Trim the fat from operating expenses all you like, but if you can't seem to stem that elusive leak in your budget you might try focusing on the revolving door to your practice instead. Offices that experience poor staff retention often get stuck spinning their wheels, unable to reconcile higher recruiting costs with lackluster productivity. Indeed, employee turnover is an insidious drain on resources — far more than most managers believe, says Donna Knapp, an independent consultant with Medical Group Management Association Health Care Consulting Group. "You lose a lot of tribal knowledge each time someone leaves," she says. "Even if they train their replacement, there's inevitably something lost in the translation." That might be the relationship they built with a patient, or something more subtle, like how your physicians like things done or the history behind that unresolved invoice. Never mind the toll it takes on morale when your remaining staff is overburdened, or the inevitable mistakes that occur due to inexperience when a new recruit is brought up to speed. "It all impacts consistency of performance," says Knapp.
Managing turnover is all the more critical in the current healthcare environment in which Medicare and many private insurers factor patient satisfaction scores into their reimbursement calculations. Patients value a staff that greets them by name, or remembers that they like their prescriptions electronically sent to a specific pharmacy. That's tough to achieve when the faces in your office are always in flux. "Medical practices need to maintain a personal relationship with their patients, so when your medical assistant leaves that connection disappears," says Knapp. "It's not like going to Macy's where you expect a different clerk to assist you every time."
Retention of clinical staff, in particular, is also playing a greater role as medical groups increasingly adopt provider team models, such as the Patient-Centered Medical Home, in which a group of providers works together to improve continuity of care. Yet, for many practices, it can be hard to hang on to nurse practitioners and physician assistants. A 2011 Physician Retention Survey from Cejka Search and the American Medical Group Association found a turnover rate of 12.6 percent for both nurse practitioners and physician assistants, more than twice the combined, adjusted physician turnover rate of 6 percent. "The implication from these findings is that forming and maintaining care teams — especially in primary care — will be among the industry's most significant challenges," the report notes.
Check your pulse
To boost your retention rate, you first need to find where you stand. You can calculate your turnover rate by identifying the percentage of your staff that has left your practice over the last five years, says Judy Capko, owner and medical practice consultant at Capko & Company. A loss rate of 15 percent or less is reasonable, she notes, while anything approaching 20 percent or more is too high. The final number, however, can be deceiving. Look beyond the percentage for any patterns that may emerge. You may, for example, have a 10 percent turnover rate overall, which wouldn't appear problematic except that it's all coming from your accounting department or nursing staff. It's time to find out why. Perhaps the supervisor micromanages, the workload is unreasonable, or staff lack the tools necessary to succeed. The only way to find out is to ask.
Employee surveys are an excellent way to take the pulse of your practice, says Gerrit Salinas, director of medical staffing for Dallas-based staffing agency Snelling. "Depending on the size of your organization you should survey your employees quarterly or twice a year," he says. "Compile the data you receive and share with the workforce what you've learned." You need not promise a solution right away, he adds. It's really about acknowledging their concerns. "Let them know that you don't have an immediate solution and invite them to offer suggestions so they are part of the process," says Salinas. Exit interviews, where managers interview departing employees, are another chance to solicit feedback on what you could be doing better. Not surprisingly, employees who have already tendered their resignation are often more candid in their appraisal.