Survey of former providers: why do they leave Whittier?

Provider turnover has been a tremendous problem at Whittier in recent years. When multiple providers leave over a short period of time it creates problems for patients, for the staff who have to pick up the work of the departed providers, and it weakens teams. It also creates an unnecessary expense for Whittier, since the cost of replacing providers can run upwards of $200,000 per provider¹.

The turnover at Whittier has been highest in the primary care departments. 74% of primary care providers and 67% of RNs who were here a year ago have left. That’s about 5-10 times the expected rate at centers similar to Whittier².

Management has often stated that there’s not much that can be done about turnover, since they feel that many of the young providers they hire tend to come to Whittier to get established in their careers, but then leave soon thereafter for more lucrative jobs elsewhere.

Survey of former providers

What are the actual reasons why primary care providers leave Whittier so frequently? We recently got the answers to that question from a survey project conducted by a Harvard Public Health School student, a physician, in collaboration with one of our professional staff. One of the student’s primary career interests is to examine the ways in which community health centers can better retain staff and leverage needed resources.

All 25 primary care providers who’ve left Whittier since October, 2016 (two years before the survey project began) were asked to complete an on-line survey. 21 of the 23 providers participated, a response rate of over 90%.

Survey results

Providers were asked why they chose to work at Whittier. 80-100% said they were drawn by the mission of the health center and the particular population it serves. It also offered the fastest route to employment for a fairly sizeable number (71%); this is worth a separate discussion at another time, since Whittier unfortunately can’t bill for providers who are on-boarded before they’re fully credentialed, which often takes several months or longer.

While working at Whittier, providers said that they were satisfied or very satisfied with two main aspects of their work: the professionalism of fellow providers (95%) and the overall quality of non-primary care services that patients received (57%). A little less than half were happy with the quality of primary care services (43%) and the physical plant (43%).

Providers were dissatisfied or very dissatisfied with several aspects of their work: the adequacy of administrative support services, like scheduling, referrals, and case management (90%); the professionalism of non-provider staff (57%); and workload (57%). Not a single provider (!) in the study felt satisfied with the support provided by management, and more specifically by the CEO.

Providers seemed open-minded about working long-term in a setting like Whittier. The vast majority who left (77%) continue to practice primary care. As opposed to Whittier’s claim that providers leave for higher pay, most providers who left Whittier have not in fact moved on to much more lucrative jobs within the healthcare field. 61% are still working with underserved patients in the relatively lower-paying areas of community health (33%) and nonprofit primary care (e.g. hospital-based clinics) (28%). Additional providers are working in certain fields, such as in hospitals, rehab centers, etc., where pay may also not necessarily be much higher.

Summary

The responses confirm what most staff know from their experience: that improvements in the work environment, better managerial support, and/or improved clinical/administrative support services, would keep many providers at Whittier. These are some of the areas that a professional staff contract hopes to address, by giving staff a greater voice in improving their work environment and in enhancing the kinds of supports they need to better take care of patients and to enjoy their jobs.

Links:

¹ Recruiting Physicians Today, 2013 Physician Retention Survery, New England Journal of Medicine Career Center, The Staggering Costs of Physician Turnover, Today’s Hospitalist, August, 2016

² Provider Retention in High Need Areas, Negrusa, S. et al., Lewin Group Report, December 22, 2014

March 29, 2019