I once was dealing with the purchase of equipment from an ultrasound vendor. We had worked with our current vendor for over a decade and had purchased over $2 million worth of equipment. Their machines were tremendous and provided excellent images for our patients in our maternal-fetal medicine practice. However, for a fair number of devices, their salespeople offered us no significant pricing breaks. We had little communication on our imaging experience, sonographer education, and lack of shared goals. We felt our practice was not being valued.
We opened the bidding to 2 separate companies. This took precious time to participate in machine demonstrations and learn about this new and different equipment. However, as our practice was large, these 2 companies gave incredibly competitive pricing to open the door to our practice and build a relationship. We purchased equipment from both vendors and ended our long-standing relationship with our first and only ultrasound vendor.
We wanted to be treated like the customer they wanted, not the customer they had.
In many circumstances, this is 1 of the critical issues in losing a provider. We will wine and dine someone to come into our city and let them get to know other providers and staff. However, we will not take the provider and spouse out annually to show them an appreciation for their work, listen to concerns, address issues leading to burnout, and ask them about future goals to hope they stay. Unfortunately, this lack of strategic involvement is unwise. The cost of turnover is staggering, with the average cost ranging from $500,000 to $1 million per physician.
Engagement of the person is the key to retention. Systems hire recruiters, but why not professional staff engagement officers? Smaller practices should have owners take a chief role in engagement. For provider engagement, a plan is needed and should be documented and followed. (See sidebar).
The Coker group has put to gether a list of 12 dimensionsof physician engagement and a tool to measure the engagement, including the following1:
1. physician connectedness,
2. physician loyalty,
3. quality of staff relationships,
5. professional development,
6. operational support,
7. clinical practice,
8. executive engagement,
9. support of external demands,
10. patient care and experience,
12. future outlook.
Coker’s tool for measuring physician engagement is a quantitative measurement of a qualitative experience and hence is limited in its application. Nonetheless, it is easy to garner feedback and upfront responses when administered, especially in an anonymous fashion.
Retention is important but recognizing burnout as a more insidious hazard in the workplace is critical. Professionally, burnout leads to decreased quality of care, increased medical errors, decreased productivity, and provider turnover.
Organizations should promote system-level solutions for retention and well-being. Mayo Clinic has announced9 organizational strategies for physician well-being.2
1. Acknowledge and assess the problem.
Staff appreciate dialogue with their leadership, and it is critical that discussions are candid and heard. After that, routine measurement of physician well-being is essential to assess and act upon deficiencies.
2. Harness the power of leadership.
Behaviors of leaders are critical to the well-being of the positions they lead. Leadership selection is crucial. Leaders must then be developed, prepared, and equipped for their roles. The effective leader recognizes the unique talents of the physician team. Evidence suggests that professionals working at least 20% of their time within their fields of strengths are at much lower risk for burnout.3
3. Develop and implement targeted interventions.
Spreading these concepts out to your entire clinical team is important. Assemble a team for action and invite insight from physicians/providers. Form focus groups and have leaders steer facility change based upon the gathered information.
4. Cultivate community at work.
Peer support has always been critical in assisting physicians in navigating professional challenges. The support can come from various activities such as celebrating achievements or supporting each other through challenging experiences.
5. Use rewards and incentives wisely.
Pay based mainly or solely upon production may be unwisely guided. This eat-what-you-kill practice environment may shorten the time spent with patients, result in ordering more tests or procedures, or promote working longer hours. Instead, rewards such as work flexibility or protected time to pursue meaningful work may allow productive physicians other means to create professional fulfillment.
6. Align values and strength and culture.
An organizational mission and vision must be kept at the forefront of interactions. Acting upon these values is critical to the organization to furnish provider guidance and later provider self-appraisal of living out the organizational values and hopefully
7. Promote flexibility and work/life integration.
Physicians are almost twice as likely to be dissatisfied with work/life integration compared with workers in other fields in the United States. Providing physicians with options to reconstruct their work effort and tailor hours to meet personal and professional obligations may reduce and assist physicians in recovering from burnout.
8. Provide resources to promote resilience and self-care.
Providers should be given tools to encourage self-care, training, and skills that facilitate resilience. Resources should be customized to address personal well-being and work/life integration, financial health, and personal preventive health.
9. Facilitate and fund organizational science.
Larger institutions are responsible for funding research to develop metrics, establish benchmarks, and conduct trials and interventions leading to publications on physician retention and burnout. These efforts are critical to the viability of our nation’s health care system.
Regarding the new ultrasound systems, we ordered from the other 2 vendors. One company did not follow up on its system upgrade promises. The other vendor’s system had image issues resulting in diagnostic errors and our relegating the machine to be the ultrasound of last resort. After our recruitment, they quickly lost trust in communication, lacked accountability, and did not resolve conflicts—they had won our business, but it was clear we were 2 separate teams. Our original vendor came back with an unbelievable deal to upgrade all the equipment at an extensive discount. Everyone ended up losing, at least in some aspect. It would have been easier for all parties with a focused retention strategy.
- Greeter A, Harrison T. Physician engagement: a crucial component of a healthy organization. Coker Group. June 2018. Accessed August 10, 2022.https://cokergroup.com/wp-content/uploads/2019/02/Physician_Engagement_-_A_Crucial_Component_of_a_Healthy_Organization_June_2018.pdf
- Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004
- Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990-995. doi:10.1001/archinternmed.2009.70