The Physician Superfecta
Four elements needed to retain talent during a time of professional crisis
Happy Saturday from Austin, Texas. Physician retention is something weighing on my mind recently. So I began to work it through in my notebook this morning. Here’s what I came up with. Something to make you think, hopefully — and so I’d love to know your thoughts.
In my current role I've been thinking about talent retention. We have built an amazing hospital and worked hard to fill it with 148 amazing physicians. But how do we keep them? And how do we keep them happy?
Talent retention in medicine was never something we had to think about. But burnout and professional flight are real issues. We need to think intentionally about our local work culture and the broader needs of the profession.
So I got thinking about four things we need — a superfecta (initially, I had a trifecta but came up with a fourth and learned that it's called a superfecta). This is a kind of Maslow's hierarchy of needs for a profession in crisis.
Mission- A professional purpose based on values and professional identity. Young doctors more than ever need to be inspired by and drawn to a sense of purpose.
Safety - The belief that someone is advocating for them and their ability to do their work. Doctors need to feel safe in their space and in their groups. Safety is a powerful need as professional sovereignty has eroded over the past generation.
Community - A group of local colleagues they trust, and who trust them. Their work family, and the people they can lean on for support.
Agency - The capacity to have some control over decisions and their day-to-day work. Physicians need to be empowered as the knowledge workers that they are.
Mission at the top is high level and more about the broader needs of the profession. Agency, at the bottom, is about the needs of the individual.
Fulfillment of these four elements requires strong leadership, something missing at all levels in medicine. If these basic needs aren’t fulfilled in our professional space, physicians will seek agency and purpose through organized labor, or by simply looking elsewhere. Or perhaps worse, remaining to care for patients without any sense of purpose or belonging.
Retention of medical talent has to be a priority for every great organization. Think of the physician superfecta as a kind of basic blueprint for thinking about retention. I think I could shape this into something bigger for organizations struggling with this issue.
I’d love to know what you think about this, or what I’m missing.
Image via Unsplash.
As a physician, the rise of nurse practitioners has been the ultimate slap in the face. This is something we’ve given our lives to, then we see untrained posers slip into our role like a pair of cheap pants.
Hospitals expect us not only to cover for them, but to treat them as peers. Not only that, but we can no longer trust any referral or read or test at all. The stories are legion. It is the ultimate insult to many of us; and I don’t see where this fits in the superfecta.
This is important. The most frustrating thing I see as a patient and observer of my loved one’s experience, I now realize contributed to my early retirement from clinical practice. It is a lack of time and attention to proper communication and follow through with the patient from the intention set by the doctor to the delivery of intended services. As a practicing physician, I had to pick up the slack in this aspect of the system personally and it took a toll.
Systems need to be in place to automatically advocate for every patient and lead them through the steps of their care. The onus shouldn’t be on the patient to badger for appointments to be made, referrals to result in closing the loop communication (that includes the patient), tests and procedures to be approved, scheduled and reported and acted upon in a timely way etc.
So many excellent doctors report they can’t fix it or it is out of their control. We need to fix this as a system or build in these resources for both patients and doctors. The lack of success in this essential aspect of care reduces patient confidence and safety, which
In turn negatively affects outcomes. Worse yet it leads to doctors burning out and patients walking away in frustration only to return sicker later. We shouldn’t have patients and doctors both just giving up.