A looming physician shortage is the number one problem facing most healthcare organizations today as healthcare reform meets an aging baby boomer population at a time when physician turnover and retirement are on the increase.
- A total shortfall of 90,000 doctors by 2020 was recently projected by the American Association of Medical Colleges (AAMC).
- Between 1990 and 2030 the number of adults over 65 (typically needing health services roughly twice as often as younger patients) will more than double from 31 million to 71 million.
- With the economy improving, physician turnover is on the rise as physicians who had delayed retirement or stayed in jobs where they weren’t really satisfied are now making career changes.
Million Dollar Vacancies
”The current cost of one physician vacancy is nearly $1 million per year when you factor in lost revenue, lost productivity, the cost of recruiting a replacement and getting that new physician up and running,” says David Cornett, Senior Executive Vice President at Cejka Search.
In coming years, competition to hire and keep top performers will intensify. In order to succeed, healthcare organizations will need to:
- Project and plan for retirement, turnover, and growth
- Benchmark their metrics and costs
- Have a good recruitment and retention strategy in place
The Top Controllable Factor Driving Turnover
According to a nationwide, multi-specialty Organizational Culture Survey, conducted by VITAL WorkLife and Cejka search, culture is key to physician satisfaction. And, based upon Cejka Search’s experience, it is the top controllable factor driving turnover—particularly for recent hires.
“The first 3 years in a practice are the most vulnerable years,” explains Cornett. “Once a physician hits the 3 year mark, the risk of turnover drops below the overall average of 6.8%.”
Specific cultural attributes are critical. For example, the survey highlighted the value of a culture of teamwork in maximizing physician job satisfaction:
- 74% of physicians said a team-focused environment is very important (rated 8, 9 or 10 on a 10-point Likert scale) to their job satisfaction.
- However, only 40% of those physicians were satisfied (rated 8, 9 or 10) with their organization’s focus on teamwork environment.
Unfortunately, more than half the administrators responding to the same survey responded that lack of cultural fit was not such a big factor in retention. Coming to grips with that disconnect and committing your organization to creating a culture that leads to effective recruiting and retention can yield an enormous return on investment.
“Achieving a good cultural fit with the expectations of today’s physicians is key to retention,” notes Cornett.
Where is Your Culture Today?
The only way to truly understand where your culture is today is to measure it. Don’t assume you know your culture—your organization may be experiencing the same sizeable gaps between administrator and physician perceptions identified in the national survey.
An online survey is a good method to use in terms of ensuring confidentiality, and providing quantitative data for benchmarking and greater understanding. Organizations can use the 14 cultural attributes studied in the VITAL WorkLife /Cejka Survey while others develop attributes of their own. Outside facilitation of the process can ensure credibility, confidentiality and that all voices are heard.
”Define your terms to make sure that when talking about a cultural attribute, such as ‘respectful communication,’ or ‘patient-centered care,’ everyone agrees on what those terms mean,” says Dan Whitlock, M.D., consulting physician for VITAL WorkLife. “We have found that these terms can mean different things to physicians compared to administrators.”
What Do You Want Your Culture to Be?
Benchmarking your results against the VITAL WorkLife /Cjelka survey or industry peers may illustrate weaknesses or strengths you may face when competing for top talent. You won’t be able to change your culture overnight, but you should be able to identify one or two attributes that are key to your physicians and start working on those.
“Be transparent about the decision process from the beginning,” advises Whitlock. “Will administrators decide? Will it be put to a vote? Let them know upfront so they aren’t surprised or offended by how you act or don’t act on their suggestions.
“Don’t go to your new docs with highly polished plans for moving forward,” continues Whitlock. “Come to them with outlines, ask their input—and then modify, modify, modify.”
Transparency & Accountability are Key
Once you’ve determined which attributes you want to address and have developed a plan for institutionalizing them—building them into your day to day operations and processes, and tying them to performance expectations—every physician needs to know what is expected of themselves, their colleagues and administrators.
Identifying this ensures shared understanding, and also allows measuring behavior and success. Make sure everyone understands what they’re accountable for and that it’s tied into performance evaluations.
It’s also important that everyone play by the same rules, regardless of their specialty or subspecialty. Organizations that “cut deals” with individuals or specific groups often undercut their efforts to create a satisfying culture for all the physicians they employ.
“It requires wisdom and courage to withstand pressure from individual specialties,” notes Whitlock. “Once you give in, expect a stampede. There may be confidentiality but there are no secrets in medical organizations.”
Walking the Talk: Addressing Gap Needs
Strong physician leadership is a key driver in change initiatives because good physician leaders can have a huge impact on whether or not your organizational culture will lead to effective recruiting, retention and return on investment.
Do you have the physician leaders you need? Great doctors aren’t necessarily great leaders. Don’t assume: ask a million questions, kindly and gently. Be prepared to provide training and mentoring opportunities to help them develop any skills they lack.
“This may be an area where you want to bring in outside consultants or peer coaches,” explains Whitlock. “Physicians are often reluctant to admit inadequacies or accept help from colleagues, but they’ll work with perceived experts to develop new skills.”
Whitlock recalls Einstein’s famous quote: “We cannot solve our problems with the same thinking we used when we created them.”
Monitoring Your Cultural Health
Once you’ve embarked on a cultural initiative, monitor physician satisfaction with your results. Ask what’s working and what isn’t. Get as many specifics as possible—and then act on the information. Inaction breeds cynicism. The more emphasis you place on institutionalizing cultural change, the sooner you’ll see results.