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Managing doctor, nurse practitioner turnover rates key to collaborative care

The projected shortage of primary care physicians in the coming years, along with a relatively high turnover rate among physician assistants and nurse practitioners will challenge medical groups as they look to embark on new collaborative models of healthcare according to a new survey by Cejka Search and the American Group Medical Association (AGMA).

Their 2011 Physician Retention Survey shows that the turnover rate for nurse practitioners and physician assistants is 12.6 percent, more than twice the combined, adjusted physician turnover rate of 6 percent.

As medical groups turn to new, collaborative models of care, such as patient-centered medical homes (PCMH), finding effective means to limit employee turnover and keep care teams intact will take on even greater importance.

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“Recruiting and retaining physicians and advanced practitioners is more critical now than ever,” said Lori Schutte, president, Cejka Search, a physician, allied health and healthcare executive search firm. “In the previous year’s survey, the majority of groups told us that the medical home model will deliver a competitive advantage in recruiting primary care physicians and advanced practitioners. Medical groups need to be prepared to hire the candidates that are the best fit for their organization.”

In order to do that, however, it is important for medical groups to understand how the skill set of doctors and advanced practitioners necessary to operate within the PCMH environment are different than they were just a few years ago.

“Eighty-three percent of respondents report that ‘teamwork qualities in physicians’ are more important now than five years ago. Traditional physician training doesn’t address this quality,” Schutte noted. “So medical groups need to develop methods for accurately assessing and rewarding teamwork qualities in the physicians who join their organizations.”

Medical groups can also be challenged by the higher rates in turnover among doctors in their first five years of employment when turnover rates are much higher. In the first two years, 14 percent of doctors – nearly one-in-seven – will leave the survey reported, and that rate falls only a bit, to 11 percent, for doctors in their second and third years of employment.

Schutte noted that the turnover cost of one physician is between $500,000 to $1 million when the cost of recruitment, practice start up and loss of revenue are taken into account. An effective way to mitigate turnover is ensuring a comprehensive hiring process that elicits each candidate’s work style and motivations.

Recruiters should “use behavioral interviewing techniques that are customized to the qualities that are important to your practice and the expectations you have for the physician,” Schutte said. “It is also important to engage the spouse or partner early in the process. If he or she is not sold on the community, it is not likely that the physician will relocate to take your position.”

With the shortage of primary care physicians not likely to ease any time soon, medical groups also need to be prepared to compete for physicians on more than salary. Lifestyle considerations continue to be a significant recruiting tool and one that can help lure new doctors to a practice.

According to the survey, three-quarters of all groups reported offering a four-day, full-time work week. Other flexible work options offered by medical groups include extended days (offered by 47 percent), weekend hours (43 percent), floating schedule (34 percent) and job sharing (30 percent).

In addition, as the gender gap between the number of male physicians and female physicians continues to narrow, medical groups may also need to develop policies that accommodate more part-time doctors. While the proportion of both male and female doctors working part-time schedules have increased significantly since 2005, women doctors work part-time at double the rate of their male counterparts (44 percent to 22 percent).

All in all, it makes for a very challenging environment in which to create the new models of care that focus on cost and quality through an integrated team approach.

“As organizations seek to meet these staffing demands, it is important to recognize that the qualities once sought in a physician or advanced practitioner five years ago have changed along with the healthcare environment,” said Donald W. Fisher, PhD, president and CEO of AMGA. “Collaboration and teamwork are significantly more important to medical groups and health systems because care models and performance measures require it. The ability to work effectively as a member of an accountable care team becomes a valued skill for physicians and advanced practitioners who increasingly will partner with colleagues in primary care, hospital medicine, a wide range of specialties and subspecialties and allied health.”