Why So Much Staff Turnover?

What Medical Shift Is Underway

Staff Instability, What Its Really Costing Your Practice?

It’s clear to me after working with practice groups for the better part of fifteen years, that the growth and profitability of practice can never be achieved or maintained if there is instability in the workplace or the workforce. This is especially true when it comes to a fee for service medical practice or group. Staff configuration and alignment is critical.

Simply put: To be the best, you have to have the best staff!

I have heard many doctors say quite frequently, “ No one is irreplaceable, everyone can be replaced, finding quality replacements is easy” in this job market.

Nothing could be further away from the truth.

The fact is, that it is neither simple nor easy to find or build a great staff in the medical community. As a point of fact, it costs lots of money to replace experienced, qualified, and well-trained staff members, not to mention the brain trust that goes along with their experience.

Think about the amount of time and effort your existing Practice Manager, ancillary staff, and other members spend training them and showing them all your processes, procedures, protocols, computer systems as well as IT software. It becomes easy to calculate the financial loss. Not to mention HR resources, stationery, and your other intellectual investments for just one new hire alone.

The loss of staff has various reasons, but here is a list of the most consistent reasons you may have heard or seen:

Factors That Lead to Attrition

  • Low Wages
  • Childcare Issues
  • Lack of Clear Job Descriptions
  • Micro-Management
  • Lack of Employee Reviews
  • Unrealistic Performance Expectations
  • Failure to say Thank You or Job Well Done
  • Discriminatory Work Environment
  • Personality Conflicts
  • Outdated Equipment or Process and Procedures
  • Rude/Ill-mannered/Ill-tempered Doctor or Practice Manager
  • Failure to create work versus home life boundaries

Whatever the reason, when a tenured staff person departs that person leaves and takes with them all your teachings, new techniques, and training just to enhance the practice of another doctor, who might possibly be your competitor!

Prospects are much more informed and as a result, expect a higher quality of care and professionalism. You can’t create that experience with high turnover.

No Doctor or Practice Manager wants to be held hostage by their staff, nor should they be. Our point here is that some team members are indispensable. It is also true that when your patients notice a high turnover of staff, they feel less secure and confident about the doctor or the patient care process.

Patients look for and need the security that comes from seeing and having a familiar face to speak with about their issues or concerns. It’s part of the continuity of patient care. A familiar face ensures a consistent patient experience at your practice, they want to know what to expect and whom to expect it from.

This is extremely important as a fee for service practices are on the increase. What will set you or your practice apart when patients are being swayed about making buying decisions is your staff.

Just think about it, how would you feel if you saw new faces every time you visited a business establishment. Constant change, lack of familiarity and instability can be very unsettling and detrimental to your practice. Your patients need to know who they are dealing with on a regular basis, a friendly face who has access to their very personal information and medical records. Seeing familiar faces builds trust, builds confidence and builds reassurance about the kind of care they can expect and will receive at your practice and with your staff.

How Do You Attract and Keep the Best Staff

  • Offer a Competitive Wage and Benefits Package
  • Create a Positive and Encouraging Work Environment
  • Encourage Friendly Competition surrounding positive patient reviews
  • Promote Continuing Education and Self Development
  • Avoid, Absolutely Avoid Micromanagement (Time Waster)
  • Avoid overutilization of salaried employees with excessive hours over 50
  • Provide consistent and positive feedback related to their performance
  • Get their input about changes in process and procedures

Doctors and Practice Managers must recognize, that just as you compete for new patients, you must also be prepared to compete for the best personnel to add to your staff. Even Google, Apple, Facebook, and LinkedIn compete with one another for the best staff. All the more so for the more competitive areas of Plastic Surgery, Cosmetic Dentistry, Dermatology, Medical Spas, Anti Aging, Concierge Medicine or any other fee for service business.

It is both the job of the Doctor and the Practice Manager to actively find, recruit, hire, train, and retain the best practice staff for improved patient experience and to help grow practice profitability consistently.

In Order to Get What You Want, You Must Help Others, Get What They Want.

What about wage increase requests, given that this is one of the highest reasons for turnover?

It is very important to note that wage increase discussions are not the time for a performance review or appraisal. Any such issues or discussions should have already occurred, long before now. Ideally, your discussion is based on the percentage of increase if a prior review was positive.

We believe at Social Media Solutions for Doctors that each job within your practice should already have a wage increase guideline based on position, annual revenue growth, and employee performance evaluation. Wage increases should always be based on the financial health of your practice and how individual employees contributed directly or indirectly to the practice profitability.

The longer the tenure, the better work performance should be, this, in turn, improves workflow, the speed of delivery, and the quality of patient care. Other factors relate to product up-sells, the dollar value of sales per transaction, and consultation closure average for leads handled which in turn raise practice profitability.

When staff members request a raise in wages, several factors must be reviewed and taken into consideration.

Recap for Raise Request


How long has the staff member been with your practice?


How have they performed in accordance with their job descriptions?


The number of days absent from work or tardy beyond ten minutes.


How vital is the service they perform in your practice?


What is the cost to find, hire and train someone new?

When you have the discussion, it is important to be prepared. You should have all the necessary information and facts at your disposal:

  • Job description
  • Attendance record
  • Figures that indicate the affordability of granting such an increase
  • How they get along with their peers
  • How much patient interaction do they have daily

The Employee Review Process:

The 30 Day Review

The new employee is given their orientation, job description, a benefits package, and work schedule confirmation. Additionally, they are also meeting their peers, getting up to speed with process and procedures as well as seeing if they are a good fit for their new role in the practice. Your observation of them throughout this process is critical.

The 90 Day Review

This can be used to see if the staff member has met or exceeded their job description. If so a slight raise may be in order, but bear in mind that it should only be a percentage of what would be given for an annual review. If further improvement is needed, then the next opportunity would be the six-month review.

The 6 Month Review

The purpose of this review is to ensure that the new employee is staying on track and to bring up any issues on both sides. You can also use this opportunity to offer as an incentive, usually a percentage of the raise due for the year.

The Annual Review

This is the time to give commendation, say thank you for a job well done and give the remainder of the scheduled wage increase for the year. Apart from as a reward for a job well done, a raise is your way of saying not only thank you but to indicate that you value their service and would like to keep them.

So in conclusion, while on the surface it may seem that your staff is replaceable. The truth is it takes both time and money to replace the knowledge and experience of a tenured staff member. It also slows down future growth plans and sustained growth in other team members because they get saddled with picking up the workload for a missing or new hire trainee. Which reduces productivity gains from their job responsibilities and continuity within the practice.

Profitability and sustainability of your practice is a team effort and you are the Team Leader, so be flexible, be their coach, cheer them on when they treat both their internal and external customers well.

As a group, you spend more than forty hours per week together. Make it time well spent for one another. Make your practice elite and successful by being the place that most people want to work. It will definitely show in your bottom line and peace of mind.

An Annual Practice Review will go a long way to identify problems and issues related to staffing before they reach a critical stage. It will also help to provide and encourage an open-door policy that focuses on team building, providing weekly practice and staff development sessions, and to help you to create and implement an anonymous suggestion box that allows staff ideas to be considered. No Doctor or Practice Manager is an Island unto themselves, you can’t run a practice alone. So make staff retention a primary focus in your practice.

So who’s to blame you say? It’s everyone’s job in management to improve the organization. By keeping an open mind you can see opportunities to provide additional training and compensation to ensure you keep a cohesive and upbeat staff?

And just remember, a staff that feels appreciated will always do more than what’s expected!

You can find additional Practice Development and Social Media Insights on my LinkedIn Page.

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Quintin L. Gunn Sr. CSO/CEO – +1-407-702-4408 Work