The other epidemic: sick care worker churn

The numbers of employed physicians are rising. Fewer graduating residents have interest in independent practice because of student loans, life style choices, fear, risk aversion and unfamiliarlity with the the business of medicine.

However, employed physician turnover is at an all time high. In one analysis, 26% of physicians reported experiencing burnout and 28% reported ITL (intent to leave) within the next 2 years. Two years later, 13% of surveyed physicians had actually left. Those who reported ITL were more than three times as likely to have left.

According to a study by National Healthcare Retention & RN Staffing Report, the average hospital turnover rate in 2017 was 18.2%, which is the highest recorded turnover in the industry for almost a decade. Since 2013, the average hospital turned over 85.2% of its workforce.

Market analysts say that healthcare’s turnover is second worst, only to hospitality. Additionally, AMN healthcare reports that hospital CEOS experience about a turnover rate of about 18%.

 As of 2015 (the most recent healthcare employee turnover data we could find), the turnover rate among primary care and family medicine physicians averaged around 14%, annually.

Physician burnout is expensive to an organization, contributing to direct costs of recruitment and replacement when physicians leave or reduce their clinical work hours. For an organization, the cost of physician burnout can range from $500,000 to more than $1 million per doctor. This estimate includes recruitment, sign-on bonuses, lost billings and onboarding costs for replacement physicians.

A research team studied 630,979 physicians treating Medicare patients and found:

• considerable turnover in the physician workforce treating Medicare patients: 19% of the physicians studied treated their first Medicare patient during the study period, while 12.4% treated their last;
• the median age of entering physicians was 35 years, while the median age of exiting physicians was 65 years – suggesting entering physicians are new to medicine, while exiting physicians are likely retiring;
• in the smallest practices (i.e., 1-2 physicians), only one physician entered for every three who exited;
• in the largest practices (i.e., over 50 physicians), more than 2.5 physicians entered for every one who exited;
• in hospital-owned practices, 2.8 physicians entered for every one who exited;
• the shift toward large, hospital-owned practices was particularly pronounced among physicians specializing in internal medicine, ophthalmology, neurology and dermatology.

All companies are stepping up efforts to retain their talent as a tight labor market increases employees’ job opportunities elsewhere.

Employers have good reason to raise their game. Last summer, more Americans quit their jobs than at any point since the federal government started tracking that metric in December 2000, and employee turnover remains near historic highs. Replacing workers is also getting more expensive. It cost employers $617 billion in 2018, compared with $331 billion in 2010, according to a report by Work Institute, a consulting company. Even if the economy dramatically slows this year, workforce experts say retaining key employees will remain critical to keep a lid on those costs.

Here are 8 signs that someone on your team is ready to quit.

At the beginning of 2020, KLAS began asking clinicians in its Arch Collaborative survey how likely they are to leave their organization in the next two years. More than 59,000 clinicians have responded to date. The data sheds light on which clinicians are likely to leave and what related factors healthcare organizations can influence to improve clinician retention and resolve clinicians’ concerns. This survey included physicians, advanced practice providers (APPs), nurses and allied health professionals. 

According to the survey, the top seven drivers for leaving a health system include:

  • Feeling burned out

  • Chaotic work environments

  • Spending too much time on bureaucratic tasks

  • Frustration with the electronic medical record

  • Lack of effective teamwork 

  • Too heavy of a workload

  • Lack of shared values with organization leadership

Those recruiting, developing and promoting sick care workers will have to depend on three basic strategies:

Competitive pay and benefits, addressing student debt, flexible work schedules, work life balance and salaries

Cultural change that includes inclusion, diversity and equity and fixes the organizational contributors to burn out and work dissatisfaction

Leaders and managers who are proactive in developing and rewarding their employees, including intrapreneurs.

Those responsible for hiring and managing the new sick care workforce should factor these things into the hiring decision:

1. Knowledge technicians will eventually be replaced by AI and other technologies, placing special emphasis on a doctor's comunication and empathy skills

2. There are many reasons why doctors don't play nice with others and they need to be addressed.

3. Only about 1% of doctors have an entrepreneurial mindset

4. You need to give knowledge technicians the knowledge, skills and attitudes necessary to evolve into managers, to leaders, to leaderpreneurs

5. It is almost impossible to pick identify and select people with a real or nascent entrepreneurial mindset. Most hide their innerpreneurial tendencies for fear of being eliminated by the BIG MEDICINE corporate immune system

6. Creating strategic alignment between the patient and profit mission is a full time job

7. Entrepreneurship or intrapreneurship is not about starting companies. It is about creating user defined value through the deployment of innovation.

8. Doctors matter. DISing them won't work

9. Intrapreneurs are employed physicians trying to act like entrepreneurs in their organization. They are fighting a two front war. Don't make it any harder than it already is.

10. You won't find many who fit the bill, so be sure you celebrate the champions and use them as role models for others. Don't make these mistakes when it comes to overlooking internal talent.

11. Renters act differently than owners

12. Quality of care is not improved in employed physician organizations.

Present trends indicate that employed sick care worker churn will increase, the rate of employed physicians will plateau and more workers will pursue non-clinical side gigs and careers and have abbreviated clinical careers compared to other generational groups. FIREd at 30 is not fired at 50.

Prepare now. Washing your hands and wearing surgical masks won't help prevent the spread of this epidemic.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Twitter@SoPEOfficial and Facebook

Updated 4/23/2022