Small medical practices struggling with physician turnover

Large hospitals and health systems are luring doctors with flexible work schedules.

By — Posted May 2, 2011

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Demographic and economic trends may be creating challenges for small medical practices to keep physicians on the job.

Physician turnover increased slightly in 2010, and groups with fewer doctors had higher rates, said the 2010 Physician Retention Survey published April 16 by Cejka Search and the American Medical Group Assn.

The survey of 62 AMGA member groups found that the physician turnover rate inched up to 6.1% in 2010 from 5.9% in 2009 as the recession loosened its hold. The rate was 6.1% in 2008 and 6.7% in 2006.

Groups of three to 50 physicians had a turnover rate of 12.6%, and groups with more than 500 experienced turnover of 5.5%.

"Small practices have got to find ways to make themselves competitive," said Lori Schutte, the president of Cejka, a health care executive and physician search firm in St. Louis. "The economy has improved a little. People may feel that they are in a better position to move."

Several factors are probably at play, particularly at small practices.

Because some younger female physicians and older male doctors want more schedule flexibility, and large hospitals and health systems can offer such flexibility, small practices may struggle to attract and retain physicians, experts said. Female doctors of childbearing age comprise a growing proportion of the physician work force and have higher rates of turnover than male physicians.

The turnover rate for women at practices with three to 50 physicians was 28.0%, but just 5.3% for male physicians. The rate for female physicians at groups of more than 500 was 5.8% and 5.3% for male physicians.

Female doctors were more likely to work part time, especially at an age when family issues are important when deciding a work schedule. About four in 10 female doctors ages 35 to 44 worked part time in 2010, but only 18% of male physicians in this age bracket did.

"The percentage of female physicians is changing practices, and if a practice is not going to allow a physician to go to three days a week, they are going to find a practice or hospital that will," said Steve Marsh, a managing partner with the Medicus Firm in Dallas. "But this is not just a female physician phenomenon."

A generational change

The percentage of male physicians of any age working part time grew faster than for female physicians. Researchers suspect this is the influence of senior male physicians who delayed retirement during the recession but cut back on their hours.

"There are some practices that don't want to encourage part-time work because they don't want to open Pandora's box," Schutte said. "But we're having a lot of professionals ask for it upfront."

Twenty-nine percent of female doctors worked part time in 2005. The figure grew to 36% in 2010. Only 7% of male physicians worked part time in 2005, but the figure climbed to 13% in 2010. Male doctors were more likely to work part time at the end of their careers. About 31% of male physicians ages 55 to 64 worked part time compared with 15% of their female colleagues in this age group. One in five male physicians older than 65 worked part time, but only 2% of female physicians in this age bracket did.

"We're really looking at a generational change," said Ken Mack, a consultant and executive coach in Cleveland who works on physician-hospital relations. "A lot of younger physicians are putting lifestyle first. And a lot of established physicians are saying, 'I'm just tired of private practice. I'm just tired of the issues. I want a job. Maybe these younger people are not so crazy.' "

Another factor at work: Hospitals and large health systems are doing more hiring. And large groups tend to have the ability to be more flexible about part-time work.

Among hospitals and health systems surveyed, 74% plan to hire more primary care physicians, and an additional 9% plan to hire "significantly more." Seventy-two percent intend to hire more specialists, and 7% intend to hire "significantly more."

"More and more physicians are coming to them who want to be hired," said Thomas Dolan, PhD, president and CEO of the American College of Healthcare Executives.

Small practices can be made more attractive by taking steps such as shortening the partnership track.

"Small practices don't have access to the same resources, and our tendency is to make things about the money," Cejka's Schutte said. "People are also looking for job satisfaction. They want to be part of a bigger vision."

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Turnover trends

Factors contributing to physician turnover include more doctors working part time and hiring trends by hospitals and health care systems, a survey of medical groups shows.

Doctors leaving by group sizeMaleFemaleTotal
All groups5.8%6.5%6.1%
3-50 physicians5.3%28.0%12.6%
51-150 physicians5.9%6.6%6.1%
151-500 physicians6.1%7.5%6.6%
More than 5005.3%5.8%5.5%
Doctors working part timeAllMaleFemale
65 or older10%9%1%
Younger than 3512%4%8%
Plans for staffing changesPrimary care physiciansSpecialists
Maintain current levels17%21%
Hire more74%72%
Hire significantly more9%7%

Source: 2010 Physician Retention Survey, Cejka Search and the American Medical Group Assn., April 16

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