July 26, 2022
10 Minute Read
Our physician workforce is burned out. For the past 10 years, about half of doctors have considered a major career change, including retiring early, switching employers, or leaving medicine altogether.
While the pandemic spotlighted this issue, it goes back much further, stemming from a profession that has become unsustainable for many doctors today.
Employers who provide physicians with the meaningful autonomy, ample time, and seamless support to thrive as both doctors and people will win physician talent.
We use the terms “employer” and “employee” to refer to the relationship between practicing physicians and the organizations they work for. We recognize that many physicians are shareholders or contractors, but use “employee” throughout our work since 73.9% of physicians are employed. Our insights are applicable to physicians across many practice arrangements.
In a 2021 survey from the American College of Healthcare Executives, CEOs for the first time ranked staffing challenges as their top strategic priority. And for good reason. From PPE shortages, to acute burnout, and now shortages in many roles, our workforce has endured a lot under Covid-19.
But this problem goes beyond the pandemic for doctors. For the past 10 years, about half of physicians consistently have considered a career change, such as retiring early, switching employers, or leaving medicine. There is long-standing, deep-rooted discontent in our physician workforce.
While the pandemic didn’t create this challenge, it did draw attention to it and force executives to double down on retention. Employers have relied on traditional tactics to date, like increasing compensation, offering extra benefits, and creating wellness programs. Many organizations focused on these areas for good reason. These approaches are tangible, quicker to implement, and can be marketed in a job description. And, like employees in any industry, doctors care about them, too.
But these tactics are now table stakes. Employers will certainly lose physicians without competitive compensation and benefits, but they won’t retain doctors with these tactics alone. In 2021, 69% of physicians reported feeling actively disengaged from their employers, even as salaries rose by 3.8% on average.
We have 10 years of data (below) proving that we need a new approach.
| Year | Percentage of physicians considering career changes |
|---|---|
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2012 |
51% |
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2014 |
44% |
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2016 |
46% |
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2018 |
48% |
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2021 |
54% |
At the core, physicians just want to care for patients. While this sounds straightforward, doctors run into barriers every day that make it hard for them to do their jobs. And these same barriers often interfere with their personal lives. For example, documentation requirements not only burden physicians with more administrative work, but long hours in the EHR also cut into personal and family time. In fact, after-hours work in the EHR is so common that there’s a dedicated term for it: “pajama time.”
While many caregiving professionals view their profession as a calling, we’ve relied on their goodwill and loyalty for too long. We must recognize that all clinicians are people with basic needs and expectations like any other employee. Physicians are both doctors and people. Employers who respect both parts of their identity, allow for more balance, and make the practice of medicine more sustainable will win physician talent.
This isn’t easy but it is within executive control. And there isn’t just one employer type or model that can provide it. All employers can improve the physician experience—whether they’re health systems, independent practices, aggregators, staffing firms, or any other organization. Doctors care less about who the employer is and more about what they offer. However, this could be a moment where certain employers emerge as more or less attractive, depending on their commitment.
Becoming the employer of choice means... Giving physicians the meaningful autonomy, ample time, and seamless support to be both doctors and people
In our research, we surfaced three ways to differentiate yourself as the physician employer of choice: meaningful autonomy, ample time, and seamless support.
Our goal is to help you do two things:
1. Center the physician experience: Executives should take an employee-centric, not employer-centric, approach to attracting and retaining talent. We’ve written the following pages from the physician point of view to directly communicate what physicians want from their employee experience.
2. Translate between doctors and executives: There is considerable dissonance between these two stakeholders, with executives often misinterpreting what physicians want. We’ve helped remove the guessing work by translating physician asks into tangible tactics to implement.
We do this by drilling down in four areas:
With this research, we dive into more detail about what it takes to give physicians meaningful autonomy, ample time, and seamless support so that they can thrive both as doctors and people. Our goal is for this research to be a starting point. We provide examples, not an exhaustive list, in order to jump-start conversations between employers and their physicians. We elaborate on more use cases for this research in the parting thoughts section on page 11 of the PDF.
Autonomy is what physicians value most in their current roles, according to data from Advisory Board’s 2022 Clinician Survey. However, it’s hard for physicians to lobby for autonomy. It’s a vague request that can be hard to operationalize. And focusing on physician autonomy can seem to run counter to other organizational goals. Below, we’ve listed the three common types of autonomy that physicians want: clinical autonomy, schedule autonomy, and strategic autonomy. We’ve ordered them from most to least common, but an employer of choice will offer physicians all three.
| What physicians actually mean | What this ideally looks like in practice | What physicians need from you | What to highlight in your retention plan |
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I have clinical autonomy to make decisions that are best for my patients. |
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I have schedule autonomy to spend my days in a way that works for my patients, my family, and myself. |
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I have strategic autonomy to help shape the practice’s future direction. |
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As care delivery becomes more complex, we’ve had to ask our physicians to do more, whether that’s documenting in the EHR or caring for a sicker patient population. To do this, physicians need more time, and they need this time to reflect all that they’re responsible for—during and outside the visit, clinically and administratively, personally and professionally. Many physician employers have already started standardizing schedules for patient access and other reasons. These initial steps can be a starting point for making sure physicians have ample time to do their jobs.
| What physicians actually mean | What this ideally looks like in practice | What physicians need from you | What to highlight in your retention plan |
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I have enough time during each visit to care for patients. |
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I have enough time outside the visit to complete all work within business hours. |
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Doctors run into barriers every day that make it hard for them to do their jobs. While a seamless workflow might feel overly optimistic, all employers can take steps to make the physician job easier. This requires both technology and care team support. Employers should offer both, but there may be times when employers need to focus more on one than the other. For example, as we write this in the summer of 2022, many execs must rely on tech to fill staff shortages. A final note: Compared to autonomy and time, this is more about supporting doctors clinically rather than personally.
| What physicians actually mean | What this ideally looks like in practice | What physicians need from you | What to highlight in your retention plan |
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I have the care team support I need, clinical and administrative, to practice at top-of-license. |
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I have the technology support I need to perform my job easily. |
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All stakeholders in health care, whether or not they directly employ physicians, play an important role in making it easier for doctors to do their jobs and be people. Below we’ve outlined a few use cases for this research.
Employers: Like we mentioned earlier, this research is a starting point, not an exhaustive list. Executives should tailor this work to their organization and define what meaningful autonomy, ample time, and seamless support look like for them. While it takes all three to be the physician employer of choice, they will show up differently at different employers. After adapting this research to your organization, take it to your physicians to ensure that it resonates and reflects their needs. To help, we’ve included a few conversation starters below:
Other stakeholders: While not all health plans, digital health vendors, and life sciences companies employ doctors, they all directly impact the physician experience. Partners who can demonstrate that they help employers give their doctors meaningful autonomy, ample time, and seamless support will be more attractive. For example, health plan partners may highlight efforts to reduce prior authorization and other administrative hurdles. Use this research to ensure that your solutions make it easier for doctors to do their jobs.