Keeping Your Doctors Close – Part II: Retaining Physicians

Part 1 of this series of articles by John Marren (1948-2025) and Thomas Babbo of Hogan Marren Babbo and Rose, Ltd. (“HMBR”) on the critical challenge to health systems in retaining physicians addressed where physicians are going; Part 2 focuses on why they are going. To effectively build a program to retain physicians, it is critical to understand why physicians want to leave and what would make them want to stay. The goal is to create an environment from which they do not want to go.

WHY PHYSICIANS LEAVE

Numerous factors, both personal and systemic, influence physician turnover. Addressing these factors is essential for improving physician retention and ensuring the continuity and quality of patient care.

• Burnout and Stress: Doctors experience elevated levels of stress and burnout due to long hours, high patient loads, and administrative burdens. The COVID-19 pandemic exacerbated these issues, leading to increased rates of burnout.[1]
• Administrative Burdens: Increasing workloads without adequate staff and resource support are often cited as contributing to physician burnout. For each hour with a patient, a physician spends two hours on an EMR.[2]
• Physician Dissatisfaction: Perceptions of quality problems, the current state of EHR technology, loss of control over the pace and content of clinical work, and little interest in the “business side” of medicine contribute to dissatisfaction.[3]
• Financial Burdens: Adjusted for inflation, Medicare physician payment rates plunged 29% between 2001 and 2024. Physicians do not receive an automatic annual inflation-based payment update, unlike other Medicare providers. The AMA’s benchmark survey showed that inadequate payment was the most cited reason for independent physicians selling their practices to health systems.[4]

PHYSICIAN DISSATISFACTION=TURNOVER/EARLY RETIREMENT

• Several factors, including burnout and systemic challenges in the healthcare industry, have influenced early retirement rates among physicians. According to a 2022 MGMA poll, about 40% of medical groups reported that a physician had retired early or left the organization due to burnout.[5] Additionally, a study by the American Medical Association (AMA) found that nearly 30% of physicians retire between the ages of 60 and 65, and 12% retire before 60.[6] Burnout, often described as moral injury, is a significant factor driving these early retirements, leading to a need to replace the retiring physician. Actual replacement costs will vary, but according to the AMA, replacing an existing physician costs between $500,000 and $1 million.[7] Included in those costs are:
• Recruitment
• Physician/Admin time
• Relocation
• Loss of revenue
• Disruption to patients and providers

Eliminating Physician Burnout and Turnover

• In a study conducted by the Medical Group Management Association,[9]several strategies for preventing physician dissatisfaction and burnout that could lead to turnover, including retirement, were identified:
• Support for documentation. Documentation tasks, especially those involving Electronic Health Records (EHRs), are often time-consuming. Many physicians report spending excessive time on documentation, sometimes extending into after-hours, known as “pajama time[10].”
• Recruitment of new physicians: Medical groups must address panel sizes and improve call coverage. This is a challenge as there is a nationwide shortage of physicians, particularly in certain specialties and rural areas. This high demand makes it difficult to find and attract qualified candidates. There is a nationwide shortage of physicians, particularly in certain specialties and rural regions. This high demand makes it difficult to find and attract qualified candidates[11].
• Disruptive or violent patient behavior: Disruptive behavior includes actions that jeopardize the health and safety of others or impede the ability to provide healthcare. This can range from verbal abuse and threats to physical violence, requiring Effective management, including staff training on de-escalation techniques, clear policies on handling disruptive behavior, and ensuring a safe environment. In some cases, involving security or law enforcement may be necessary[12]
• Regular Formal Sabbatical Periods: Effective planning is crucial for a successful sabbatical. This includes setting clear goals, arranging for coverage of clinical duties, and securing funding if necessary[13]
• Work-Life Balance: Improving work-life balance for physicians is crucial for reducing burnout and enhancing job satisfaction. This will create the ability for physicians to delegate administrative tasks and consider outsourcing non-clinical responsibilities. This can free up time for patient care and personal activities[14]
• Flexibility in employment packages: Tailoring employment contracts to meet individual needs, such as specific work hours, location preferences, and responsibilities, can make positions more attractive[15]
• Improvements to EHR workflows to minimize administrative burdens for physicians. Analyzing and redesigning current workflows to eliminate bottlenecks and redundancies can enhance efficiency. Engaging end-users in this process ensures that the changes meet their need[16]

Conclusion

Implementing these improvements can be costly, and independent practices frequently cannot afford them. In the following article in this series, we will address a sure-fire option for health systems to assist physicians and avoid the disruption and costs incurred by physician turnover.

If you would like to discuss this method of aligning health system and physician community goals and to get answers to the questions above, contact:

Thomas J. Babbo, Thomas.Babbo@hmbr.com

[1] Burnout is a health crisis for doctors—and patients, https://www.ama-assn.org/about/leadership/burnout-health-crisis-doctors-and-patiens

[2] Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine, https://pubmed.ncbi.nlm.nih.gov/37278062/

[3] Id, at 6.

[4] Is private practice collapsing? Congress can help stem the tide, https://www.ama-assn.org/practice-management/private-practices/private-practice-collapsing-congress-can-help-stem-tide#:~:text=Payment%20challenges,historically%20minoritized%20and%20marginalized%20patients

[5] Burnout-driven physician resignations and early retirements rising amid staffing challenges, https://www.mgma.com/mgma-stats/burnout-driven-physician-resignations-and-early-retirements-rising-amid-staffing-challenges.

[6]Early retirement? 5 factors physicians should evaluate, https://www.ama-assn.org/practice-management/career-development/early-retirement-5-factors-physicians-should-evaluate

[7] Please don’t go: ways to reduce physician turnover, https://www.mgma.com/mgma-stats/please-don-t-go-ways-to-reduce-physician-turnover

[9]  Burnout-driven physician resignations and early retirements rising amid staffing challenges, https://www.mgma.com/mgma-stats/burnout-driven-physician-resignations-and-early-retirements-rising-amid-staffing-challenges

[10] Study: clinical documentation work leads to physician burnout, https://www.athenahealth.com/knowledge-hub/clinical-trends/medical-documentation-physician-burnout

[11] Overcoming the Top Healthcare Recruitment Challenges, https://skywalkgroup.com/blog/post/healthcare-recruiting-challenges.

[12] Disruptive Patient Behavior: Case Studies and Best Practices, https://riskmanagement.proassurance.com/article-library/disruptive-patient-behavior-case-studies-and-best-practices.

[13] Sabbatical for doctors: the how, what, and why, https://lookforzebras.com/sabbatical-for-doctors/.

[14] 7 Ways To Find More Work-life Balance as a Physician, https://www.physicianonfire.com/find-work-life-balance/.

[15] Ensuring Flexibility in Physician Employment Contracts, https://physiciansthrive.com/wp-content/uploads/2021/05/Ensuring-Flexibility-in-Employment-Contracts-Physicians-Thrive.pdf.

[16] Your Guide to Developing an EHR Optimization Strategy, https://johnlynchandassociates.com/the-perfect-guide-to-developing-an-ehr-optimization-strategy/.