Once a physician signs the contract to join a medical group, the practice's effort to bring another doctor into the fold has only just begun. Making sure that doctor stays is the real trick.

 

"It's a natural transition. It's like dating somebody for a long time, and then you marry them. You've still got to move everything in together and get it to work," said Denise Moore, business administrator of Physicians To Women (PTW), a Florida medical group with offices in Stuart and Port St. Lucie. Physicians To Women has four doctors on staff, one recently recruited, plus two nurse practitioners and two midwives. The group is recruiting yet another physician now.

 

"Communication is going to make or break whether they are happy or not," Moore said about new doctors on staff. "The thing you have to do is acclimate them, let them know the other physicians' personalities and the general work flow."

 

Physicians To Women sends its new doctors a training disc of the electronic health record ahead of time, so they arrive prepared to logon. Also ahead of time, the practice asks for the new physician's list of preferred instruments and equipment, so those are available when the doctor's ready to see patients. The practice arms new doctors with a booklet featuring the floor plans of both offices, identifying each person's office or desk, phone numbers and job duties. For the first two weeks, new doctors don't see patients, then they ease into the schedule with 30-minute appointments, then 20 minutes and then 15 minutes. "It takes about six weeks," Moore said.

 

The practice also sets up appointments for the new physician to meet other doctors in the community, particularly specialists such as perinatologists with whom they will work most frequently. Moore said the practice is lucky because the local hospital has a top-notch orientation for new physicians. Were that not the case, helping the new doc acclimate himself or herself to the hospital facilities and personnel would be imperative, she added.

 

Kenneth T. Hertz said, even with a hospital orientation, existing physicians in the practice should regularly visit the hospital with the new doctor in tow and lunch frequently in the hospital cafeteria. Based in Louisiana, Hertz is a consultant with the Medical Group Management Association and teaches physician-retention seminars for the organization.

 

Hertz said practice-orientation strategies such as the ones used by PTW are important steps. "To the extent that you can bring the person into the fold early on, make them feel a part of things, you've got a better chance of keeping them," he said. He recommended assigning one of the most experienced and effective nurses in the practice to the new physician, even if it's just on a temporary basis. He said too many practices hire a new doctor and then a new nurse to work alongside him or her, and that's a mistake.

 

Yet Hertz said successful physician retention actually has less to do with what the practice does after the doctor starts work than one might think. "The No. 1 key to retention starts at the very beginning of recruiting. That's the piece that so many practices miss," he said. "You do your homework upfront." Ideal candidates need to be "the right fit," he said. Do they have ties or family in the area? Are they comfortable in your region of the country? Are they city dwellers, whereas your practice is in a rural environment?

 

Then there's the process of making the offer. "Do you make the physician feel as though you really want that doctor in the practice, that you really want her to come in and be a part of the practice, that you think she's a star player and you want her, or do you play this negotiation game and say, 'Well, we're going to lowball her and see how she does. If she signs, well, we saved some money'? Is that a way to start a relationship?" Hertz asked.

 

In addition, Hertz cautioned that practices also fall into a trap of promising too much upfront and then not following through. "What I promise you, I need to be able to deliver 100 percent. That may sound way obvious, and it is, but it doesn't always happen," he said. Too many practices promise a three-month review with a raise attached, and then don't approach the physician to set the time aside for that review. "Instead, here's what practices do," he said. "We're so busy putting out fires, trying to figure how to implement an EHR, cutting staff, fighting with insurance companies and dealing with declining reimbursement, we don't remember to have the meeting with the doctor at three months. Well, we've broken a promise. I don't know about you, but if I go somewhere and somebody makes me a promise, I expect them to keep it. A year goes by, and guess who's leaving town."

 

The sure-fire insurance that the physician who was so actively – and expensively –recruited by the practice will stay with the practice is an obvious one, though. "With a new doctor, you want to communicate, communicate and communicate. Give the new doctor feedback, positive and constructive, and you want to listen to what the new doctor has to say," Hertz said. "Constant, almost compulsive, communication, and that doesn't mean nonstop talking. It means listening twice as much as you speak. That's why God gave us two ears and one mouth, so they say." A few 'attaboys' or 'attagirls' along the way help, too.

 

Why do some doctors leave? Hertz acknowledged that it's sometimes about the money, but he added, "It's usually about the culture, it's about the community, it's about broken promises."