Building Authentic Relationships to Foster Early Career Physician Loyalty, with Jackson Physician Search
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We are back with another business solutions podcast with one of our favorite groups that we work with here. It's Jackson Physician Search. We work with Jackson on data reports, on market research, and on live events like we saw in Orlando recently.
Daniel Williams:Today, we have Tony Stajduhar, who's president of Jackson Physician Search. We've also got Neal Waters, regional vice president of recruiting at JPS. Gentlemen, welcome back to the show.
Neal Waters:Thank you. Thanks for having us.
Tony Stajduhar:Thanks, Daniel.
Daniel Williams:Great having y'all here. And it's really interesting y'all because as MGMA and JPS have been doing the last several years, put together some market research, and we're gonna look today at a report on how organizations can move from contract to connection. And that's by building those authentic relationships that foster physician loyalty and retention. Tony, let's start with you and let's go big picture. Talk about this research, what stood out to you, anything you want to share with us that really emerged.
Daniel Williams:I know I've talked to you for years and years now, and you already know the market, but there's always wrinkles in there or things that just really resonate with you from the research. What stood out to you?
Tony Stajduhar:It's always interesting to me when you do these types of papers, and I love that we've been doing this with you all for the last few years because it gives you the opportunity to say, we look at what's reality for a physician. You know, we're asking these questions to physicians, but then we also have to ask it from the administrative standpoint because that's the only way we're gonna find are are we really speaking the same language? Are we on the same page? And I think the thing that really came out of this to me very similar to some of the past research that we've done is that physicians go into this first job coming out of their programs, and they typically stay in these jobs, and they have the anticipation that they're probably gonna stay in jobs probably three years or less. So almost 60% of the physicians coming out of programs will be in their first position for three years or less.
Tony Stajduhar:The part that is never ceases to amaze me, though, the administrative side, they believe the physicians coming out of their first practice are with them for at least six years. So you wonder, how does that happen? How do you have that big of a discrepancy between the two sides? So that's always a really fascinating piece to me of these programs that we do. But I think the other things that came out of this were just trying to find out the reasons why physicians leave And I think we'll be diving into that and some of the questions that that you're gonna be asking.
Tony Stajduhar:Neal's gonna have some great insight on some of this as well. But I think it's very interesting to find out that you would think that a lot of the reasons you always hear the reason people leave practices is because of the financial rewards or lack thereof, if you will. And in essence, it's really not the main focus or the main reason why people leave their first practices. So I think some of the things we're gonna be talking about will open some of the doors to this and kinda surprise everybody a little bit.
Daniel Williams:Yeah. Thank you so much for that, Tony. And you and I have had a lot of discussions about that, that disconnect there. And so, hopefully, we can shed some light on that today and just share a little bit more with our MGMA listeners. So thank you for bringing up that point about that gap in expectations.
Daniel Williams:So I'm going to turn to Neal now. Neil, from your perspective, are there red flags? And if there are, what are those red flags that give you an indication as a practice leader that that physician may not be in it with you for the long haul?
Neal Waters:Yeah. Great question, Daniel. Where do we start, Right? On the the red bike. The answer is yes.
Neal Waters:There definitely are. But there are some that are specific to the individual. You know, Tony mentioned the disconnect. Right? And and we're a disconnect.
Neal Waters:Where does that come from? Not being able to truly know your employee, your physician, that person who's an employee of your organization, being too far apart. So I think some of those red flags can be specific to that individual, their personality, what their career aspirations are. So I think it really starts from even before they start, you know, even the the pre boarding, the onboarding. I think, you know, our our paper touches on, you know, all these subjects, but it's making them feel heard, welcomed from the very beginning, or even as I mentioned before they start.
Neal Waters:But, you know, some generalities once they get into a position, whether it's the first few months, first year, first couple of years, just engagement. You know, are they being engaged with staff? You know, do are does it seem like they're making an effort outside of just their patient contact hours? Are they getting involved in the community? Are they getting involved in events that the hospital might be putting on in the area?
Neal Waters:So that's a pretty basic barometer across the board is just to typically look at engagement. How happy do they seem? You know, are they stressed? Is, you know, are they, you know, worried about their income guarantee going away at the end of one year or two years? Those can be some some red flags and I think opens up hopefully early healthy discussions to get ahead of those things and try to get them corrected on the right course before it's too late.
Daniel Williams:Right. Yeah. Thank you for sharing that. I'm going to turn back to Tony for this next question. And in going through the data, it was alarming to me that it said more than one in four physicians at least consider leaving within that first year.
Daniel Williams:Tony, we know that early part, that onboarding and that integration is vital, but what is it about that? What is it about those early months, and what can be done about it?
Tony Stajduhar:Yeah. You know, and I think we've probably talked about this on some of our webinars before, Daniel. Right. But recruiting and relocating somebody to a new location, especially when it's a new position and it's their first, you know, the first opportunity coming out of program.
Tony Stajduhar:There's such a psychology to recruiting and and bringing people into a into the fold, so to speak. But keep in mind, these physicians are coming out of programs where they're in a very protected environment, and they're where they know they know people. They've known people for years. Their family's kinda gotten ingrained in the community. They've been there at least three years, maybe longer if they finished med school in the same place, but they're they're in a situation where there's there's some feeling of security.
Tony Stajduhar:Now it's going off into the great unknown. Now in many cases, physicians will make the easy decision to stay either where the physician's from or where their spouse is from or in some cases where they did the residency program. And and too many times they do that because it's the easiest thing to do. You know, it's the the quick and easy thing to do. I don't have time to really go out and find what's right for me.
Tony Stajduhar:You know, they've been in two or three states in their entire life, and that's pretty much what they're what they know. They don't know that North Dakota's even a state or that there would even be a practice there. Right. But lo and behold, they still get in these new practices, and they're now joining people who they haven't known. They're not in a protected environment like that anymore.
Tony Stajduhar:And especially when not much is done on the onboarding or the preboarding, if you will, ahead of time, it almost has a sense of, like, here's the keys to your office. Good luck. God bless you. Hope it all goes well. So that's on the professional side.
Tony Stajduhar:That's daunting enough and scary enough that now they come in, and they're kinda left to their own devices in many situations. And similarly, on the family side, if the family's going to a new location or someplace different than what they've been accustomed to, the physician comes home to that scenario to find out, hey. How are thing how are things gone for the day? How are the kids? What's going on there?
Tony Stajduhar:And there can be a certain level of despair and concern and almost like feeling overwhelmed if they don't have consistent communication to what to Neil's point earlier, if they don't have consistent communication and feedback and and quit people saying, hey. How's it going? How are you doing? What can we do better? What can we do to help you?
Tony Stajduhar:So I think that people who go into that with very little preboarding are already at a disadvantage. And then when they get there, if they don't have things set up for ongoing communication, then it's a potential recipe for disaster.
Daniel Williams:All right. Wow. Neal, I wanna turn to you for the next question. This was yet another statistical point that really caught my attention. It was showing that recent grads are leaving their roles even faster than later career physicians.
Daniel Williams:Are there trends? What is driving that? Because I thought maybe they might want really establish themselves in a place, but no, that doesn't seem to be the case from the data here.
Neal Waters:Yeah. It was eye opening when we saw it, but after we digested it a little bit, it made more sense because we experience it and we see it, you know, on a daily basis. But it really comes down to a big part being generational. It's a completely different generation. You know, the generation now is much different than the baby boomer generation that in most cases went into their first job search and they were thinking in their heads, I wanna pick a place where I can see myself starting a career and having a career long term where where I'm gonna prove myself and I'm gonna build a practice.
Neal Waters:You know, I'm gonna give it all I've got. And not to say that this this newer generation isn't going to do that, but it's it's been a role reversal a little bit more so. They're in such high demand that they're coming into the first position saying, I think this could be a good fit. It's my best guess, and I'm gonna give it a shot, but it's up to you employer or group to prove to me that this is a great place to work. Otherwise, I've got a million different other options.
Neal Waters:So it gets down to again that the generational differences of how they view positions, employers, or group settings, and what the expectations are.
Daniel Williams:Okay. Tony, for the next question, I want to talk about something that I think you and Neil have both brought up. It's that pre-boarding process. I wanted to follow-up earlier, and let's do that now. Let's talk about what that pre boarding process looks like.
Daniel Williams:What is it that sets the stage so that physician coming into the practice feels wanted, needed, and everything else?
Tony Stajduhar:Yeah. Great question. Let me give you an example from our experience. So here we are, the firm that is working with with a group practice, for example. They've hired us to do this, and, you know, there's a lot of work that goes into it.
Tony Stajduhar:There's so so much so much upfront work, anticipation, planning, strategy, that sort of thing. How do you recruit the person? How do you find the right person? How do you get them in for the interview? You go through this whole process, and it's it's a long, arduous, drawn out process.
Tony Stajduhar:You know, if you're lucky, you could be done in ninety days. You know, in some cases, it takes six months, a year, but you go through this and you get that doctor and you finally say, oh gosh. We've got the one. This is the one. We know it's great.
Tony Stajduhar:There's that sense of just like an exhale to say, finally done it.
Daniel Williams:Right.
Tony Stajduhar:So so you basically you've now signed the contract. You've got it done. And in reality, there's more work to be done, but it's like a little bit of an exhale because you're saying, well, this position is probably not starting in some cases a year, eighteen months. You know, it's that far ahead, especially when they're finishing their program. Sometimes it's a little quicker, but usually there's that much time between.
Tony Stajduhar:So what happens? We are on to our next client, our next assignment, and the the client now who signed the contract is is feeling like, okay. I've got a lot of other fires to put out. I've got things to do as we all do in our daily routines, and you just start losing track and you forget about the people that you've just signed. You're just assuming they're ready to go.
Tony Stajduhar:It's done. You really don't have to do much. You'll see them when they get there. You know, we'll we'll talk to you when the moving vans are on the way. So now in reality, what happens is that as Neil alluded to, there's a huge physician shortage as we're all well aware of, and so everybody's looking for these physicians.
Tony Stajduhar:So in the meantime, these doctors, even though they've signed a contract, the world doesn't know this, so the these doctors continue to get peppered with opportunities. And if they've you know, if it's like, okay. Well, great. You know, I just got engaged to this to this guy. I haven't heard from him in three months.
Tony Stajduhar:I think we're still engaged. I'm not sure, but, you know, they're still getting courted by other people. So this is really the reality of what what can happen. So while physicians don't purposely go out and try to look for ways to break their agreements, they're getting hounded by these people. And if they're not being contacted by the people who've already signed them, they start wondering, is everything okay?
Tony Stajduhar:Am I missing something? Should I be communicating? And it's incumbent on us as clients to be able to continue to start immediately reaching out to them. You know, I've heard some interesting things of, you know, for example, clients signing up the newsletter from the community or the you know, in my day, would have been the newspaper, but now now the online version, of course, going to them, you know, setting up communication, maybe a little gift once a month from something from the city or the area or something like that to continue to let them know, we can't wait to get you here. And in addition to that, also kind of assigning a mentor right off the bat.
Tony Stajduhar:Somebody that they can start relating to and just talking to occasionally, maybe once a month. Maybe somebody who's gonna be peer because as we'll talk in a little bit, peers are very important to new physicians as well. So somebody that they can talk to, and sometimes that peer doesn't always have to be with the on the physician side. It may be somebody who resonated with the spouse on the interview as well who hit it off with another spouse in the community. They have some similar interests, and they just continue to reach out to them as though we can't wait to get you here.
Tony Stajduhar:What can I do to help you in the meantime? So this communication is vital. If if you if you don't do it, you run the risk of them thinking that, okay. Great. They're taking me for granted or they've forgotten about me, or do I still have a job?
Tony Stajduhar:I'm not sure. So doing these things, will it keep physicians from from, from this type of situation for good or all the time? Not necessarily, but it'll it should sure really lessen your odds of that physician either not coming at all or leaving early.
Daniel Williams:Yeah. I love that analogy of it's like an engagement, so to speak, when you have signed that contract and then, yeah, you want to continue to get those touches that you know I'm out here and where's the love? So I really appreciate that. Neil, I'll turn to you. What it really sounds like, in a lot of ways, what we're talking about is relationships.
Daniel Williams:Tony hit on so many key points about building those relationships. Anything else you want to add to that as far as a practice, perhaps putting it into operations, putting it into processes so it is a really seamless venture there in bringing those physicians on board?
Neal Waters:Yeah, absolutely. I mean relationships, just that word, you know, says so many, so many things. Tony touched on the mentor, you know, relationships. The peer to peer really came out in this study. It's people who you're gonna be working next to every single day.
Neal Waters:And, you know, how how can we or the employer or the group make this person that we put so much effort into recruiting to our group that we had touted as being amazing and great? How do we make them feel as comfortable as possible that first day and ongoing? So there's already gonna be so many systemic things that they're just gonna have to learn when they get there, electronic medical records, you know, all those things. But what are some possibilities for introductions, as Tony mentioned, assigning them a mentor before they start, make introductions to staff physicians before they start leading up to it. Even staff that they're gonna be working with, NPs, PAs, medical assistants.
Neal Waters:I mean, nice would it be that everybody's not a brand new face the first day? And it's like, oh, hey, you know, it's you know, I've I've kind of known you for six months or three months. These are ideal scenarios, some ideas, but what can we do to start sooner than that first day?
Daniel Williams:Okay. I'm gonna switch gears a little bit, but we're we're gonna get back to those relationships. But Tony, we know that compensation plays a major role. It certainly starts the conversation. It might get that foot in the door.
Daniel Williams:But what it showed in the study was that long term, now we get back to the relationship side. That relationship side so the the money part, the compensation part got them in the door, but that may not keep them, though. So talk about that dynamic.
Tony Stajduhar:You know, with so much information out there today about starting salaries and RVUs and, you know, what's what's the going everybody kinda knows their value these days. You know, it's like the NFL. You know, this this quarterback makes this much money. Everybody in the world knows it, so now the next quarterback's gonna make the same amount of money or more.
Daniel Williams:Right.
Tony Stajduhar:Right. Shooting for now. Physicians, unfortunately, don't have that free agency, feel, so they do have some kind of limits, but at least they know what their market value is. So, yeah, getting them in there at something fair and giving them some upside if they choose to work at that kind of level, then, you know, that's that's all well and good, but now they're there.
Daniel Williams:Mhmm.
Tony Stajduhar:And the things that just kinda resonate, you know, culture and the environment and that sort of thing. There's an old saying that people don't leave positions. They leave bosses.
Daniel Williams:Mhmm.
Tony Stajduhar:So that is from the from the top down, and it's all about culture and what you build there. You know, that's one of the things we really pride ourselves in here is to be culture. I was proud the other night. I I don't know if I told you this or not, but we just got ten years in a row. We were rated in the top 10 in The United States places to work.
Tony Stajduhar:Wow. That's because you work at building a culture of a place where people wanna be, and you do that by making things inclusive. You do that by making them feel that they are heard, that their voice matters, and you do all these sort of things and build a culture where people wanna be. And you not only do that just based on what they feel with their leadership, but that you feel within the organization. And while I would love to say that, oh, culture is all because of me.
Tony Stajduhar:No. Culture is because these people here at JPS, they all care about each other, they get along well. And you build that culture internally, and you but you've gotta start somewhere. You've gotta get it started somewhere and show the reason why we're doing this. And if you wanna be part of this, it's something really cool.
Tony Stajduhar:So if you can do that, people rarely leave really good cultures. And, you know, I think if you can do that and show people that the leadership cares, the leadership lessons, and that your peers feel that way, then, you know, you've got a much, much better chance of retaining people than you do the other way. And by the way, I keep saying we keep talking about retention and retaining. I'm trying to get away from those words because I sometimes I feel like retention almost feels like you're shackling someone. Yeah.
Tony Stajduhar:As opposed to just saying, work on building the relationships, and the relationships will keep people who wanna be there.
Daniel Williams:I love that. Alright. Neil, in looking at the study, there were some biggest less likely to stay triggers. Some of those were bureaucracy, workload imbalance, poor leadership interaction, etcetera. So where does administration go?
Daniel Williams:What do you start tackling? Do you just dive in, get them all at one time, one at a time? How do you address these triggers?
Neal Waters:Yeah. So, you know, to get the starts, it's gotta start early. And it's it's accessibility, availability, and putting the word out there that those things are there. You know, so many times maybe they might meet the CEO on the interview. Maybe not.
Neal Waters:You know, they don't they don't know or the leader of their department or the medical director, tends to be disconnected. We've had that word come up a few times. So, knowing these things, addressing it early on, and having it be an open door policy so that they feel like their voice is heard. These things, you know, poor leadership interaction. Well, when you're interacting, that's hard to define it that way.
Neal Waters:But get just getting ahead of a lot of these things, I think bureaucracy kinda ties into that. It's a lot of times probably not bureaucracy, but the lack of knowledge of what's going on at a different level from the administrative standpoint. So, you know, open communication early, ongoing, can help a lot of these things in the bud.
Daniel Williams:Tony, we were talking a lot about getting that engagement going in the pre boarding process, the onboarding process. Part of that engagement is feedback. So how does the practice establish a feedback loop with the physician where there's trust involved but not overwhelm, like, oh my god, they're coming to talk to me again. They're giving me more feedback. So how do you make that balance, and what does it look like?
Tony Stajduhar:Yeah. I think there's a few different approaches to this. One is that mentor and peer relationship. Again, Mentor is kinda if you picture that as somebody who's been a leader or been with an organization for a long time. Mentor doesn't always mean their boss necessarily.
Tony Stajduhar:It's somebody who's been there. We actually have a mentor mentee program here at Jackson Healthcare as well, and it's really cool to see that happen because people get to kinda choose who they wanna be with in in many cases. So if you give with the right mentor, I kinda say that's the person you wanna set a monthly meeting with, but that meeting is set in stone to say that every second Tuesday of the month, we're gonna meet and it's right here. There's no canceling unless there's an emergency, but this is what we do, and we're gonna go over what's been going on for the month. So let's talk about the pros and cons, things that we've observed, that sort of thing, and have that kind of communication with them.
Tony Stajduhar:The peer program is much more like, okay. This is my buddy who say, hey. Let's go grab a cup of cup of coffee at Starbucks this morning. So we just go out. We sit and talk and say, man, did you run into this when you were here?
Tony Stajduhar:You know, this is what I noticed today. Did you notice notice this with the nursing staff? Am I being too tough? You know, just somebody that you can talk to and really bounce things off of and feel it's safe environment where you can talk. So for me, that's really the best way.
Tony Stajduhar:If you can get those kind of connections, that's the immediate feedback. But the other piece of immediate feedback is, you know, what if there's something that comes up that may not be able to wait for that monthly meeting with the mentor? What if it's a department head that needs to talk about it? Well, if there's something that's out there that the physician has a question or vice versa, maybe we have a question for the physician that we're not sure we understand, then let's let's call a quick time out. Let's schedule fifteen minutes at the end of the day, and let's sit down and chat about this and pull the Band Aid off, so to speak, and just have some intellectual honesty to say that help me understand, you know, what's going on and what can we do to make this better.
Tony Stajduhar:Yeah. And I think that's what they're looking for. Because if you have that that certain thing that happens in the second week of the month and you're not scheduled to meet anybody higher up until two more weeks, it it can feel like it drags on forever. It can fester. It can get worse instead of just saying, Let's just address this head on.
Tony Stajduhar:And I think physicians appreciate that. They'd rather just be straightforward, honest, and just have that kind of open communication.
Daniel Williams:Neil, I've got a question for you. And the word culture has been brought up a couple of times. It can sometimes be this nebulous term like, Okay, we've got culture here, we've got culture there. But how do you see it? How do you see it defined where it is supportive of that physician, where they feel supported, they are part of an organization and a group where there is trust from day one.
Daniel Williams:There's trust, there's that engagement, all the things that we've been talking about. How are you envisioning culture in that regard?
Neal Waters:Yes. There's so many of things we talked about today and we talked about in this paper are the formula that makes up culture or part of the formula that makes up culture. So we talked about relationships. You know, we we talked about creating these relationships, peer to peer, mentor, staff. You know, some of the most successful organizations from a cultural standpoint that I've seen over the past twenty years have been ones where people really like to be around each other.
Neal Waters:You know, Tony mentioned, you know, I feel like that's how, you know, our campus here is at Jack's Health Care. It's, you know, people are smiling not because they have to, but because they like being. And, you know, people are doing things outside of work. You know, their families are friends. They know about each other's kids.
Neal Waters:So, you know, encouraging those relationships and it getting breaking it down to you're not physician number 0021 on the payroll. You know, you're Doctor. Smith's. You know? And, you know, I know you've got three kids, and one of them plays soccer and and so on and so forth.
Neal Waters:So, you know, those relationships developing over time are really, really what helps to bring that culture together long term.
Tony Stajduhar:Okay. I just got Daniel, I saw that I jumped the gun on your next question. So, so I kinda answered that on the last one, but I let me answer a different question that I'll throw out there. But the one thing that I'm gonna harken back to our previous research that we did together, and that was on retention. So relationships again.
Tony Stajduhar:Right? Relationships and not retention. But but when you ask administration, it was something don't know if you remember this or not, but it was something like 79% of administration said, oh, yeah. We've got a great retention and great program set up. Physicians love it.
Tony Stajduhar:And then on the flip side, the physicians that were asked, like, less than 25% said, what retention plan? No. We don't have a retention plan. You know? So so it's like, okay.
Tony Stajduhar:Another major disconnect. So the key is how do you make this better, and how do this this is a great way to help people become part of that culture, part of the organization is bravo for wanting to build a program and build something that you can hear. But what you've gotta do to do that, you've gotta first start it. You've gotta make sure you get something set up so you get consistent feedback from people to see, is this actually working? Is this actually resonating?
Tony Stajduhar:Where are we missing missing the mark? But before any of that, you've got to get those people involved. If the key targets of building a program for for helping people want to be there is for the physicians, it might be a good idea to actually ask them what they think or how they feel or what would you think we should be doing. Get them on part of your committee for retention so you can have representation from the medical staff side, whether that's physicians, APPs, nurses, whatever, or all of the above. But that's a huge way to get them feeling like they're part of something.
Tony Stajduhar:And you can do that right away. They don't have to be there for two years to be part of that, but still if if only two people out of a 100 physicians are on that committee, so to speak, at least the physician the rest of the physicians feel, well, at least we have representation here. And we can we're we're being heard so we can get our voices heard through those people.
Daniel Williams:Yeah. I love that. Thank you for sharing that. And I've got a final question here, and y'all can both chime in on this if you want to. I'll start with Neil.
Daniel Williams:We've been hitting all these different points, but if you had one piece of advice to give our MGMA listeners who are running medical practices, who want to improve physician loyalty so their physicians aren't looking for that exit sign within that first year or two or three, what would it be?
Neal Waters:Yes. I think, one simple thing is, and it applies in many different parts of life, is put yourself in their shoes. You'll under get to know them. Get to understand what makes them tick. Each individual person, what are their career aspirations?
Neal Waters:What are their personal goals? You know, understanding those things about a person early on, is gonna help shape how you can make them happy in the immediate term and the long term. So developing relationships. Talked about it quite a bit. Work on that in the very beginning, and it's gonna make things so much smoother and easier long term for sure.
Daniel Williams:Alright. Tony, anything you wanna share as a final thought then?
Tony Stajduhar:Yeah. I think just getting people early on involved with others and help them get introduced to many people and continuing to try and foster those kinds of relationships. Sometimes, guess what? Sometimes we may think, oh, this would be a really good relationship, but maybe it's not quite right. That doesn't mean you say, oh, shoot.
Tony Stajduhar:I this guy or gal can't get along with anybody, so I might as well just give up. No. You keep trying. You know? You keep saying, oh, we're gonna have a little social get together.
Tony Stajduhar:Let's get everybody together. Let's do this and that. And just continue to do that and make people feel that they're a part of something bigger than just their own individual practice or or or So that that's the best advice I could give is just make sure to just keep trying. Don't ever give up.
Daniel Williams:Alright. Well, Tony, Neil, thank you so much for coming back on the MGMA podcast. Great talking to y'all.
Neal Waters:Pleasure. Great seeing you. Thanks, Daniel.
Daniel Williams:Alright, everybody. So the full research report, I'm going to give you the full title to it here, and I want to make sure I get this right. From Contract to Connection, How Authentic Relationships Foster Early Career Physician Loyalty and retention. Although Tony's telling me we may change that word retention there. We may do a late edit here.
Daniel Williams:But this research, y'all, has been co published by Jackson Physician Search and MGMA. We're both organizations very proud of this research. There's some great stuff in there. What I'm going to do is provide a direct link so y'all can access this. You can read it.
Daniel Williams:And we'll also provide that link in our episode show notes. So until then, thank you all for being MGMA podcast listeners.
