More than half the physicians hired by groups leave in the first 5 years. Here's how to keep that from happening in your practice.

"The practice had recruited a specialist from one of the top programs in the country, but they didn't know when he was showing up and had no 'onboarding' program for him," says Priddy, executive director of Physicians Career Practice, a career management consulting firm in Westminster, Colo. "I suggested that he shadow an established member of the staff, but none of the other doctors slowed down long enough to offer him any guidance. He found another job within a year."

The typical medical practice may not be that cavalier about greeting a new associate, but it's not uncommon for newly hired doctors to stick with the job for only a short time. (See page 90 to find out what such departures cost a practice.) According to a survey conducted by the American Medical Group Association and the physician-recruiting firm Cejka Search, close to 50% of physicians leave a practice within 3 years, and 60% exit by year 5. Reasons include practice issues, compensation, location, and a spouse's dissatisfaction with the new surroundings. While some recruits undoubtedly know coming in that they only intend to stay for a short time, others would stick around longer if they felt valued, fairly paid, and knew the answer to the important question, "How am I doing?"

"Groups must be clear about what they require of new associates, and they should question job candidates to determine what they require of the group. This is an ongoing process that should begin during the initial phone interview, extend through the site visit and follow-up conversations, and proceed to a job-offer letter," says Kenneth T. Hertz, a senior consultant with the Medical Group Management Association Health Care Consulting Group in Alexandria, La.

Hertz says that when one group of orthopedic surgeons was in preemployment discussions with a potential associate, no one talked about expectations. "I don't mean the terms of the contract," he says, "but the unwritten provisos: Will the new doctor be responsible for promoting his practice? What level of control will the doctor have in running his practice? What do the partners expect of him, and he of them? What's expected in terms of covering satellite locations, practice governance, staffing needs?"

Call coverage requirements should be laid out, too. "New physicians don't want to be expected to handle the bulk of this burden," says Judy Capko, a practice management consultant in Thousand Oaks, Calif. "Young doctors value family time and won't tolerate what was once the norm in terms of time dedicated to the practice."

Of course, it's essential to lock in the financial arrangements. Like marriages, many employment relationships founder over financial issues. "The practice employment contract may be vague on how compensation will be handled-particularly bonuses or incentive compensation after the first year," says Hertz. "The compensation deal should be included in the employment contract-along with specifics about benefits, workweek, and educational opportunities-and the details must be transparent for the employed physician. Trust is critical, and lucidity and sticking to a plan will help tremendously."

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