AAPPR 2022 Provider Survey

RPT_CoverPDFIncreased Provider Turnover and Inadequate Retention Programs Spotlight Industry Volatility and Challenges Ahead for Health Care Organizations

Carey Goryl, MSW, CAE, CPRP, Chief Executive Officer, Association for Advancing Physician and Provider Recruiting (AAPPR)
Excerpts reprinted courtesy of AAPPR.

It’s no secret that the market for physician and advanced practice provider (APP) talent is more competitive than ever. Data forecasts show physician shortages in many specialties continuing to climb for the foreseeable future.
Increasing clinician turnover at the nation’s health care organizations — driven by the COVID-19 pandemic, burnout, and other factors — portray a bleak outlook with escalating concerns of how to best retain employed physicians.

The challenge: new physician job opportunities are opening faster than existing positions are filled. And the consequences are profound. Every open provider job has a measurable impact on a health care organization’s ability to fulfill its mission and maintain productivity and profitability, regardless of whether the employer is a practice, a hospital, or a health system.

To illuminate the causes of turnover and explore possible solutions, the Association for Advancing Physician and Provider Recruiting (AAPPR), the nation’s leading professional organization for physician and provider recruiters, recently performed comprehensive qualitative and quantitative
proprietary research. Quantitively, the Association fielded its sixth survey in early 2022 on the reasons providers leave as well as the prevalence and perceived effectiveness of various retention strategies. The survey was compiled, tabulated, and analyzed by Industry Insights Inc., an independent research and consulting firm. For the qualitative initiative, the Association brought together a focus group of seasoned physician recruitment leaders to
comment on changing employment market conditions, the impact on their organizations, and how their organizations are responding. Their comments provided insightful validation and aligned well with the quantitative data.

The group shared both longstanding and emerging physician recruitment and retention challenges that affect virtually every health care organization as the industry collectively grapples with persistent clinician shortages,
turnover, and discontent.

Their observations are also alarming. Together, AAPPR reveals the urgent need for their organizations to address the physician and APP turnover challenge with fresh retention strategies and greater commitment and intention. Failure to act risks not just a tougher recruitment battle, but also productivity, profitability, access to care, and even care quality.

Pressing Issues, Some Unanticipated, Dominate Recruiter Concerns
The recruitment executives who participated in the focus group were a cross section of the profession representing a diverse group who recruit for a wide range of health care settings, including hospitals, ambulatory practice, federally qualified health centers (FQHCs), assisted living, skilled nursing, rehab hospitals, and integrated systems, located in all parts of the country. And their employers vary broadly by size, ranging from single facilities to nationwide networks.

Yet, despite these differences, these industry leaders share remarkably similar observations about physician and APP turnover. Several timely concerns — exacerbated by a lack of retention strategies to address them — dominated their comments, with one dominant concern at the forefront.

Insufficient Clinical Support Staffing
Adequate support staff is paramount to provider productivity and job satisfaction. Support staff keep practice workflows moving, allow providers to delegate routine tasks, and are critical to the patient experience — yet the importance of maintaining sufficient well-trained staff is sometimes overshadowed by other management issues.

Two years (and counting) of the COVID-19 pandemic has intensified the extreme competition for skilled nurses, been well-documented in health care media and even the mainstream press, has strained health care facilities around the country. Now the growing challenge of keeping clinical support staff in place is making physicians’ and APPs’ jobs more difficult and undermining their productivity.

Less well documented, and frequently overlooked, are other clinical and non-clinical support staff that are essential to an organization’s success, a provider’s well-being, and a patient’s satisfaction. Whether in environmental
services or imaging or the front desk, too many unfilled positions in any part
of the workflow can eventually cause more stress for physicians. It only follows that the ongoing struggle to retain qualified support also puts more pressure on recruitment professionals to hire top talent to meet the needs of the patient population.

Labor demand is outpacing supply, causing wage expectations to climb. As salaries in other sectors increase, health systems, hospitals, and practices must try to compete, to avoid losing valuable talent to other industries. Focus group participants also noted that employees at all levels — physicians, APPs, nurses, and even junior staff — are attuned to the competitive market and negotiating more knowledgeably and forcefully.

As a result, compensation budgets are increasingly strained. Other costs of care are climbing, too. Reimbursements, however, are not keeping pace.

At the same time, recruiting new employees— whether support staff, physicians, APPs, or administrators — continue to be costlier than retaining existing ones. This is especially true for the organization’s top performers. It underscores the importance of better retention efforts not just for physicians and APPs, but for the staff who support them. The difficulty of hiring and retaining excellent support staff is amplifying another organizational concern.

The Key to Success:
Formal Retention Programs

One in three physicians (30%) and nearly one in every two APPs (45%) have departed for a new/similar position elsewhere. Despite this, fewer than a quarter of our quantitative survey respondents said their organizations have a formal retention program in place. And though many of our focus group participants hail from large (even nationwide) hospital networks and integrated health systems, most also said their employers do not have a formal retention program in place.

Recruitment leaders noted that this should be an imperative in their organizations. Patient demand and the competition for physician and provider talent are forecasted to continue growing for years to come. For this reason, encouraging clinicians to stay in their jobs is as or more important than attracting new hires.

While some organizations have launched retention efforts, they are more often targeted or grassroots efforts versus top-down or coordinated, cross-departmental programs.

For example, follow-up or mentoring programs may emerge within specialties. While not a replacement for a more comprehensive program, this decentralized approach may have certain advantages since colleagues may understand best how to engage and support each other. One-off events inspired by the need to avoid the larger gatherings that were possible pre-pandemic provided an opportunity to experiment.

PROMISING PRACTICE: One key success factor to minimizing turnover is creating coordinated, organization-wide retention programs with senior level support.

Some organizations are experimenting with other targeted and innovative ways to retain:

  • Expanding and formalizing a physician leadership development program
  • Investing in physician-led EMR usability improvement
  • Enlarging the senior team to include multiple chief medical officers (CMOs)
  •  Creating research and teaching opportunities for physicians in non-academic practice
  • Identifying a mentor for each new physician (within the same specialty)
  • Committing to a policy of physician involvement in all physician-related decisions
  • Roadshows and focus groups featuring senior executives, where physicians can make contacts and give feedback
  • Developing virtual physician roles (e.g., telemedicine, or handling calls or colleagues’ in-boxes)
  • Introducing incentives for physicians to commit to a retirement timeframe enabling more effective backfilling and less team disruption
  • Conducting stay interviews to learn the reasons providers choose to stay and what might cause them to leave

Also of note is the importance of signals from the CEO and senior management to physician retention. Having a senior leader who is a physician (or one who is simply focused on physician engagement) helps
ensure that physician concerns are heard throughout the enterprise.

Key Takeaways
Competition for clinical talent including physicians, APPs, nurses, and clinical support staff continues to dramatically rise. However, added to these market scarce positions are non-clinical support staff from schedulers to environmental engineering to dietary aids. These positions are critical to the success and well-being of providers and their absence can mean reduced productivity and increased stress. Ensuring an organization has the staff it needs plays an even more critical role in recruiting and retaining providers in today’s volatile labor market.

During a time of heightened stress and unpredictability, it is critical for organizational leadership to continue to listen to the needs of providers and to creatively implement necessary changes that will help to minimize fatigue and provider burnout, thereby reducing turnover. While many organizations track and report provider turnover, the most successful organization will act on the data to identify trends and mitigate factors contributing to provider and staff exits.

Finally, developing and implementing organization-wide, robust retention programs are increasingly important for organizations. The revenue lost as a result of provider vacancies can be well into the six figures, not including the costs involved recruiting and onboarding new providers. Less costly are the creation of retention programs from bonuses to mentorship to a policy of physician involvement in all physician-related decisions and evolving roles for providers such as reduced schedules or telemedicine.

Through the collaboration of leadership and recruitment professionals, health care organizations can develop practices and programs that ensure the continued success of provider recruitment. With the goal of retaining top clinical and non-clinical talent, and reducing the turnover, organizations
can create a work environment that demonstrates they are an employer of choice.

To view the full white paper, visit https://aappr.org/aappr-white-papers.