Why physician alignment and not just engagement is the real retention test

Physician engagement scores can look fine while turnover risk is quietly rising. The missing piece is often alignment; whether doctors trust leadership, believe in the mission and values, and feel decisions match what the organization says it stands for. When that alignment slips, physicians stop speaking up, withdraw into “just get through the day” mode or become openly cynical; warning signs that retention problems are already underway.

In an interview with Physicians Practice, Scott Polenz, principal consultant advisory services at CHG Healthcare, explains how his background in health care administration informs his view on the differences between engagement and alignment.

Physicians Practice: Tell us a bit about yourself.

Scott Polenz: Well, I’ve had quite a career in health care. I’d say a majority of my career has been in central Wisconsin—kind of northern, western central Wisconsin—so more of a rural background. I’ve done a variety of different things: a financial background, but mostly in operations. I oversaw, at one point in time, probably about 25 or 30 clinics, about 225 physicians, about 1,500 staff.

Then I moved into an organization that started to buy and build hospitals. We built a brand-new hospital while still overseeing clinic relations and things like that. Then my last five years or so, I was part of our executive team. I oversaw physician and APP recruitment, onboarding, retention and engagement, and oversaw our whole engagement journey.

That’s really where I got exposed to—and I have a great respect for—physicians and their well-being, their engagement and alignment. If you want, I can tell you why I talk about alignment versus just that generic “engagement” everybody talks about. But that’s my background. And now, as you mentioned, I’m at CHG Healthcare helping other health care organizations improve physician relations, recruitment, and onboarding.

Physicians Practice: OK, well, let’s dig right in. You’ve already broached the subject of engagement versus alignment—engagement isn’t enough. What does that look like in a practice day to day?

SP: Let me just step back a little bit. What we found in the organization I worked for—a larger rural health care system—we did an engagement survey, and the scores weren’t that good.

Over time, myself and my dyad partner—my physician partner—we realized we actually had physicians who were engaged and wanted to be here. They just weren’t aligned with the mission, the vision, the values, and our executive leadership.

We felt if we’re going to improve engagement—which ultimately retains physicians—then we need to focus on alignment. And alignment, to a certain extent, boils down to trust: trust that we’re living our mission, trust in executive leadership, and so on.

So when you say engagement isn’t enough, you’re asking: What does it look like when physicians are aligned and engaged? At the end of the day, physicians truly care about the quality of care and the patient experience. It’s important for them to practice medicine the way they want to practice medicine, take care of patients, and do it with high quality and a great experience.

But as things evolve and engagement might wane, you start focusing on alignment. Physicians can become quieter. Early in their career, they’re going to meetings, they’re on time, they’re raising their hand, they have ideas. Then, like all of us, if we’re not aligned with the organization, we don’t suggest as much—we keep our head down, we’re just trying to get through the day.

Or you can become more boisterous, more sarcastic—“Oh yeah, I can’t wait to see what administration did today”—that kind of thing. I don’t want to say obnoxious, but you get so frustrated you verbalize it every chance you can: to your medical assistant, your nurse, your manager, leadership—because physicians are extraordinarily blunt. They’re not afraid to tell you or me what we did wrong that day.

So that’s a little bit about alignment and engagement, and what it looks like when it’s starting to not be as good as when they were first with you.