By Jason D. Fodeman, MD, MBA
As medicine has become more consolidated, the issue of physician retention has become increasingly important and warrants examination.
Jason D. Fodeman, MD, MBA, is a practicing primary care physician. He specializes in delivery systems and health policy. He is also an at-large member on the Early Career Physicians Section Governing Council and one of the winners of PAMED's Top Physicians Under 40 Award in 2017.
Physician turnover is costly to not only the employer, but also to insurers, taxpayers, and patients. Buchbinder et. al. found the costs of losing a primary care provider ranged from $236,383 for a family medicine doctor to $264,645 for a pediatrician1. Health care systems, physician groups, hospitals, universities, and other employers absorb these costs, but the costs to the patient are even higher. It can be confusing for a patient to start with a new physician and certainly frustrating. The break in continuity can lead to delays in care.
It can also lead to compromised care. It can leave patients without their medicines and with nowhere to turn to but overcrowded, disjointed, expensive emergency rooms.
With 54.4 percent of physicians experiencing burnout2 and 48 percent of physicians planning to limit hours, retire, or change employment in the next one to three years3, the status of the physician workforce is in jeopardy.
To tackle this problem, provider organizations should adopt formal physician retention programs. The commitment to this initiative should start at the top. The C-suite needs to understand the importance of physician retention and make it a strategic priority.
PHYSICIAN RETENTION PROGRAMS SHOULD CONSIST OF AT LEAST FOUR PARTS
Provider organizations should engage physicians in decisions. Doctors should be kept informed about changes with open, transparent communication. Leaders should actively and genuinely seek out physician input. Doctors in the trenches can provide a valuable perspective that can mitigate unintended consequences. Additionally, empowering doctors in this way would give physicians a sense of ownership and pride for the organization.
Health care systems should also offer physician development programs designed to teach physicians new skills and offer a more fulfilling, diversified career. Development programs should also involve mentorship and leadership training.
Physician Leadership and Management
Physician managers, in particular, should receive formal training in leadership. The training should stress mentorship, engagement, and retention.
It is also important that physician managers practice the specialty they are supervising in some capacity to better understand the challenges in the trenches.
Maximizing the "Why"
Yet, the most important part of a physician retention program should be to maximize the "why." The "why" is the medicine. It's the patient. In recent years with an onslaught of regulations, physicians are spending more time facing a computer, inputting data, checking boxes, and filling out forms, and less time practicing medicine
Organizations should arrange infrastructure to best support physicians and ensure they are spending their time with patients not with computers. Is checking off boxes and navigating difficult drop-down menus the best use of someone with 11 years of education? There has been a push among policymakers to have nurses work to the top of their license. Administrators should be committed to having physicians work to the top of theirs.
As health care becomes more consolidated, it is important that the health care industry prioritizes physician retention and strives to offer balanced, fulfilling jobs that doctors are excited to do.
1Sharon Bell Buchbinder, Modena Wilson, Clifford F. Melick, and Neil R. Powe, “Estimates of Costs of Primary Care Physician Turnover,” The American Journal of Managed Care, Vol. 5, No. 11, (November 1999), pp. 1431-1438.
2Tait D. Shanafelt, MD; Omar Hasan, MBBS, MPH; Lotte N. Dyrbye, MD, MHPE; Christine Sinsky, MD; Daniel Satele, MS; Jeff Sloan, PhD; and Colin P. West, MD, PhD, “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014,” Mayo Clinic Proceedings, Vol. 90, No. 12, (December 2015), pp. 1600-1613.
3The Physician Foundation, “2016 Survey of America’s Physicians,” September 2016, at www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf (January 24, 2016).
A version of this article appeared in the spring/summer 2017 issue of
Pennsylvania Physician Magazine and was reprinted with permission.