Poor economy makes physicians less inclined to leave a practice

An AMGA survey finds turnover has declined, and retirement is being delayed. But work-life balance remains a big issue.

By Victoria Stagg Elliott — Posted May 25, 2009

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The nation's economic situation means physicians are staying at their current jobs and retirement is moving further into the future. But the need to juggle the demands of family life with a job remains a significant determinant as to whether a doctor stays with a practice, according to a report recently released by Cejka Search, a St. Louis-based medical recruitment company, and the American Medical Group Assn.

"The stock market has really reduced physicians' ability to retire," said Brian McCartie, Cejka's regional vice president. "And there's difficulty in moving, because they don't want to turn around and take a $200,000 loss on their house."

Last year, researchers e-mailed surveys to 342 AMGA member medical groups. Fifty across the country from urban, suburban and rural areas responded. The practices represented a total of 9,985 physicians.

In 2008, 6.1% of physicians left a practice, a decrease from 6.7% in 2006. Most, 73%, separated voluntarily. Another 14% were terminated, 11% retired and 2% died.

Of those who left of their own volition, 50% said the practice was a poor cultural fit, and 32% moved to be closer to their families. Approximately 22% sought communities that better suited them, and 18% left because their spouse's job moved. In addition, 8% exited because of incompatible work schedules, and 6% left because of excessive call requirements.

The survey found that factors related to work-life balance may be playing a significant role in making women younger than 39 and working part time, significantly more likely to leave a practice than their male counterparts.

The strategies used to recruit and retain physicians, however, do not yet address work-life balance issues.

In hopes of keeping physicians on staff and attracting new ones, 96% of practices offered relocation assistance and 94% guaranteed income. In addition, 71% provided signing bonuses, and 68% offered liability insurance tail coverage. Around 26% provided education loan forgiveness. But none mentioned anything related to assisting with work-life balance.

"Practices have to figure it out, because half of your work force is female," McCartie said.

Retirement still means that men older than 55 were also some of the most likely to separate from a practice, although this is becoming more difficult because of economic conditions. Practices also are offering incentives for older physicians to stay. Of survey respondents, 62% believed that physicians were delaying retirement because of the economy, but 73% of practices allowed pre-retirement physicians to reduce hours. In addition, 56% allowed for these doctors not to be on-call, and 20% allowed for specialization to select patient groups. Other options included extending vacations up to several months and modifying job descriptions.

Keeping competent older physicians in practice has been mentioned as one possible solution to health care work-force shortages. The American Medical Association's Senior Physicians Group, the Advisory Committee on Group Practice Physicians and the Organized Medical Staff Section will host an education program, "Keeping Senior Physicians in Practice: Issues of Competency, Recertification and the Value of Experience," June 13 in conjunction with the AMA's Annual Meeting in Chicago.

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Why do physicians leave?

Turnover of doctors working in group practices has declined from 6.7% in 2006 to 6.1% in 2008, but the reasons for leaving have consistently focused on cultural fit and family issues. A survey of members of the American Medical Group Assn. revealed that, of those who quit in 2008:

50% did so because the practice was a poor cultural fit.32% wanted to be closer to their families.26% sought more money.26% had some other reason.22% were looking for a community that suited them better.18% left because their spouse's job relocated.8% said the work schedule was not compatible with their lives.6% felt call requirements were excessive.

Source: 2008 Physician Retention Survey, AMGA and Cejka Search

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Better communication

Turnover has declined, but physicians are still in short supply. Medical practices are taking advantage of an array of incentives to lure new ones and hold onto those they have. Practices responding to a survey of American Medical Group Assn. members said that in 2008:96% offered relocation assistance.94% guaranteed income.89% gave bonuses or other productivity incentives.71% handed out signing bonuses.68% supplied liability insurance tail coverage.38% awarded advances of base salaries.26% forgave educational loans.19% provided a stipend while physicians completed their training.12% conferred retention bonuses.

Source: 2008 Physician Retention Survey, AMGA and Cejka Search

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External links

"Keeping Senior Physicians in Practice: Issues of Competency, Recertification and the Value of Experience," educational program organized by the American Medical Association's Senior Physicians Group, the Advisory Committee on Group Practice Physicians and the Organized Medical Staff Section (link)

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