Hospitalist Turnover’s a Big Problem – Or is it?

By  |  December 17, 2008 | 

Leslie Flores writes…

When you ask hospitalist physician leaders or practice administrators about their most pressing challenges and concerns, physician recruitment and retention are always high on the list.  You have a heck of a time finding a hospitalist to join your practice, and the minute you do one of your existing hospitalists decides to leave – so you are always playing catch-up.  In fact the Phoenix Group, a think tank comprised of representatives from many of the nation’s largest private hospital medicine groups, recently identified the hospitalist workforce shortage as the single most urgent issue demanding the specialty’s attention (see the Phoenix Group’s white paper “Confronting the Hospitalist Workforce Shortage”).

As John Nelson is fond of saying, hospital medicine is a career with low barriers to entry and exit – and individual hospitalist jobs are the same.  You can leave a hospitalist practice tomorrow without having to worry about closing up shop and selling your assets or your patient list, choose from a dozen attractive offers, and be fully busy in a new job within a few days.  Because the demand for hospitalists is so much greater than the supply, and changing jobs is relatively easy, it seems like turnover is rampant among hospitalist practices.

But hospitalist turnover may not be as high as we think.  There are many examples of practices that have low turnover.  I recently visited with an eight-doctor hospitalist group in the Midwest that has been in practice for around 10 years and is just now experiencing its first unplanned turnover.  That’s amazing, and says something really great about the strong culture and internal cohesion that group has built.

The upshot is that we need some facts.  SHM’s Practice Analysis Committee is currently administering a Focused Survey that will attempt to capture accurate data on hospitalist turnover.  In addition, we are exploring the use of part time hospitalists and hospitalist participation in organizational quality improvement initiatives.  We are also updating the 2006 Focused Survey we conducted on quality-based incentive compensation plans.

At least one of these topics must be of some interest to you.  If so, I hope you’ll make sure your practice is participating in the current Focused Survey.  Even if none of these is a burning issue for your practice at the moment, we need your help to get accurate information.  The more practices that participate, the more representative and valid the survey results will be.  You can access the survey at and I hope you’ll do so soon and help us figure out what’s going on with hospitalist turnover – and improve the quality of our data about the state of hospital medicine.


About the Author:

Leslie Flores
Leslie Flores is a founding partner at Nelson Flores Hospital Medicine Consultants, a consulting practice that has specialized in helping clients enhance the effectiveness and value of hospital medicine programs as well as those in other hospital-focused practice specialties since 2004. Ms. Flores began her career as a hospital executive, after receiving a BS degree in biological sciences at the University of California at Irvine and a Master’s in healthcare administration from the University of Minnesota. In addition to her leadership experience in hospital operations, business development, managed care and physician relations, she has provided consulting, training and leadership coaching services for hospitals, physician groups, and other healthcare organizations. Ms. Flores is an active speaker and writer on hospitalist practice management topics and serves on SHM’s Practice Analysis and Annual Meeting Committees. She serves as an informal advisor to SHM on practice management-related issues and helps to coordinate SHM’s bi-annual State of Hospital Medicine Survey.


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