Physician turnover was 6.8% in 2013, the highest since the AMGA began collecting data in 2005. The average turnover rate for physicians in their second to third year of practice is 12.4% and small groups suffer from 20.8% turnover among physicians in those early years. (Source)
Even more surprising, according to the 2014 Medscape Physician Compensation Report, only 51% of physicians would choose to become doctors again. Slightly down from 54% in 2012, and a huge decline from 2011 when 69% said they'd choose medicine again.
Physicians are facing an era of unprecedented change – including what’s expected of them. In addition to being solid clinicians, they are expected to display new levels of leadership, innovation, and collaboration. Unfortunately the way we train, recruit, and develop physicians has not kept up with the pace of change. Physician retention and recruitment is anything but deliberate in ensuring that physicians and hospitals find the right “match”, and physician professional development is haphazard at best. You can see the strain. Hospitals struggle with physician performance and behavioral issues, while physicians struggle to find a situation that will allow them to grow, develop, feel valued, and succeed.
I found it interesting that the most recent volume of the Physician Leadership Journal had articles on topics including: executive coaching, adding structure to the physician interview, why surgeons behave the way they do, and workplace behavior. There is a growing realization that physician performance is tied to variables that go beyond clinical and technical skills, and that being a physician leader is something different today. We’ve been having a discussion about this for some time, but now we are facing a tipping point where the industry will start thinking about a deliberate way to develop a physician “workforce” for the future. The goal is that this is done in a manner that continues to respect the noble nature of practicing medicine, and the need for physicians to find success and satisfaction in their careers.
We are seeing a growing interest in three areas, particularly:
Understanding the role of “operational fit” – Before we get to talk about emotional intelligence, collaboration, professionalism, and other behavioral competencies, we need to understand the operational variables that impact physician success. The most common reason for physician turnover is a mismatch of expectations and organizational culture. It happens all the time. Disagreements over program development, clinical staff support, responsibilities, goals, and expectations – cause strife that damage the relationship and lead to physicians leaving. While we talk about complex “alignment” strategies, we miss the basics. We’ve found that a short operational fit survey can provide an analysis of the degree of alignment of goals, expectations and needs. It also identifies the issues that need to be resolved before signing the employment agreement.
The Physician Interview – Human Resource professionals have known forever that the standard physician interview is essentially useless as a tool to predict behavior. The basics of behavioral interviewing work for professionals at every level, including executives. They provide insight into how the candidate has behaved in the past, and provide insight into how he or she will perform in the future. This can be done for physicians without losing the professional dialogue that usually occurs between physicians. Moreover, letting a candidate know what’s expected of him or her, what the organization values, and discussing how the organization is going to make him or her successful – is a selling point – not a detriment to selling a candidate on your hospital. In fact the Physician Leadership Journal article shows that a structured interview is well-received and can even predict disruptive behavior.
Physician Leadership Development – We are asking physicians to lead but are they prepared to lead in this new environment? Many have useful leadership traits but we do them a disservice if we don’t provide guidance and structure to a developmental plan. No other industry asks so much of what are, essentially, executives, and then leaves them to their own devices to sink or swim. Some health systems have thriving physician leadership development programs. Those who don’t have several options: Executive coaching is becoming more popular and can be effective. Using executive assessment tools to understand individual and group strengths and weakness can form the basis of a developmental plan. For some, the first step is simply defining what it means to be a physician leader in the organization. It’s a bit silly, really to expect “something” different, but not define it. We’ve helped clients recently do this and not only is it critical to evaluating and developing the defined skills, but physicians find it an incredibly useful effort – as they can help to define the vision of a physician leader.
While medicine is a unique and noble profession, the “science” of physician performance has a lot in common with the approach for any important professional or executive: Define the expectations – operational and behavioral, evaluate the individual fit, strengths/weaknesses, and put a plan in place to help them to succeed.
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