Forming and maintaining primary care teams will be a significant challenge

As the era of accountable care evolves and the medical home model becomes more prevalent in organizations, the delivery of successful patient outcomes is expected to be increasingly dependent on the performance of an effective patient care team. Forming and maintaining care teams - especially in primary care - will be among the industry's most significant challenges, according to the American Medical Group Association's (AMGA) and Cejka Search 2011 Physician Retention Survey, which for the first time includes staffing and turnover benchmarks for both advanced practitioners and physician staffing.

The turnover rate for both nurse practitioners and physician assistants reported by the survey is 12.6 percent, which nearly doubles the combined, adjusted physician turnover rate of 6.0 percent. The combination of a projected physician shortage and already high turnover for nurse practitioners and physician assistants places even more pressure on medical groups to use advanced practitioners to fill the gaps in patient care and compensate them appropriately.

"As organizations seek to meet these staffing demands, it is important to recognize that the qualities once sought in a physician or advanced practitioner five years ago have changed along with the health care environment," said Donald W. Fisher, Ph.D., CAE, AMGA president and chief executive officer. "Collaboration and teamwork are significantly more important to medical groups and health systems because care models and performance measures require it. The ability to work effectively as a member of an accountable care team becomes a valued skill for physicians and advanced practitioners who increasingly will partner with colleagues in primary care, hospital medicine, a wide range of specialties and subspecialties and allied health."

"Recruiting and retaining physicians and advanced practitioners is more critical now than ever," said Lori Schutte, president, Cejka Search. "In the previous year's survey, the majority of groups told us that the medical home model will deliver a competitive advantage in recruiting primary care physicians and advanced practitioners. But finding, hiring and keeping them is a growing challenge. Medical groups need to be prepared to hire the candidates that are the best fit for their organization."

More than two-thirds (67%) of respondents from the 2011 survey reported that the involvement of advanced practitioners in their groups has grown "somewhat" or "significantly" in the past five years. This response increases to 75% when looking ahead toward the next five years. The respondents also indicated that they identified 21% and 13% growth in new positions, respectively, for physician assistants and nurse practitioners in their groups in the past twelve months.

Hiring primary care physicians and advanced practice providers is a priority for most of the responding groups. Nearly three-quarters (74%) of the responding groups reported that they would hire more or significantly more primary care physicians in the next 12 months, than they did in the prior year. This was particularly noticeable among groups between 150 and 500 physicians and those in integrated delivery systems. No groups reported that they would reduce their Primary Care staffing. Plans for hiring more specialists were only slightly less aggressive.

Other Key Findings
•Survey respondents reported AMGA Groups average turnover of 5.9 percent in 2011 compared with 6.1 percent in 2010 and average turnover by non-AMGA members was reported at 6.3 percent.
•In 2011, turnover in the first two years after a physician joins a practice was 14 percent, followed by 11 percent for the next two years, and more than 8 percent between years three and five. Once a physician has stayed at a practice for five years, the physician is more likely to stay.
•The 2010 survey identified that turnover can cost as much as $1 million per physician when all recruitment, start-up and lost revenue cost are totaled. The 2011 survey took it one step further, finding the average interview cost per vacancy is $31,090.

Flexible Physician Scheduling Remains Top Incentive
•One in five (22%) male physicians and 44 percent of female physicians are reported to be working part-time by survey respondents in 2011.
oLooking back at responses from 2005, only 7 percent of male physicians and 29 percent of female physicians reported working part-time.
•Flexible work options are key to physician retention: 75 percent of groups offer a four-day full-time work week.
•According to the survey, male physicians approaching retirement and female physicians entering the workforce are the most likely groups to look for part-time and flexible scheduling options, as they are the two fastest growing populations in the physician workforce.

Performance-Based Incentives Evolve
•Pay structures and incentives have changed in the past five years to focus on outcomes for quality, efficiency and satisfaction, yet the survey found no clear indicators show a consensus about the role of incentives toward these outcomes.
•About half the survey respondents indicated that primary care physicians are incented "somewhat more" or "significantly more" for both quality (52%) and satisfaction (50%) than they were five years ago.
•Incentives to achieve efficiency will need to become more compelling: 44 percent of respondents think that driving changes in practice efficiency outcomes would require incentive compensation of at least 10 percent.
oIn contrast, respondents believe that incentive compensation of less than 5 percent will drive desired quality and satisfaction outcomes.

An electronic version of the 2011 survey is available to non-survey-participating AMGA members for $100 and to non-AMGA members for $200.

Methodology
The Cejka Search and AMGA 2011 Physician Retention Survey was distributed electronically via e-mail to 2,823 medical organizations, representing both AMGA medical group members and non-members. Survey data was collected from November 2011 through January 2012. A total of 80 survey responses were compiled, representing a 2.8 percent survey response rate. In 2011, the 80 respondents collectively employed 14,366 physicians.