Five Questions Every Hospital Leader Should be Asking About Provider Retention

By Caleb Sutton

Small, rural, and critical access hospitals all face similar challenges when it comes to attracting and retaining excellent physicians and advanced practice practitioners (to whom I will collectively refer as “providers” throughout this article), and we are all aware of the cost involved in provider turnover, as well as how challenging it is to recruit to our communities. The recruitment timelines are long, the cost of personnel hours, agency fees, and licensing significant. By investing just a small amount of time and resources into retaining our great providers, we can create an environment where the whole team benefits.

Since Integritas is so focused on attracting and retaining providers, we have learned over the years what it is that great providers are looking for in a work environment and an employer and have distilled this knowledge into five questions hospital leaders should ask themselves to help improve provider retention. I encourage you to ask yourself these questions and take a hard look at how you relate to your provider team members. Hopefully with a little more attention and curiosity up front, you can avoid unhealthy turnover on your provider team.

1. Do We Understand Why Medical Staff Really Leave?

We make many assumptions when it comes to why providers leave. The truth is that a dissatisfaction begins to set in long before a provider decides to leave, long before they receive that “offer they can’t refuse”.

There are a lot of reasons why providers leave an employer. Here are a few of them:

• Pay. Competitive pay signals respect and acknowledges the unique pressures of this vocation.

• Respect. Providers endure significant stress and bear a huge amount of responsibility that non-clinicians will rarely feel. Given their years of study and ongoing professional development and experience, providers crave and deserve respect.

• Culture & Environment. Providers are not immune to the stresses that come from a poor work environment. Gossip, poor behavior, and outright hostility will lead to turnover.

• Support. Providers need encouragement, coaching, and help, just like any of our team members. They need to feel seen and known when at work, and they need access to the training and tools that will help them be successful.

Acknowledging that there are many ways to help physicians feel respected, appreciated, and supported can go so far in helping them be successful long term. Ask good questions and provide the environment and support that providers will never want to leave.

2. Are We Paying Attention to Early Signs of Burnout?

Regarding provider retention, few topics have received as much attention in recent years as burnout has. As healthcare leaders, we need to become experts at understanding the symptoms and signs of burnout, and this is going to require really getting to know the providers on our team so that we can notice when things aren’t going well.

Ensuring providers have time off from work, equipping them with on-site resources for rest and recreation (such as an exercise space or access to healthy food), and making mental health resources easily available all play an important role in preventing burnout and contributing to long-term success for our physicians. Are we really supporting our providers in their unique vocations and the unique demands of their jobs? Are we encouraging and allowing for healthy balance between work and family/personal time?

3. Is Our Schedule Sustainable?

Because of the high stress and long hours medical providers typically work, we need to pay close attention to how we schedule our medical providers and how we involve them in that process. Understanding each individual provider’s desires and expectations, setting clear and fair expectations up front, and remaining committed to those expectations is vital. Are schedules published far enough ahead of time? Are each provider’s unique needs and requests being considered? Are nights, weekends, and holidays being spread out among the team in a fair and equitable fashion? How often is the schedule changed and how are those changes communicated with the providers? Do the providers have an opportunity to provide input into that process?

4. How Strong Is Our Physician Leadership?

People don’t leave organizations; they leave leaders. Providers have a unique vocation and they need leaders who share that vocation. Your providers need physician leaders who are more than leaders by title only. They need to be involved leaders who develop relationships with their team members, know them personally, and are invested in their success and wellbeing not only as members of the team but as human beings. Only providers can fully understand what other providers face, and having an invested, involved, and caring physician leader will go perhaps further than anything else in ensuring long-term sustainability.

5. When Was the Last Time We Had a Meaningful Conversation With Every Provider?

We often go by the maxims “if it ain’t broke, don’t fix it” or “the squeaky wheel gets the grease”. Don’t let this be true of your relationships with your providers. Make opportunities to have meaningful conversations with them, at least once a year but hopefully more than that. Don’t wait until there are problems. Just be a friend and show that you care. How are they doing? How are they feeling about their job, their team, the organization? How is their family doing? How can you help them? Just knowing that you know them and care about them will go so far to helping them be successful in the long term. They need to know that you know they are human, that they are in need of support from time to time, and that you have their back.

Retention Is Ultimately About People

If you focus on your people before and above all else (metrics, financial goals, community perception, etc.) you will find that provider retention and satisfaction will improve, that healthy turnover is the only turnover you will experience, and the rest of these important priorities will fall into place as well.