I have a confession to make — I’m feeling a little burned out by burnout stories in the healthcare industry. Every week it seems there’s another piece decrying and analyzing the industry’s high staff turnover rate, usually focusing on physicians.
It’s not that burnout isn’t an important issue — on the contrary, it’s an urgent problem that is growing worse and which costs healthcare about $5 billion a year. Only the hospitality industry has a bigger problem retaining staff.
No, my fatigue at the steady drumbeat of burnout stories stems from doubts that people are actually taking effective action to address the problem. Everyone likes to talk about it, but I wonder how many of them are taking steps to tackle high turnover, as it affects all staff, especially at physician-owned practices.
As with any problem, the nature of burnout and turnover needs to be well understood before it can be addressed effectively. And in my experience at MGMA, where we closely track such metrics, I’ve found it to be the case that sometimes, and sometimes justifiably, physician-owned practices don’t measure their turnover and hiring rates.
When we ask them about their business, we usually get back a helpful, detailed picture of the metrics they understandably regard as the most important, such as compensation levels, expenses, and anything else that relates back to revenue. This makes sense — if they didn’t understand these numbers well, they’d probably be out of business.
However, we also usually get back an incomplete view of staff turnover levels. Either retention isn’t an issue at these practices or, much more likely, in the face of other high-priority data, turnover is not a key metric.
As you might expect, hospitals and multi-specialty practices more closely track this data, perhaps in part because they have bigger operations and more staff available to monitor trends. For example, in our 2019 MGMA DataDive Practice Operations survey we found that front-office support staff turnover in hospitals went from 19 percent in 2016 to 15 percent in 2017 to 20 percent in 2018. Hospitals’ clinical support staff turnover rates went from 9 percent, to 18 percent, to 17 percent in the same three years.
That data doesn’t highlight any obvious trend about what’s going on, but that misses the point. Merely by tracking the numbers, hospitals and larger practices show that they are paying attention to this issue, thereby putting themselves in a position to address it. There’s no shortage of resources telling healthcare leaders how to increase retention rates and build cultures that make people feel valued. Those resources start with the simple act of noticing when the numbers are or aren’t going in the right direction.
The big difference between tracking turnover or not was made clear to me by the personal experience of working for two very contrasting organizations. One hospital I worked at for a decade set a staff turnover target of seven percent and put a lot of effort into tracking that number. As a result, it also put in a constantly changing array of best practices to keep it low. By putting in place staff committees and leadership development programs, it was able to create a culture of loyalty that acted as a shield against burnout and kept turnover impressively low. A subsequent organization I worked for showed no interest in monitoring turnover and never talked about it. As you can imagine, their results differed.
It’s easy to see why tracking turnover might seem like a low priority at small, busy physician-owned practices that don’t have a dedicated person to monitor turnover trends, let alone enough staff to make every day not feel like a circus. It may seem pointless, too, to report on staff turnover when you have a small team of 5-10 people and none of them left this year.
In fact, it is well worth reporting these numbers to build a long-term picture of the practice’s performance on turnover and retention. Over time, it is a crucial factor that can have a big impact on the revenue and productivity numbers that practices must value for the sake of their business. The cost of one medical staff member leaving can range from $38,000 for a nurse to $200,000 or more for a doctor. But every time someone leaves there’s an additional trickle-down effect that can weaken morale and undermine patient loyalty and satisfaction.
Tracking turnover and retention can also help start conversations within practices, which can lead to positive changes, such as implementing policies that make all staff feel more valued and likely to stick around. If a practice’s leadership has no interest in these numbers, it’s a telltale sign that they aren’t focused on building a supportive culture that keeps the organization true to its mission, vision, and goals. And nothing is more important than that when it comes to nurturing a loyal, happy, non-burned-out team.
Cristy Good, MPH, MBA, CPC, CMPE is a Senior Industry Advisor at MGMA