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Building and maintaining high-performing teams requires a diligent approach to recruiting and retention. Effective physician recruiting requires a clear vision, an engaging mission, and a team environment where a physician can envision success; effective physician retention relies heavily on the same foundations. A successful retention plan engages physicians meaningfully in the practice, provides productive feedback, and generates individualized plans for professional development. In this chapter key concepts and important steps for ensuring long-term, satisfying, productive relationships are described.

While most emergency medicine practices devote considerable attention to recruiting qualified providers, little focus is placed on retention of its members. Surveys indicate that relatively few organizations have formal retention initiatives in place; even when a plan exists, it may not meet the organization's needs adequately.1,2 Loss of physicians can be very costly, involving recruiting and relocation expenses; orientation and onboarding costs; and losses from low initial productivity.3-6 Physician turnover also affects the group's morale, team performance, and the reliable delivery of patient care. In addition, current staff must endure both the practicalities and the emotional toll of a new recruiting process. The reputation of the department (and even the stability of the contract) may suffer.

Physician retention is plagued by numerous challenges and sobering realities. In truth, well-trained, experienced physicians usually have many options in the workplace. Increasing workforce shortages significantly increase competition for qualified emergency physicians and other providers.7 The leadership and management skills required for successful retention programs may not be natural for (or viewed as important by) the physician group or its leaders. Finally, certain practice environments may not be ideal, producing additional pressures on physician retention.

Changing the Paradigm

A successful retention program complements successful recruiting and supports sustainable excellence in patient care. In practical terms, a successful physician retention program equips new physicians for entry into a practice while also addressing the needs of more tenured staff. Omitting key areas or missing simple steps can result in an otherwise avoidable departure. Optimal approaches involve basic “dos and don'ts” that produce a good work environment and promote engagement for each physician. Interestingly, the best retention plans result in the emergency department (ED) being “the place to be” and the “team to be on,” while truly engaging high-performing, team-oriented physicians. Strong leadership is critical to success, especially when there is a strong mission-driven foundation supported with considerable focus on the quality of relationships with colleagues (Box 101-1).

Box 101-1 Drivers of Physician Retention

Why Do Physicians Stay?

Physicians remain with a practice when foundational aspects ...

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