The healthcare industry has been trying to cope with high turnover along with simultaneous shortages among physicians, nurses and home health aides. This has driven labor costs—already providers' biggest financial burden—even higher. Turnover can also stunt productivity, hurt the patient experience and jeopardize outcomes.
Providers are trying to stabilize their workforces through offering student debt repayment, development opportunities supported by tuition cost-sharing, employee stock ownership plans, partnerships with academic institutions to keep the pipeline flowing, employee appreciation programs, flexible schedules and more autonomy.
More health systems are adopting loan reimbursement and tuition-assistance programs, said Christopher Duchesne, group vice president of client services at EdAssist, a Bright Horizons division that helped Memorial Hermann with its retention program.
Loan reimbursement can be a compelling offering for employees who want to grow beyond their role or try a different field, he said.
“The labor shortages and stress in finding folks to do the jobs that are needed in healthcare are more acute than almost any other sector,” Duchesne said. “More than in any other industry, healthcare is adopting things like loan repayment programs in greater volume and speed.”
Almost every system out there is facing a huge retention problem, said Alan Rolnick, CEO of Employee Engagement and Retention Advisors.
It's not just the cost of a replacement but the loss of institutional knowledge, he said. Most healthcare employees are micromanaged, and they typically have no idea of the strategic direction of the organization or what their role is, Rolnick said.
This dynamic could discourage millennials and Gen Xers who make up a large portion of today's workforce and who place premiums on being fulfilled by their job and taking pride in their companies' missions.
“Employees are not empowered,” Rolnick said. “They go do the work and there is no effort to get to know them or reinforce good work. Employee alienation is higher than ever before; it's a mess.”
There is a shortage of about 14,000 primary-care physicians that is acutely felt in rural areas, according to HHS' Health Resources and Services Administration. Many aspiring doctors choose higher-paying specialties to pay off their debt quicker. If they do choose primary care, they often don't want to live in rural areas.
The physician data company SK&A estimates that the annual physician relocation rate is 12%. About half of the 17,000 physicians surveyed in a 2016 Merritt Hawkins report said that morale is negative, primarily due to regulatory and paperwork burdens and loss of clinical autonomy. More physicians are in many cases joining health systems in part because of the former, despite less of the latter.
“That day when their autonomy is questioned, and the insurance company says, 'You can't do this for the patient,' that's when doctors say it's time for something else,” said Kurt Mosley, vice president of strategic alliances for Merritt Hawkins and Staff Care, companies owned by the staffing agency AMN Healthcare.
Financial bonuses may also be misplaced. Some hospitals reward high citizenship scores related to community involvement, which can be oddly measured by attending hospital-coordinated meetings on the topic, Mosley said. Providers also reward high patient-satisfaction scores, although patients who are happy aren't necessarily healthier, he said.
It hurts when doctors leave. According to Merritt Hawkins' 2016 physician retention report, each physician generates an average of $1.56 million in revenue every year for his or her affiliated hospital related to patient care, goods and services purchased and supporting jobs. Gastroenterologists, for instance, generate an average of $1.42 million in net annual revenue for their hospitals. One month without that specialist translates to a $118,556 loss, but it's more than just a financial loss.
“Turnover really affects quality,” Mosely said. “The cost, quality and effectiveness of care are in a doctor's hands and it's important to keep them happy because this new movement toward value is highly doctor-dependent.”
Bringing in scribes to navigate EHRs or an insurance specialist to grapple with payers can free up doctors to allow them to spend more with patients. It makes a major difference, Mosley said. Some systems have liaisons that strictly deal with physician burnout, he said.