How much is physician turnover really costing you?

Even if you and the rest of the medical staff feel the loss of a physician who retires, accepts another position, or goes on maternity leave, you might not know how much a vacant position is actually costing your institution. Three-quarters (76 percent) of organizations do not quantify the cost of turnover, according to a survey by healthcare recruitment firm Cejka Search. But neglecting or underestimating turnover could be costing you, notes Cejka Search President Lori Schutte.

"It is very rare that we talk to an organization that has done a really good job of quantifying exactly what those costs are," Schutte said. "If you have an open position that is a billable position--a revenue-generating position--what is it costing you for every month that position is left open? There is a cost to having that vacancy."

For example, if a lost revenue for one full-time equivalent (FTE) is $990,034, recruitment costs is $61,200, and annual start-up costs is $211,063, that means replacing one physician leaving and getting another on board will cost the organization more than $1 million ($1,262,297), according to the report.

Consider tracking those recruiting, hiring, and retaining metrics. You might be astounded, said Schutte. How can you estimate what turnover is costing you? Think about factoring in the following variables:

  • Lost revenue
  • Start-up costs
  • Recruitment agency fees
  • Sourcing and advertising costs
  • Interview travel costs
  • Signing bonuses
  • Moving costs

In addition to the financial costs, consider the time costs too. For example, after calculating how many interviews it takes until you hire a physician, think about how much time it costs both the interviewer and the interviewees. Like they say, time is money.

Having those estimates will help you generate or improve your game plan for retention and recruitment. Say, if your organization finds that it interviews 10 candidates before hiring someone, it might be time to look at your interview process to narrow down the interview-to-hire ratio.

Schutte also warned that retention doesn't stop when the physician enters the door. All too often, the hospital wins over the physician and gets her to sign the dotted line, but then drops the ball on keeping her. Like a good relationship gone bad, hospital-physician relationships can quickly turn from sweet to sour if the organization doesn't continue to woo the physician through a strong retention strategy.

Consider the following five tips on physician retention, which can translate to dollars in the wallet:

1. Have a solid onboarding strategy
"It's more than orientation. Problems don't crop up until one month, three months, and the problems change over time."

The first couple of days are dedicated to orientation, which will include the standard not-to-forget items, such as meeting the appropriate colleagues, touring the building, getting business cards, and reviewing OR schedules (if applicable). However, after that, check in with the new physician regularly about the challenges that they will certainly face as time goes on, such as using the electronic record system.

2. Offer flexible scheduling
Many younger female physicians and older men close to retirement age desire some part-time schedule, according to Schutte. Even if your organization resists offering part-time work, it might be worth it to change your mind. Show your organization the data. The flexibility can help recruit good candidates who might be attracted to the work schedule.

"You have to make it a win-win for the organization and the individual," said Schutte. "Having the physician work part time is better than having an empty spot and no billing at all."

3. Partner with nurse practitioners and physician assistants
Nurse practitioners (NP) and physician assistants (PA) need not be mere fill-ins. Partner with nonphysician providers to help relieve the work burden on existing physicians. However, be warned. Physician reaction to NP or PA involvement can vary.

"It won't be for everyone, but having the right partnership can greatly improve your productivity. It can be a good experience for the patients as well," said Schutte.

4. Implement or improve a physician mentoring program
Although three-quarters (74 percent) of respondents said they believed mentoring helped reduced turnover, only about half (56 percent) assign one to a new physician.

Find a seasoned (and willing) physician to work with the physician, as well as check in regularly. However, Schutte also cautions to find a good fit.

"Not everyone is a good mentor. It's finding the right people who are willing to put forth that extra effort and invest in the newer folks that are coming up through the ranks."

5. Say thank you, for goodness sake
A simple thank you goes a long way. It's not rocket science; recognizing someone can help contribute to employee satisfaction. I've never met a person, let alone, a C-suite member, who said "thank you" too much.

Recognizing physicians can be as formal as presenting an outstanding physician a doctor-of-the-year award, celebrating Doctor's Day (on March 30, by the way) with a fun annual party, or even a pat on the back at the end of the day. Recognizing a job well done needn't be isolated to special quality projects or IT initiatives, either, but rather for physicians continuing to do their jobs every day and providing the care that they do.

I encourage readers to dedicate some time to looking at your current turnover, the costs associated with it, and reevaluating your retention strategy.

Mary Barber, Cejka Search vice president of recruitment partnerships and marketing, summed it up: "It's really a question on return on investment. Can you invest in retention in order to keep them? Can you invest in a real efficient and effective recruitment process that is tied into onboarding, mentoring, keeping the physician engaged after the hire so that you really can measure a return on investment?" she said. "But you really have to start [with] 'do you know how much turnover is costing you?'"

Good luck with calculating the math and implementing your retention strategy. I'd love to hear how it's going. - Karen