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Emergency Medicine News:
doi: 10.1097/01.EEM.0000324845.65663.b9
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Physician Retention: Making It Work Long‐Term

Katz, Barbara

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Ms. Katz is the president of the Katz Company, an emergency medicine consulting firm dedicated to providing expert physician recruitment services and training emergency medicine residents in effective job searching.

Part 6 in a Series

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Many groups have figured out the formula for successfully retaining physicians, and while their stories may sound like self-promotion, they have the numbers to back up the statements.

CEP America in Emeryville, CA, has approximately 900 physicians in 60 contracts around the country. Ninety percent of their physicians earn level 2 partnership after one year and remain with the group for more than 10 years. They even have a handful of doctors who have been with them for more than 30 years. One of those is Ted Kloth, MD, who has been with CEP for 32 years, and is now the vice president of business development while still working clinically. He attributes his longevity to local autonomy and central support. CEP holds partnership meetings annually, where performance awards are presented, and they work with their hospital administrators and nurse managers on best practice models, creating a stimulus for improvement and increasing communication between the hospital and the ED.

Dr. Kloth said CEP's transparency has contributed to physician longevity. “There's nothing hidden, either financial or partnership related,” he said. “It's all out there for any physician to see.”

Dr. Kloth said that he is continually amazed that CEP's physician board of directors “always does the right thing for their physicians. It's never about money.” At a recent meeting, a CEP business consultant commented that it was the first time he had heard doctors talk about their legacy, not just how to get dollars out of the practice. “This demonstrates for me just how smart the partners really are,” Dr. Kloth said.

He added that CEP offers satisfying work opportunities, strong compensation, and an effective in-house billing company. “When a new physician starts, [they soon feel] the collegiality, and that feeling quickly becomes a primary reason for staying,” Dr. Kloth said. “We have stayed true to our core values as a group, and those who come into the group are taught those values and how to live them. We don't just post a mission statement; we live it.”

Drew Mihalik, MD, has remained with CEP for 32 years. Though it took nearly 10 years for him to make partner due to a weekly commitment to a migrant farm workers clinic and rural family practice clinic, CEP supported him and helped him achieve his goals. Job security is also important to him. “I'm still at the same hospital I walked into on Sept. 6, 1976. I'm proud of our department and delight in being part of a dynamic group as we continuously change in response to the mercurial demands of our practice. We are appreciated, valued, and rewarded for our efforts.” He attributes his longevity, however, to his partners. “My coworkers are the best. We have a tradition of compassion and care in our treatment of our patients and each other.”

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TeamHealth

TeamHealth has a physician retention rate of more than 90 percent and a medical director retention rate of more than 95 percent. Their longevity statistics also are impressive, especially considering their size. John Staley, MD, the CEO of the company's Emergency Coverage Corporation, said his division is composed of the “rural gurus.” This division has one of the highest physician and contract retention rates in all of TeamHealth. “Patients expect the same quality of physicians in small towns as they do in big ones, and that is the focus of ECC,” he said. “Our goal is to identify the physicians' professional objectives, comfort zones, and hot buttons that guide the personal lifestyles they seek.”

He said doing so leads to the prioritization and recognition of each physician's personal achievements, and match him with a facility that is a good fit. “We endeavor to create a core group that supports one another, reduces stress, and avoids burnout,” he explained. Monthly site evaluations by ECC senior management address issues common in rural EDs, such as weekend coverage. Chief hospital personnel attend these meetings and are accountable for their part in the process, Dr. Staley said. “This supports the [emergency] physician, makes his job easier, and adds to physician retention,” he said.

James Garrett, MD, is the medical director of the Onslow Memorial Hospital emergency department in Jacksonville, NC, a TeamHealth contract since 1996 which has retained more than 83 percent of its physicians for more than 10 years. Dr. Garrett left a partnership-for-life position for this department, and calls it “the best professional decision” he ever made. He was offered the opportunity to run his own operation, and given a new professional direction at a time when his profession wasn't challenging.

Dr. Garrett initially joined the Onslow staff under EPA, and admits he was apprehensive when TeamHealth took over. But with TeamHealth he said he found “strong personal relationships with the top people in the organization who are genuinely friendly and honest.” Dr. Garrett said his department has remained the same operationally and philosophically. “The TeamHealth dedication to quality medicine and education of physicians is actually growing stronger every year,” he said, adding that high physician retention is due to being allowed to operate autonomously with outstanding support.

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Gunderson Clinic

On the vastly smaller side, the group at Gunderson Clinic in La Crosse, WI, has lost only three physicians in 25 years. Ben Wedro, MD, who has been with the group for 20 years, said they have worked hard at the front end of their doctors' careers to ensure longevity. “Eight-hour shifts, block scheduling in four-week periods, bundling of night shifts together, interspersed with forced time off on nights all help to make shift work palatable,” he noted.

Dr. Wedro said he believes that physicians who take an active role in policy-making are more likely to achieve longevity than those who just do their shifts and little else.

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© 2008 Lippincott Williams & Wilkins, Inc.

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