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Academy News: January 2006Establishing a physician retention program In my last column I focused on recruitment of a new physician associate in a group practice. It is almost equally important to establish an organized retention program once the recruitment process concludes, to ensure that the new associate stays in the practice. I have seen too many circumstances where lack of consideration in making sure that a new associate fits in, ultimately leads to problems down the line and a rapid breaking of those professional relationships. These splits are costly, both financially and emotionally, and might be avoided if a retention program had been established as part of the formal recruitment process. I will try to review areas to consider in setting up such a program. I must again thank Brian A. Smart, MD, FAAAAI, who put together an outstanding program on physician recruitment and retention in the AAAAI Practice Management Workshops, for providing me with assistance on these suggestions and ideas. Unfortunately, few groups approach physician retention with the same intensity that they put into recruiting. The reason most physicians leave a practice is because they feel they cannot fit into its culture or the local community. A physician may leave a practice for unavoidable reasons, such as changes in the needs of the physician or a family member, retirement, disability or death. Avoidable losses are those that could have been corrected or prevented in the first place through more careful recruiting and consideration. Avoidable issues include:
Setting up a plan that addresses each of these issues can easily be done, and can eliminate problems before they fester. A good retention plan starts with a thorough orientation program before patient hours are fully implemented, to allow the new associate to get settled into the practice. There should also be a marketing plan established to help the new associate become better known in the community. A reasonable time commitment should be made to introduce the new physician to the practice staff and referring medical community. This helps the physician become acclimated to the new environment. Establishing a mentoring relationship with a senior physician is a very useful option in allowing for smooth adjustment and creates the type of bonds that will make a new associate feel a sense of partnership. The mentor will be useful not only as a confidant and advisor, but will provide performance feedback on practice issues like appointment access, workflow efficiency, staff and physician satisfaction, patient satisfaction, and documentation compliance. Feedback can be given in a less threatening way, when coming from the “mentor” and also allows the new associate to provide feedback about the staff that can be filtered back through the mentor. The meetings between the mentor and new physician should initially be formally scheduled, but as time goes by, the meetings will become less frequent. However, once such a relationship is established, the new physician will generally feel more comfortable in seeking feedback on his/her own. Because we know the importance of spouse involvement in the ultimate decision of retention, if possible, establishing a mentor/buddy system for the physician’s spouse can also pay dividends as well. It is also important to consider the non-clinical leadership roles a new associate will take in helping run the medical practice. Ensuring that the associate has some structured, assigned input in practice management decisions is important. He/she should be encouraged to take on roles in the management of the practice, which will help create a sense of responsibility and create a bond with the organization. Financial considerations are very important. Although we addressed issues of initial salary in the last column, I feel that it is essential that open and honest discussions be initiated early on in a relationship regarding partnership options and potential buy-in costs. This issue is a major cause of anxiety and conflict, and a clear understanding of the theory and practice of how and when partnership is offered needs to be understood well before any such offer is made. It is understandable that any physician in an established practice deserves to be reimbursed for the value of the hard assets that have already been purchased by the practice, prior to the taking on of a new partner. These figures can easily be agreed upon following any reasonable appraisal of real property and assets. It is certainly more difficult to agree upon soft assets or “good-will” value of an established practice. How much is an established physician reputation worth to a new associate in terms of guaranteeing a steady revenue stream? Certainly the value of an already established practice that is being sold to a physician, is worth more than a practice opportunity to join an established individual who will continue to practice medicine and ultimately still be around to funnel patients away from the purchasing physician. Keith Borglum, a consultant and medical practice appraiser who has been an outstanding resource to us at the AAAAI Practice Management Workshops, presented a formula for calculating a value of a practice, based on how much the practice profits are in excess of an average allergy practice profit. For example, a practice that can provide a profit of $400,000 per year is worth investing in, if an average allergy private practice provides a $250,000 annual profit. I appreciate such a formula, because it allows all parties to understand what is being “bought.” I have seen and heard of other formulas that seem to work as well, based on percentage of aspects of revenue stream, and feel that any can work if linked to something that can be concretely measured. When parties are at an impasse, hiring a consultant can be helpful in resolving these issues and letting the discussion move on. Ultimately, the value of any practice is established once a willing buyer “pays” a seller. It is essential for all parties to understand that it is in their mutual interests to come to an agreement that both can live with. I hope this outline will prove helpful to anyone in the process of finding a new associate or searching for a position. Again, I feel the success of the recruitment and retention process requires forethought and commitment, and I encourage all entering this process to plan ahead. I look forward to hearing your feedback. Please e-mail me at grodoc@aol.com. |
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