Study cites effects of insurers' doctor turnover

A recent study showing that health plans have a median physician turnover rate of 7.1% is more evidence that reimbursing physicians fairly and giving them control over treating their patients is good for health plans' own bottom lines and their members' health, the authors said.

The study, published in the August American Journal of Managed Care, noted that annual turnover rates for the 615 health plans that reported to the National Committee for Quality Assurance ranged from 0% to 53.3%. The plans reported their data from 1999 to 2001.

The study also showed that patients were less satisfied with health plans that had high physician turnover, and that patients in plans with high physician turnover were less likely to receive preventive care. For example, a 10% turnover rate was associated with a 0.9% drop in patient satisfaction rated "high," and a 2.7% drop in well-child visits the first 15 months of life.

Mary Plomondon, PhD, who is affiliated with the Care Coordination Research Center at the Eastern Colorado Health Care System, Denver Veterans Affairs Medical Center, and was the lead author for the study, said there may be a certain level of physician turnover that could be characterized as the cost of doing business, "but there's a huge range ... Is the normal cost of business 5%, or is it higher?"

Citing previous studies and surveys, Dr. Plomondon and the other authors said physicians who feel they have authority in caring for patients are less likely to leave a network, and that they prefer to be reimbursed based on their own work rather than a contract negotiated by their group.

The authors looked at physician turnover alone and in combination with turnover of nurse practitioners, physicians' assistants and allied health professionals and in both cases found the same correlation between low turnover and high satisfaction, Dr. Plomondon said.

American Medical Association President-elect Nancy H. Nielsen MD, PhD, an internist from Buffalo, N.Y., said this study "provides yet more evidence indicating that continuity in the patient-physician relationship is key to the provision of high-quality medical care. To enhance quality medical care, the health insurance industry must preserve continuity by making a radical shift in their treatment of physicians."

Turnover hits health plans' bottom lines as well. Estimates of health plan costs associated with physician turnover were between 3.4% and 5.8% of their budgets, according to a study that appeared in the January/February/March 2004 edition of Health Care Management Review.

The lead researcher for that study, J. Deane Waldman, MD, a health care consultant and a pediatric cardiologist at the University of New Mexico Children's Hospital in Albuquerque, said health plans -- just like hospitals and physician groups -- need to look at retention over time rather than annual turnover to better understand the cost of losing their employees. In most cases, nurses and physicians leave an organization because of the way they are treated.

Health plan officials said they recognize how important physician retention is to their plans' success.

Aetna works with physicians to resolve issues that could lead to "network loss," spokeswoman Wendy Morphew said.

"Physician retention is important to Aetna, as we want to offer our members a stable network that avoids disruption of the patient-physician relationship," she said.

"While turnover is inevitable in the normal course of business, we do not resign ourselves to a certain percentage of turnover each year due to physician dissatisfaction," Morphew said.

Tyler Mason, spokesman for UnitedHealthcare, said he wasn't familiar with the study but that the company had been successful in retaining doctors.

"UnitedHealthcare contracts with more than 537,000 physicians across the country, and annually less than 1% of those physicians do not renew their contract with us," he said.