by just one percent can save an organization up to a million dollars.” Retaining physicians also lowers overall healthcare costs, with a recent analysis estimating that primary care turnover adds nearly a billion dollars in excess healthcare expenditures per year.
The lack of organizational effort toward physician retention surprises Farrago. “When you look at other industries, especially big tech, these companies are doing everything they can to retain employees. They’re offering wine bars and ping pong tables, remote work opportunities, whatever they can to retain well-trained employees. If it’s worth this much to keep a coder, why aren’t healthcare industries doing the same?” Farrago points out that competition for physicians is high. “A shortage of nearly 122,000 physicians is projected by 2032. Unemployment in November 2019 was at 3.5%,” he says. “Doctors are your biggest asset, and happy doctors stay.” Fortunately, there are several simple steps to help organizations retain great physicians.
1. Assess physician satisfaction
According to Douglas Farrago, most organizations fail to accurately assess physician well-being in the workplace. “Using physician retention rates is difficult because most companies don’t actually want to know the number,” he says, noting that he worked at an organization that claimed to have very high physician retention, which was contrary to his direct observation. “The center had 80 doctors come and go just in the year that I was there.” Further, relying on exit interviews to determine why physicians are leaving is challenging, as doctors may be hesitant to ‘burn bridges.’
Farrago says that surveys of physician satisfaction often fail for various reasons: they are too long, physicians fear a lack of anonymity, or they believe employers will not act on the results. Instead, he recommends the use of a simple survey called a Net Promotor Score (NPS), which assesses loyalty to an organization: “On a scale of zero to ten, how likely would you be to recommend this company to a physician colleague looking for employment?”
The NPS system, which was developed by Fred Reichheld, categorizes respondents into three groups: Promotors, passives, and detractors. “To calculate your score, you take the percentage of employees who are promoters and subtract the percentage who are detractors, while ignoring the passives,” says Farrago. “So, let’s say you have 30% promoters and 20% are detractors. The calculation is 30% - 20% which equals 10%, or a score of positive 10.” In his research, Farrago found that physicians in traditional, doctor-led practices had Net Promoter Scores of + 19 and were likely to recommend their organization as a place to work. Physicians working in large, management-led healthcare organizations had more detractors, with a Net Promoter Score of negative 13. “If you don’t have a good score, the next step is to figure out why, and what you can do to fix it,” says Farrago.
2. Show doctors that you care
Health systems need to show physicians that they are valued, says Farrago, who experienced the opposite at one organization he worked for. “Six months after my practice partners and I were recruited to join a new hospital, the CEO didn’t even recognize me,” he says, a striking contrast from the attitude he experienced before he signed his employment contract. “The administration went from throwing us a big party and hugging us to not even acknowledging us. Now, does that leave a mark? It does.”
Farrago notes that with the growth of social media, doctors talk about the way they are treated by organizations, and showing care and concern makes a big difference. This can be expressed by simply acknowledging physicians. “Physicians need to feel that the CEO and administration know who they are,” he says, noting that small gestures like a personal note go a long way toward increasing physician morale. Organizations can also acknowledge the education and training physicians by using their appropriate title (rather than the catch-all term ‘Provider’) and by celebrating Doctor’s Day.
3. Produce a better work environment.
Providing adequate workspace, equipment, and support staff is essential to retaining physicians, but even small steps in elevating the work environment can make a difference, says Farrago, who recalls an early experience in his career. “A friend used to bring me and other colleagues to his hospital’s doctor’s lounge, because they had really nice coffee and biscotti. He ended up recruiting several new physicians to the hospital.” According to Farrago, the relatively minor expenditure of upgraded coffee made an impression on physician visitors. “It made it seem that the hospital cared about their doctors.”
Farrago advises: “The bottom line is that great hospital environments create happy doctors. Those happy doctors stay. Happy doctors recruit other happy doctors. And happy doctors make patients happy. This saves you money and makes you money.”
4. Assign or hire a staff member as a physician liaison
Douglas Farrago strongly advocates that every organization employ a physician liaison to support doctors in the group. A physician liaison can help orient new hires, provide resources and support, and act as an anchor for doctors in the group. Farrago recalls Jane, a former nurse who worked as a physician liaison in one of his hospital practices. “She was wonderful. She made sure the lounge was stocked. She would get you your white coat, and make sure that you had what you needed.” Farrago points out that a liaison’s job is not as a manager. “This person doesn’t need to be involved in negotiation or employment quarrels. They are just there to help with anything that the group of doctors need.”. (Author’s note: I get nostalgic thinking of my residency program physician liaison, Norma. She was almost a mother figure to us; a friendly face, a supportive voice, and a place of refuge during difficult times.)
5. Create a sense of community
Douglas Farrago notes that studies show that physician retention is improved when doctors feel that they are part of a community, which has become increasingly difficult as doctors are siloed and isolated from each other in daily practice. Organizations can create a sense of community by creating physician-only spaces, like the traditional doctors’ lounge, which Farrago believes should be exclusively for physicians. “Non-physicians can have their own space, but doctors need a place where they can talk to each other.” In addition, organizations can help create community by providing meeting opportunities offsite and by encouraging physician membership in local county medical societies, including funding membership dues.
To help implement these steps, Farrago suggests that organizations consider creating a Physician Retention Program, headed by a physician leader. He notes that programs that have created such a program have reported a reduction in turnover rates with significant cost savings and improved patient care.
Rebekah Bernard, MD is a family physician in Fort Myers, Florida, and the author of four books, most recently Imposter Doctors: Patients at Risk. You can watch her entire interview with Douglas Farrago, MD on her YouTube channel, Patients at Risk.