A large portion of physicians say they are toying with plans to leave their current position in the near future—a tough issue for healthcare organizations keenly aware of a practitioner shortage projected to worsen in the coming years.
Specifically, about 35% of doctors said they are likely to walk out the door within the next five years, with roughly 60% saying they’re likely to leave clinical practice wholesale, according to McKinsey’s most recent survey of 631 physicians fielded last summer.
Fifty-eight percent said their desire to find a new job grew within the past year—up 15% from the prior year’s survey—and 72% said they’re approached about alternative job offers at least once a month.
The survey showed that doctors also have a long list of grievances and demands weighing on their minds, McKinsey partners and consultants wrote.
Healthcare organizations that address these concerns—which broadly fall under the camps of compensation and incentive structures, lifestyle needs and well-being, involvement in decision-making, and staffing and support systems—"could start to boost physician attraction and retention and address their workforce supply-and-demand mismatch,” they wrote in an accompanying post.
Redesign compensation and incentive structures
Interest in a higher paid position was a top factor for leaving a role, having been cited by 69% of the polled physicians. But, as government physician reimbursement continues to decline, across-the-board physician salary raises may not be on the table for many organizations.
Rather, McKinsey suggested performance incentives that align with organizational strategy, such as productivity bonuses under fee-for-service or cost-of-care measures within a value-based system.
At the same time, McKinsey noted that many physicians “don’t fully understand the complexities of their compensation and incentive structure.” The management consulting firm’s survey found that less than a quarter of the physician respondents reporting having a “very good understanding” of what they need to do to meet contract goals, outlining a need for healthcare organizations to “invest in making expectations and targets clear to physicians."
Truly tackle physician lifestyle and well-being
Physicians listed their family needs and other competing life demands right alongside compensation considerations when telling McKinsey why they may choose to leave a role. Nearly at the same level were related lifestyle and well-being considerations such as the workload intensity (66%), emotional toll (65%) and the physical toll (61%) of their jobs.
McKinsey noted that 51% of respondents pointed to schedule flexibility as also playing a role in retention, yet more than 40% said their workplace wasn’t pursuing any efforts to implement flexible scheduling. The responses suggest programs that help physicians coordinate shift arrangements, investments in preference-based scheduling platforms, telehealth or leaving behind payment models tied to total hours worked could each support these physicians.
Additionally, the firm found that 40% of the responding physicians said they were experiencing at least one symptom of burnout. That portion grew to 52% among those who worked 60 or more hours a week and to 66% among those who said they were dissatisfied with their schedule.
While scheduling and workload balancing initiatives would help address these, McKinsey stressed the need to broadly address burnout by creating an internal culture “that fosters appreciation and a sense of belonging among staff.”
Enable physician decision-making
Most physicians told McKinsey they expect to be involved in major organizational decisions surrounding areas like patient care quality, culture, resource allocation and strategic priorities. At the same time, about three-fifths said that not feeling listened to or supported, as well as too much uncertainty and lack of control, influences their decision to leave an organization.
As such, McKinsey advised healthcare organizations to set up channels for feedback and physician input—and then to actually follow what they hear.
“While these channels exist at most organizations, they are not always optimally and consistently used as vehicles to obtain physician feedback that might inform planned organizational decisions or to communicate the rationale and benefits of confirmed decisions,” the firm wrote. “Additionally, using these channels after the fact to share how physician input was incorporated is another critical step to help organizations build trust.”
Physician leadership programs can also help in this area, though McKinsey warned that “physician figureheads”—giving out titles but excluding recipients from weighing in on clinical or workforce decision-making—is a “common failure.” Leadership development programs to build skills among those given leadership can help them “clearly explain the needs of the physician workforce in administrative meetings, while also understanding the challenges that management faces."
Focus on staffing and support systems
Most survey respondents reported that insufficient levels of support staff (57%) and insufficient quality of support staff (56%) influence their decision to leave. Further, about 70% said their organization doesn’t provide administrative support for tasks that do not exclusively require a physician to complete.
The solution, McKinsey wrote, is to ensure that other members of the workforce such as physician assistants and nurse practitioners are completing tasks at the top of their license—i.e., clinical work rather than scribing.
Organizations should work with their clinicians to hammer out clear roles and responsibilities, train appropriately and offer incentives that “motivate physicians to direct a larger share of their responsibilities to others without concern that others receive the credit in productivity-based compensation models,” the firm advised.