Why Doctors Quit

One of the great challenges of ED management is retaining top talent. Here’s how to keep your docs from seeking greener pastures.

Dear Director: I’m the director of a 10 doc ED group. Over the last two years, we’ve had five doctors leave. I’m not sure what’s going on but that turnover rate seems pretty high. What do you think could be going on and how do I prevent further departures?

Turnover in the emergency medicine world is not uncommon, so in a typical 10 doc group, you could anticipate one person leaving a year. In a bad year, maybe two, but five in two years seems very high.

Conventional wisdom says that people join great companies but leave bad bosses. This was confirmed by a Gallup Poll of one million employed US workers (not exclusively in healthcare), which showed that a bad boss or supervisor was the number one reason people left their job. This was often due to the environment their boss created and how employees felt they were treated. Of course, the word “boss” can be applied at many levels.  Typically, we think of the medical director or department chair. This means that when we have high turnover, we, the chairmen, need to look in the mirror. But it could also mean the president of your group or someone in hospital administration. While I’m a chairman in a private group, I have at least five bosses spread out between my own group and service line reporting within the hospital structure.

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Greener Pastures
Year’s back, I worked for a great boss.  We went years without any employee turnover, mostly because of this chairman.  One of the reasons I left, however, was when the COO, who was responsible for the ED, decided to stop funding our provider-in-triage program.  This occurred at the same time that the hospital was planning a new multi-million dollar patient tower rather than invest in an ED that was bursting at the seams. I didn’t leave because of my boss; I left for the hope of more ED support.

As emergency physicians, we’re in high demand and have great flexibility in where and in what environment we work.  Hardly a day goes by that an EM doc doesn’t get an email, a phone call, or a card in snail mail trying to recruit them to another site. Not having to lay down roots in a hospital like a specialist is in part what drove many to emergency medicine. Yet the reality is that most people aren’t looking to job hop.  There is stress and time involved in the job search and there is stress and time involved in becoming part of a new ED team.  Therefore, most EM docs have a driving force behind their decision.  As I talked to a friend who runs a large emergency medicine group, he says it almost exclusively comes down to people leaving for the promise of greener pastures.

Emergency physicians usually leave their current position for one of three reasons: the ED environment, money, or work/life balance.  The ED environment includes everything from ED operations and flow, having enough staff (nursing to care for patients and docs so you don’t feel like you’re always working), and feeling appreciated (by the boss, the group, and the hospital). The chairman is responsible for producing a good work environment, the culture of the group, and how major decisions are made—dictatorship or by consensus.  Sometimes there is also a job mismatch between the expectations laid out during the recruiting process (or not laid out at all) and what the candidate expected. There could also be a cultural mismatch between what the group and/or hospital prioritizes. While all hospitals focus on patent satisfaction, length of stay or patient throughput, each doc brings his or her own priorities and, in the best fits, the group, the hospital, and the physician’s priorities align.  The effective director needs emotional intelligence to solicit input, communicate a strategic vision, fix problems, coach, mentor, and provide feedback, and value and recognize employees

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Rarely do I come across docs who are leaving jobs just for more money. Let’s be honest – most ED docs make pretty comfortable salaries and even a 10% raise may not be worth the growing pains of transitioning to a new environment. However, sometimes a great signing bonus is just what a doc needs to pay back a loan or put down a home deposit. Years back I had a doc who left my group because of a mismatch between the group’s expectations in performance and his perceived abilities. Although I reassured him that he had the skill set to hit our performance expectations, a six figure signing bonus from a new group allowed him to get out of his condo and buy a bigger house for his expanding family.

My friend Barb left a job she loved in Baltimore to move to Boulder, Colorado.  She and her husband, another doc, prioritized their hobbies and home environment more than jobs. They both ended up with great jobs, but they also tell me that they take advantage of their surroundings with hiking, mountain biking, or skiing just about every weekend. I’m honestly a little jealous of people that go to these lengths to achieve work/life balance.  More commonly, I see people change cities to be closer to family.  Sometimes it’s to care for elderly parents, others to raise their own kids closer to family. And sometimes they move to follow their spouse to a job. Either way, it’s a very personal decision that is unique to the provider.

The Solutions
Recruitment and retention is a critical component of the chairman’s job.  If your group is having retention issues, you need to take a long, hard look in the mirror assessing each aspect of your operation.  Depending on the size and nature of your group, exit interviews done by someone in HR can be useful and if you have access to these results, you should review them and craft solutions based on the feedback.

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Improving Employee Engagement
Once you have stabilized operations, created a fair schedule, and have everyone on board with your vision, you need to focus on individual employee engagement. John Baldoni defined employee engagement in the Harvard Business Review as “people want to come to work, understand their jobs, and know how their work contributes to the organization.” Improving employee engagement results in less absenteeism and turnover, improved profits, and fewer patient safety.

Directors need to make sure they’re talking to their docs for reasons other than to get clarification on a complaint or a patient issue.  The docs need to feel connected to their boss and know that their directors appreciate their work.  This may be as simple as tracking someone down to say thanks for staying late to see extra patients during a busy shift or may involve creating a more formal recognition system.  Providing mentorship, as well as regularly meeting with employees to focus on goals and projects, can also improve employee engagement.  Since our biggest time and dollar investments are in our newest hires, additional time spent with new physicians is a must.  I strive to meet for a casual lunch outside of the hospital every 6 months for the first 12-18 months along with additional informal meetings in my office to review progress.  Social functions, ranging from happy hours to intramural kickball leagues can be a great way to have employees interact away from the patient arena. Since engagement increases as people understand their contribution better, getting docs involved in committee work throughout the hospital can help them understand how the ED fits into the bigger picture.

Conclusion
The ED chairman is responsible for recruitment and retention. While people leave a job for a variety of reasons, our job is to make sure the issues that we can control are in control.  We need to connect to our staff and they need to know that we appreciate their work.  Getting a high level of professional engagement can be achieved while also recognizing that there are differences in what individuals value in the workplace.