Poor economy makes physicians less inclined to leave a practice

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.