Once a physician has stayed with a practice for five years, the likelihood of him or her leaving is negligible—but turnover rates for those first five years can be high, according to the 2011 Physician Retention Survey from the American Medical Group Association and Cejka Search. In that survey, turnover was:
What drives that level of turnover? The nationwide, multi-specialty Organizational Culture Survey we conducted with Cejka Search in 2012 suggests that “cultural fit” is a prime driver of physicians’ satisfaction and dissatisfaction with their jobs.
The more than 2,200 physicians who responded to our survey rated the importance of cultural fit to their job satisfaction at an average score of 8.4 (on a 10-point Likert scale—but only 7.0 in terms of their perceived cultural fit in their current jobs. Clearly physicians perceive cultural fit to be important—and a fairly high percentage don’t feel they fit, or fit optimally, at their current places of employment.
“Cultural fit is a determining factor in a physician’s decision to join—or leave—a practice,” said David Cornett, senior executive vice president of Cejka Search. “Because turnover and prolonged physician vacancy can cost a practice as much as $100,000 per month, organizations can achieve significant returns by investing in the assessment and cultivation of cultural fit.”
Almost half (48.5%) of physicians responded with a score of 8, 9 or 10 that a lack of cultural fit prompted them to leave a practice or job, and almost two-thirds (61.9%) likewise said that their expectation of cultural fit was a determining factor in their accepting a practice or job opportunity.
A companion study of healthcare administrators found that while they have a reasonably good sense of what is important to physicians’ satisfaction in terms of organizational culture, they significantly underestimated cultural fit as a driver in terms of recruiting and retention.
Organizations that underestimate the importance of cultural fit, do not accurately assess cultural fit in candidates, positively convey their practice culture, and then support the enculturation of newly recruited physicians place themselves at a significant recruitment disadvantage and higher risk for turnover.
Your organization may have worked long and hard to develop a clear mission and values—but, you can’t assume that mission and values translate into a culture that will attract and retain the type of physicians you want.
While clear mission and values was deemed important by the physicians surveyed—it was among the lowest ranked cultural attributes. Indeed, the top cultural attributes cited by physicians were:
”The study clearly shows areas of disconnect between what physicians look for and what they find—and what organizations think they provide,” said Dan Whitlock, MD, MBA, VITAL WorkLife consulting physician. “At a time when physician engagement is of paramount importance and healthcare organizations seek to promote satisfaction and loyalty, closing these organizational culture gaps can have a strong positive impact.”
Start by creating a list of cultural attributes that are present or desired by your organization. You may want begin with the ones used in our survey.
We developed our list of cultural attributes by reviewing several standardized survey instruments which were developed for healthcare organizations. We then narrowed the attributes down to the 14 which we felt were most applicable to physicians and reflected the experience we have working with physicians and healthcare organizations.
Ranked by order of importance to physicians surveyed, those attributes were:
There may be other attributes which resonate with your physicians. Add them to your list. Share the results, then ask your physicians to help you prioritize where to begin the process of change, based upon the biggest potential impact, or the biggest gaps between expectation and reality.
Identify the key stakeholders and potential change champions. Think broadly, but make sure physicians are involved—and, potentially, leading—subsequent efforts. Look at the cultural attributes you’ve identified, and then think about who can have an impact.
For each cultural attribute, ensure that there is agreement about what it is, and the day-to-day behaviors and actions that support it at the individual, workgroup and organizational levels. This will help greatly in measuring results and helping hold stakeholders accountable for results.
After prioritizing, pursue the one or two attributes that will have the highest impact, and follow a defined path toward achieving meaningful and positive change. Do not let this initiative die in committee—set tangible benchmarks and accountabilities, and develop formal action plans.
Then, develop a roadmap on what needs to change, communicate it and act on it. Allow no exceptions. Make it as tangible as possible, and provide tools and resources to support those who are impacted.
Provide adequate time for your physicians to work on change initiatives. Simply adding committee meetings and additional work without placing value (monetary or otherwise) on the time and initiatives developed will be counterproductive.
When significant progress has been made around the first one or two cultural attributes, start on the next priorities.
Organizational culture also needs to be reinforced and nurtured. Recruit for cultural fit. Develop assessment tools and processes to ensure that physician candidates understand the organizational culture and demonstrate their ability to fit in and support the culture.
Use behavioral interviewing techniques to drill down with candidates regarding such things as conflict management, teamwork and communication—making sure they tie clearly into the desired cultural attributes.