Before matriculating to medical school, I spent several years managing a technical sales team at an informatics-based technology company in San Francisco. I had recently graduated from Stanford University and was putting off medical school to move to San Francisco and gain some life and work experience before committing my next decade to medical training. Although I was young, by virtue of hard work and some luck, I was offered a managerial position much earlier than I anticipated. I ended up deferring medical school for three years — and I learned some valuable lessons about managing high-performing teams that have proven valuable during my medical training.
Now, I work primarily in an outpatient clinical environment, and staff turnover in our organization is a hot topic. As physicians, we rely on a multidisciplinary team — our efficiency depends on our support staff and our reviews often depend as much on our front desk as on our physician-patient interactions. Staff turnover impacts physician satisfaction, patient care, and the practice’s bottom line. Despite this, we get little to no managerial or leadership training in medical training. Based on my experience in people-first tech organizations, I’ve assembled five strategies for decreasing staff turnover in your medical practice:
1) Define and declare the purpose of your organization. The organization I worked for prior to medical school was a SaaS (software as a service) data and analytics business, but they didn’t define the organization by what their product did. They brought multifunctional teams together and hired effectively (growing from 50 to 250 people during my tenure) with their strong mission statement: “to help the world learn from its data.” In medicine, there is purpose built into what we do (help our patients), but implied professional purpose is not a substitute for defining organizational purpose. Perhaps your mission will be aspirational and broad; perhaps it is niche and specific — but whatever your style, it is imperative to define your mission statement and use it often. Spend time defining your group’s mission and involving staff in your collective broader purpose.
2) Get to know each member of your team. Understanding teammates’ motivations helps anticipate natural turnover. The first mistake I made as a manager was assuming that everyone on my team had the same goals and motivations that I did. The reality was, I ended up taking a different path than every single person in my company (I decided to go to medical school!). Of course, my motivations were drastically different from my teammates. When I invested in each of them through scheduled check-ins, casual lunchtime conversations, and genuine interest, I learned that each member of my team had different goals. One wanted a steady, dependable job that allowed them to spend more time with their partner and focus on their growing family; another was focused on gaining technical skills to eventually start her own company. Knowing this, I could anticipate how long each of them were likely to be happy in their role, and I could feed them projects and opportunities that would be more meaningful to them and keep them engaged.
At our clinic, we’ve had medical assistants suddenly put in their notice to go to nursing school. We’ve had staff unexpectedly announce they’ve found a position working closer to home. When we can anticipate these changes, we are thrilled for our staff members who are getting opportunities we may not have been able to offer. When we are surprised by these changes, it is easy to feel blindsided and hurt, especially because we then have to scramble to fill open positions with first-available candidates, repeating the cycle.
3) Build an organizational structure and match your hiring practices to well-defined roles. Give some thought to how long you expect team members to stay in their position and build out your organizational structure accordingly. I know a physician who runs a small practice and routinely hires pre-medical students to work as her medical assistants. Similar to an academic practice that relies on residents, she has built an organizational structure that expects these positions to turnover every one to two years, and is designed to launch students to their next stage. She feels this program works for her because though her assistants turn over frequently, they are highly motivated and learn quickly. Her organizational structure is willing to accept a short turnover time and builds in time for overlap, which allows the previous class to train the incoming students.
Alternatively, I know physicians who expect to work with the same physician assistants or front desk staff members for many years. For these physicians, it is expensive and exhausting to train staff, and they do not want to have a fully-ramped clinical team member decide the role is not a good fit after six months on the job. Their organizational structure and planning should account for this desired longevity — it should build in leveling and opportunities for growth, and secure management, promotion, and pay increases for staff. These expectations and opportunities for growth should be clear in interviews and job postings. Turnover can be part of the natural life cycle for many roles in a medical practice – but the point is to be able to anticipate, support, and celebrate it. Planning ahead prevents disappointment, surprise, and resentment.
4) People management is not optional. If you need help, outsource. As physicians, we are on a well-defined track, and most of us keep pushing through training until we get to the end. For this reason, in medical school and residency, our superiors are not focused on keeping us around – where would we go? We are a captive audience, either paying tuition to be there or having landed a coveted if inflexible residency spot. Once we’re out in practice, however, the team structure is different. Your staff are at-will employees and can pursue a better opportunity at any time. This can be tough to remember because many of us are stuck in the “stick it out” mindset. You can be an incredible boss leading an organization with an awe-inspiring mission, but just as we keep up with medical literature and advances in our field, managers need to understand the market forces behind hiring and growing staff. This can include market research on salary comps, as well as keeping a pulse on the number of other opportunities available to your employees. It’s a time commitment, but if you want to keep great people and have great retention, people management is not a nice-to-have. If you cannot do it or don’t have the time, outsource. Hire a business and people manager, or, even better promote a strong employee looking to grow into the role.
5) Don’t repeat the bad habits you learned in medical training. Although a fair portion of medical school consists of intense, solitary knowledge accumulation, once you hit the clinical world you will find yourself working in teams of varying permutations. From the hierarchical academic pod rounding in the hospital (led by an attending physician, senior resident, junior resident, and gaggle of medical students), to the multifaceted OR (with a surgical team, anesthesia team, nurse circulators, and scrub techs), to outpatient clinics (interfacing with front-desk staff, medical assistants, nurses, and clinicians), there were a few times I was inspired by the cohesiveness, unity, and efficacy of the teams I floated into. More often than not, I felt like the most basic people management skills were not prioritized. I feel fortunate to have worked in a different industry prior to medical school because it gave me the perspective of a markedly different management style.
I urge you not to repeat the bad habits you experienced in medical training. Strive to be better. Dr. Charlotte Grinberg writes about infusing basic management tips that can be used on the wards, such as setting clear expectations and providing regular, consistent feedback. Entire books and graduate degrees focus on effective people management — learning and incorporating these principles into your practice will pay dividends.
Finally, give yourself grace. Staff management can feel like one more “to-do” item on an ever-growing list of physician responsibilities. Remember that turnover can be a natural part of a healthy business model and does not necessarily reflect a personal failing or poor business decision making. I have certainly had temporary working relationships that have been fruitful and even transformational. For the “Ted Lasso” fans, as Higgins tells Keeley, “A good mentor hopes you will move on, [but] a great mentor knows you will.” Mentorship is a broad term; while you cannot act as a mentor to every member of your team, you should aim to be a good manager to each of them. Your practice will reap the benefits.
How do you train and retain staff members in your clinical practice? What works and doesn’t? Share your expertise in the comments!
Rebecca Yanovsky Dufner, MD, MBA is a resident physician training in dermatology in Boston, MA. She graduated from Stanford University, Tufts University School of Medicine, and the Heller School for Social Policy and Management. In addition to her passion for dermatology, she has led cross-functional teams in health care and in tech, and is interested in health outcomes, access, and delivery on the patient and population level. Rebecca is a 2021–2022 Doximity Op-Med Fellow.
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