Compensation Amounts, Formulas: Key Reasons for Job Hopping

Compensation Amounts, Formulas: Key Reasons for Job Hopping

PCR interviewed Michael Broxterman, chief operating officer of Pinnacle Health Group, a physician recruiting firm in Atlanta, about reasons why physicians leave jobs, and what they’re looking for in new positions.

What’s the top issue leading physicians to change jobs? Our firm did an informal survey, asking our own 10 recruiters the most common reasons they hear from physicians already in practice for seeking a new job. We compiled the answers, presenting the top 10 reasons in order. Of course, every physician’s reasons are unique, and many cite more than one.

The No. 1 reason? We most often hear, “I’m not making enough money.” Of course, physicians know that in many specialties the top pay levels are in areas where they may not want to live, so most are willing to balance pay with location, type of practice, and position.

Are there other compensation issues near the top? Yes. We classified a wide group of “practice type issues” as the second most common reason for job hopping. Many such issues concern pay formulas and revenues. Some very productive physicians object to equal shares. On the other hand, lots of physicians want a regular paycheck and 9-to-5 hours, and so want a salary scale with no real marketing responsibilities at an HMO or hospital. Revenue issues include referrals within multispecialty groups and referrals that flow to single-specialty groups with strong reputations.

What other practice issues have you detected? Getting out of managed care is the second most common refrain we hear from candidates. The main thing there is money, but the practice-control issue also is important. So people want to go to locations or practices that don’t rely heavily on managed care revenues.

Physicians today are very concerned about where they live and family life. And those are our third and fourth job-changing reasons: geography and family issues. Some people want a particular city or state for a variety of reasons: climate, money, nearness to family, liking the community. Others just want to be near the beach or mountains.

Family events — marriage, divorce, starting a family, needing to care for elders — precipitate lots of job changes. Seeking fewer and more flexible hours at work to spend more time with family also is an important reason.

Broadly speaking, you’re talking about quality of life. That’s our fifth reason. Usually this means seeking a more family-or community oriented environment, and lower crime rate and cost of living. Often, this means looking for a small-to-medium-sized community.

Do many want warm weather year-round? Most do, and climate is our sixth reason. But some want the wind of Chicago, or four definite seasons. Within the Sunbelt, there is dry, like Arizona, and wetter like Houston and Florida.

What about relationships among physicians? That’s our seventh most common reason. Competition is common among physicians within a group or between groups in the same specialty. Sometimes personalities simply don’t mesh; there’s no chemistry. In small towns, the addition of a physician is usually a political issue.

What about if a practice hits hard times? That’s our eighth reason. Practices go bankrupt and dissolve. And there are other ways that practices repel their own physicians: getting too busy leading to burnout, restructuring in a way that hurts some people, or a steep worsening in a group’s business.

Shorter hours attract some people. Do longer hours send some away? Yes, and that’s our ninth reason. One of our recruiters had a client who was working 130 hours per week, an emergency physician two of whose three partners left the practice. Burdensome all coverage also leads some people to leave.

What’s your 10th reason? Very high malpractice premiums and frequent filing of malpractice suits. This mainly affects some states such as Pennsylvania and West Virginia, and will help states where such suits are more in control.

Is there an experience level when job changes are most common? Yes, two to five years out of residency. Residents choose a place to work most commonly based on money and location. Then they start working and find that other issues are more central to their happiness. They practice medicine in a different way or have different values than their colleagues do. So they start looking. A physician job survey done by another firm found the No. 1 reason to be simply “looking for change.”

PCR has done other articles about job changing and retention. Another issue cited was whether the physician feels he or she is meeting a need, is appreciated, and enjoys working with physician colleagues in the particular job. That’s similar to the politics and chemistry issue we cited. Physicians want to feel useful.

Another issue cited was having a voice on important group decisions and on administration and management generally. Often physicians leave be cause they’re not invited into partnership; they may “have” to leave or may want to find a practice that wants them more. Young physicians who want a say in management will usually be attracted to small and medium-sized practices. Lots of physicians don’t want a say; they may be attracted to Kaiser.

A related issue was wanting to go into management as a medical director or executive. We don’t hear this very often, but we do occasionally Physician management has grown significantly in the last few years but is still a fairly small segment of the profession. Most physicians want a clinical practice.

The last item we’ve heard that wasn’t in your survey was the quality of the organization, that is, of colleagues as clinicians, and of facilities, equipment and support personnel. Practice managers and support people are extremely important. The demands on physicians today are incredible, with low reimbursement, paperwork and other burdens. Physicians need good support, or they can’t practice good medicine. And they certainly need to respect their peers, especially in groups that work closely together clinically. Not all groups do.

What’s your outlook on physician job changes? Physicians are moving more and more and changing jobs more and more. It used to be that they would stay at the same practice for 20 years, but that’s less common today. Now they look at it as more of an opportunity, a job. That’s why the recruiting business has grown so much. There are more candidates looking, and more vacancies to fill, left by physicians who were recruited.

Contact Broxterman at (800) 492 7771 or mbroxterman@phg.com.

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