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Retention Recommendations


Retaining good hospitalists is one of the major factors in building a successful hospital medicine group—but it’s also one of the biggest challenges faced in the industry today. Why is hospitalist retention a problem, and what can be done to ensure your hospitalists stay for the long haul?

“As in any profession, there are some [hospitalists] who constantly look for bigger and better opportunities in the employment world,” admits Kenneth G. Simone, DO, founder and president of Hospitalist and Practice Solutions, Veazie, Maine, and a consultant to hospital medicine groups. “Sometimes this involves individuals looking for a better practice fit or for a better financial compensation package. In addition, hospitalist medicine can lead to burnout if the practice is not created or operated in a prudent manner, thus leading to turnover.”

Retention Is Crucial

Why is it so important to retain your hospitalists? For one thing, keeping physicians in your program for the long term can directly decrease costs, time, and effort related to recruitment and training.

More importantly, by decreasing staff turnover, retention can stabilize your hospitalist program. “A stable staff is influential in maintaining the providers’ focus on the practice mission, goals and objectives, and values,” points out Dr. Simone. “It de-emphasizes personal agendas, which may develop if an individual was looking to move on to another practice or up the ladder at the expense of the practice and fellow providers, and allows the practice team to gel over time. This is in some ways similar to a professional sports team, where chemistry and trust in one’s teammates are created over time.”

You can get your own hospitalist team to gel by retaining physicians for years if you initiate a program with that very goal.

How-Tos of Retention Programs

“There are a lot of [hospitalist] programs that haven’t developed retention programs at the outset,” says Dr. Simone. “They may be behind the eight ball, but they can and should create one. Successful programs identify their practice mission, values, and objectives, and clearly and concisely spell them out. This policy can then be utilized with the existing staff to align the team’s values and can also be used in recruiting future candidates.”

Once you have a solid written mission and vision statement, check to see if your hospitalists share the same values. Have your clinical director or an administrator sit down with providers one-on-one and find out their vision, values, and objectives. If what you hear differs from the core values of the practice, then you must develop a plan on which you can all agree.

“You may also have to consider altering some of the program’s vision and objectives, if appropriate,” says Dr. Simone.

Scheduling: A Core Value

Your group’s values can be reflected in the schedule you set for staff. “The practice structure and schedule plays a very important role in provider retention,” says Dr. Simone. “In general, various schedule types work for different individuals, and—in all probability—the provider will seek out the practices that offer a particular schedule to their liking.”

A hospital group that values time over money may offer larger chunks of time off. “We’ve found that our recruitment and retention improved when we went to a schedule of seven days on, seven off,” says Dr. Simone. “A lot of individuals are attracted to this because it gives them a week at a time to spend with their families or to pursue other interests, such as travel or educational pursuits.”

Whatever schedule you choose, there are some basic tenets Dr. Simone recommends, including:

  • Create a schedule that is consistent and stable rather than constantly changing;
  • Make sure the schedule is perceived as fair for all providers;
  • Ensure that all providers get appropriate time off;
  • Give providers enough flexibility to participate in other projects such as teaching, subspecialty clinics, administrative duties, or special projects; and
  • Adhere to a schedule that promotes/accommodates a safe patient to provider ratio.

Salary and Bonuses

Money does matter in retention. As long as the pay you offer is perceived as fair, you have a good start. “In the end, you can only afford what your finances dictate,” says Dr. Simone. “Smaller hospitals may fall short on salary, so it’s important for them to recognize their strengths and sell them in order to compete.”

Your hospitalists may be attracted to participate in an incentive program that rewards them for hard work and productivity. “Incentives help change behavior, and people are stimulated when they have direct control over their own pay,” says Dr. Simone. “There are hospitalist programs with incentive plans, but many programs aren’t sure how to incentivize. You don’t want to reward doctors solely on the amount of work they do.”

For instance, a hospital-based program that rewards hospitalists on the basis of how many patients they admit is basically encouraging them to hospitalize every patient they see.

“I recommend finding a way to reward quality work and dedication, while not neglecting productivity,” says Dr. Simone. “In my opinion, the focus needs to be on increasing the program’s ability to standardize care following evidence-based protocols, encouraging participation in the value-added services that hospitalists are so good at, like participating in a rapid response team or a code blue team, acting as hospital leaders, educating hospital staff and residents, etc.”

Feeling Connected

Unlike many other physicians, hospitalists don’t get many opportunities to connect with patients or a community.

“In my opinion, a hospitalist’s professional job satisfaction and retention is influenced by the perception of feeling connected to the practice and providers, patients, colleagues, and the hospital,” says Dr. Simone. “There are various characteristics of an employment arrangement that may help an individual feel connected. When an employee feels connected, he/she will typically dedicate themselves to the mission of the company and perform at or above expectations.”

Create or revisit your group’s retention program today. By ensuring that the values and objectives of your practice are clearly stated, and catering to those values and objectives in scheduling and other management practices, you can begin to build your retention. TH

Jane Jerrard writes the “Career Development” column every month for The Hospitalist.

Turnover among Doctors Higher than Believed

A physician retention survey conducted by Cejka Search, a national leader in physician and healthcare executive recruitment, and the American Medical Group Association, shows that physician turnover is higher than perceived by medical groups. According to the survey, medical groups commonly believe their turnover rate is around 5%. The survey found, however, that the average rate of turnover was actually 9%.

Hospitalist Pay—What We’re Making

According to SHM’s 2005-2006 Survey of Hospitalist Productivity and Compensation, the median total compensation for hospitalists at the time was $169,000; the median salary was $150,000. Approximately 67% of hospitalist respondents received a bonus. The median bonus was $20,000. Compare salaries and compensation in your hospital medicine group; the complete survey is available on the SHM Web site at under “Resource Center.”

Shortage of Physicians Predicted

Richard Cooper, MD, director of the Medical College of Wisconsin Health Policy Institute (Milwaukee), predicts a shortage of 50,000 physicians by 2010 and 200,000 by 2020.

Kansas Hospitalist Training Program Debuts

Kansas has its first hospitalist training program, thanks to Wesley Medical Center in Wichita. Wesley plans to enroll two physicians a year beginning in August 2006. The hospitalist traineeship will be open to graduates of accredited programs in either family or pediatric medicine.

And the Most-Recruited Specialties Are …

Merritt, Hawkins & Associates surveyed more than 300 hospitals nationwide in 2005 on their physician recruitment. Results showed the most recruited doctors are family practitioners (43%), followed by internists and orthopedic surgeons (40% each). The same specialties showed up on the previous survey three years ago.—JJ

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