Culture Gaps Cost Practices Manpower, Dollars

Ed Rabinowitz

Lack of cultural fit is a key determining factor in a physician's decision to join or leave a medical practice. Dissatisfaction and the resulting turnover can be extremely expensive to a medical practice - as much as $100,000 per month.

It may come as a surprise, but lack of cultural fit is a key determining factor in a physician’s decision to join, or leave, a medical practice. That was made clear by a Physician Wellness Services and Cejka Search survey that found substantial gaps between physicians’ satisfaction and experience with key cultural attributes in their health care organizations.

The survey, which collected responses from more than 2,200 physicians nationwide — including single-specialty, multi-specialty and hospital-employed practitioners — showed a clear disconnect between what physicians look for, and what they actually find, in the health care organizations in which they’re employed.

But perhaps the most important point, according to David Cornett, senior executive vice president of Cejka Search, a physician and healthcare executive search firm, is that physician dissatisfaction and the resulting turnover and prolonged vacancy can be extremely expensive to a medical practice — as much as $100,000 per month.

Bottom-line impact

Cornett says that the $100,000 figure opened a lot of eyes. But, he points out that too often individuals who run health care organizations, large and small, do not put pencil to paper and calculate the actual cost.

“It comes from lost opportunity cost — the loss of patients; potentially the threat of the loss of a whole service in some cases,” Cornett says. “It comes from the direct cost of recruitment, which is expensive. Physicians often move from one location to another, and the cost for an organization to get its message out into the marketplace and attract attention is high.”

But the costs don’t stop there. The cost of interviewing, bringing physicians in for an interview, oftentimes accompanied by their families, is high. Then there’s the cost of all of the people involved in the interview, including medical practice or health care organization leadership, whose time is expensive. Other physicians often have to take time away from clinical work to become involved in a very intensive interview process.

“And then there’s the cost of relocation, and some other soft costs that are not even measured in that $100,000,” Cornett adds. “All of that adds up.”

Analyzing the gap

What was not so surprising, Cornett points out, was how important culture is to physician satisfaction. He says that Cejka, which has been doing health care executive and physician recruitment for the past 30 years, has always observed a gap between what physicians want and need, and what non-physician leadership understands is important to them. However, key factors have made the stress points between those two elements even greater.

“There have been discussions for years about the shift in generation attitudes, including those of physicians toward work and work-life balance,” Cornett says. “And then there’s heavy pressure on health care organizations now to deliver more and more value. Health care organizations are unique because you have physicians with their focus on patient care, and then you have leadership which needs to manage those organizations to keep them financially viable in the face of these competing pressures.”

The highest-ranked cultural attributes for physicians are respectful communication, a team-focused environment, and supportive management regarding errors and mistakes.

Closing the gap

Cornett suggests that medical practice and health care organizations need to go back to the beginning when it comes to closing the culture gap. Start by analyzing how the organization goes about hiring a physician. How do you define the position? How do you decide what kind of attributes a candidate should have, and what are they? Who’s involved in the interview process? How do you present your practice? What might make it more attractive to physicians today?

“The first thing is to begin to interview for fit,” Cornett says. “If you make the right hire, then that’s a significant part of the battle right there. If you make the wrong hire you’re fighting an uphill battle.”

Once the new physician arrives, Cornett says there are many best practices to ensure a successful on-boarding process — short-term, mid-term and long-term.

Short-term, it’s making sure that the practice is ready for them; that their first day in the practice is one that gives them a good, solid orientation. Set appropriate expectations for their initial workload. Set them up with a mentor — someone in the organization who embodies its cultural values.

Mid-term — from three to nine months — there needs to be continued interaction with the mentor, but also with other leaders, depending on the size of the organization. The head of the organization needs to check in periodically with the new physicians.

“Beyond that, give them opportunities, if they want, to participate in the life of the organization,” Cornett says. “The goal should be to maximize the degree to which their physicians are engaged in the organization. Not just coming to work and taking care of patients, but really engaged in all of the things that the organization does.”