Rural Provider RetentionRetaining Rural Providers in a
Competitive Market
Stacey Day, Director of Provider Recruitment, SCORH
And Mark Jordan, Director, SC DHEC Office of Primary Care
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Rural Retention Planning
Congratulations!
You’ve recruited a great new
Family Medicine physician,
Nurse Practitioner, Physician
Assistant, or other provider for
that hard to fill Rural position.
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…But this is just the beginning.
RECRUITENTION =
RECRUITING TO RETAIN
a/k/a, You got them. How do you keep them?
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While Recruiting, did you Develop the
“Ideal” Candidate Profile for a Rural
Practice “Match”?
-Check-list of must-haves, and
wants
-Rural background?
-Early determination of desire for
career in medicine (“I’ve known
since I was in 10th grade”)?
-Rural Training Track somewhat
predictive
-Remember in replacing retiring
physicians, may be a 1:1.5 FTE
replacement=Work/life balance
consideration
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…of the beginning.
Your first action after your new clinician
signs the dotted line is to
A. Cross your fingers, have a drink, and hope
it works out.
B. Cross you’re fingers and hope it works out.
You don’t drink.
C. Check this item off of your Provider
Retention Plan and communicate with the
team with whom you worked to recruit this
new provider. This is just one step in an
ongoing process.
D. All of the above.
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So What is a Provider Retention
Plan?
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A comprehensive plan that
though flexible, comprises
-A focused, team approach
-Formal and informal processes, to
include Onboarding
-Relationship building
-Constant assessment and
evaluation of skill sets of each
member of the retention team
-Communication loop
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Why develop A Provider Retention Plan?
Job Turnover
•
For physicians
-Practice different than expected or explained during
recruitment
-Physician and family never became part of the community
-The “myth” of Rural America
-Feeling a Lack
-of control over practice
-of feedback (little to no
onboarding)
-of two way discussion
-of appreciation
= a GAP – between real or perceived
expectations
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Why Rural Retention? The Flip Side
of “Just Recruiting”
“This is not at all what
I expected or what
they said it would be
like!! Help!”
-Costly to recruit and train - time and
resources
-Patient continuity of care, trust
-Practice “security” – fiscally,
psychologically
-Practice demise -if you go, who will
provide care?
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RETENTION IS PART OF A
PROCESS, NOT AN
UNRELATED EVENT
-Physician retention begins with strategic planning, provider
needs assessment, a recruitment plan, interviewing, hiring and
orientation.
-Strategic planning tells the organization where it is going and
how it will get there.
-Needs assessment should review efficiency issues, patient
volumes and types of patients, market share, and determine
the type of provider who will fit that need (associate staff or
medical staff ).
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RETENTION IS PART OF A PROCESS, NOT
AN UNRELATED EVENT
-Interviewing process should be defined as part of the
planning. Keep the surprises to a minimum.
-Hiring should move the new physician smoothly into
relocation and orientation.
-Orientation is step one in developing a retention plan
that is part of a total process, which includes a feedback
loop (exit interviews, succession planning and the
strategic plan.)
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Retention Planning Worksheet
1) Create your team – keep in mind skill sets of all
involved. Ideally
-Coordinator
-Onboarding Representative
-Orientation Representative
-Communication Representative
-Spouse/SO/Family Liaison
-Other Support Team Members
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Retention Planning Worksheet
2) Identify Resources Needed
and Those Available

-Materials
-Contacts
-Budget
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Retention Planning Worksheet
3) Retention elements and tasks with
timelines –typically a three year plan

-Onboarding Plan
-Orientation
-Recognition Activities
-Social Activities
-Mentorship
-Practice Review
-Satisfaction Surveys
-Exit Surveys
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Onboarding
For hospital-based or larger
practices
-CEO calls or sends note
welcoming physician to the
practice
-Professional Mentor selected for
new physician
-New physician is sent a copy of
the Physician Mentorship
program
-Partner or Recruiter POC keeps
in touch with physician and
spouse to check in on relocation
preparations
For independent rural health
clinic or solo practitioner
-Partner calls welcoming
physician to the practice
-New physician is sent a copy of
the Physician Mentorship
program
-Partner keeps in touch with
physician and spouse to check in
on relocation preparations
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Onboarding = An essential component to
physician retention
Physicians dissatisfied with the workplace have many
choices.
-Retention survey from Cejka Search and AMGA
found that turnover is at its highest since 2007
recession at 6.8%.
-Average turnover rate for physicians in their second
to third year of practice was 12.4 percent.
-Small groups suffered from a 20.8 percent turnover
among physicians in those early years.
Silver lining - medical groups that had formalized
onboarding programs with a dedicated mentorship
program showed a better retention rate.
All from Mokasti.com, http://www.mokasti.com/physician-leadership-and-physician-retention-a-majorchallenge-in-the-new-health-age/
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Retention Planning
“Key to physician retention is regular contact with
physicians and spouses to stay abreast of how they
are adjusting, and to anticipate any problems that
may develop...The most critical element in any
retention plan is a mechanism to “check in” on the
physician’s expectations. Keep in mind the needs of
physicians’ spouses and families because frequently
physicians’ satisfaction depends on their families’
adjustment.”
Tim Skinner, former 3RNet Executive Director, from 3RNet/ HANDOUTS AND FORMS/RECRUITENTION OF
PHYSICIANS AND MEDICAL PROFESSIONALS, 2007
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Retention Plan – Year One
Professional - Monthly Communication
-To discuss practice development, community outreach,
ongoing mentoring
-If hospital-based, recruiter meets with new physician after two
months to see if expectations meet reality. If small practice,
partner physician will meet with new hire.
-Some hospital-based practices assign committee duties and
bring in physicians to work on projects.
-Alternate options for small practices or solo practitioners?
Telementoring?
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Retention Plan – Year One
Social - Monthly, then Quarterly Communication
-To find out how family is adjusting, unmet needs, resources
within the community? Social mentor/partners?
-Spouse or SO Needs/Wants met?
-Community connection
-Religious needs met?
-Educational needs met?
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Retention Plan – Year Two
-Physician and family deeply engaged in the community
-Professionally physician is doing well and feels both
supported while retaining some autonomy
-Socially, connections are made and deepening
-Continuous feedback loop to to “check-in” to see how
things are going
-Emerging family needs or changes based on children’s ages?
Spouse or SO Needs/Wants met?
-Community connection
-Religious needs met?
-Educational needs met?
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Primary Care Recruitment and
Retention Programs
SC Rural Physician State Incentive Grant - State
-Between $40-70,000 (total) for 3 year commitment
-Fairly competitive– an average of 14 or so primary care
physician awards made each year, with a handful of
lesser dollar award advanced practice awards
-Eligible physician specialties (outpatient only); FM,
Peds, Ob/Gyn, IM
-State Contact is Kristin Cochran/SC AHEC
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National Rural/Recruitment/Retention
Resource List
3RNet www.3rnet.org & 3RNet Resource Library
www.3rnet.org
HRSA http://bhpr.hrsa.gov/
Mokasti.com http://www.mokasti.com/physicianleadership-and-physician-retention-a-major-challenge-inthe-new-health-age/
National Health Service Corp (NHSC) http://nhsc.hrsa.gov/
National Rural Health Association (NRHA)
http://www.ruralhealthweb.org/
Rural Assistance Center (Raconline)
http://www.raconline.org/
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SC Rural/
Recruitment/Retention
Resource List
SC AHEC http://www.scahec.net/
SC Office of Primary Care
http://www.dhec.sc.gov/health/opc/
SC Office of Rural Health www.scorh.net and
www.schealthcare.com
SC Office of Healthcare Workforce and Analysis
http://officeforhealthcareworkforce.org/
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