Residents, Recruiting and Retention

Today, as I write, the “R” of September prompts me to contemplate not oysters, but the three “R’s” of residents, recruiting and retention. The upcoming ACEP meeting in October coincides with the beginning of the recruiting season for senior emergency medicine residents and that too spurs me to offer a few thoughts about these aspects of an emergency physician leader’s job. The specialty’s publications, including Emergency Medicine News, see a spurt in positions offered advertising and the recruiters will be out in force looking to collect the curricula vitae of as many senior residents as they can. Ah, the sound of the whirring fax machine as it spits out all those pages of accomplishments into your and my in bins.

I’m addressing you who are recruiting or as is equally likely, hoping to retain the fine physicians who are already among your staff and colleagues. How well does the annual position chase serve your needs? Does this annual rite of autumn bring you concern that your some or many (!?) among your staff are searching for greener pastures? What can you do about it? What can you do about it now?

Retention begins during recruitment, by not over-promising nor failing to address the real questions of the candidates you interview. But, today you are contemplating the possibility that you will be one or two physicians short of full staffing in just a few months and you’re wondering if you can or should forestall their departures. Well, I’ve learned from sad experience that in the main a leader should not counter-offer or negotiate with a staff member who has already announced his/her resignation. It’s unlikely to really re-engage the departing physician and those that remain are likely to suspect that a “special arrangement” not available to them has been negotiated. As a consequence, you may receive other “resignations” intended to extract a “special arrangement.”

Nonetheless, talking to a restive colleague or staff member to learn why he or she is unhappy or looking elsewhere is a useful undertaking. The long-standing member of the group may simply be reassessing his or her value in the greater world of emergency medicine or seeking to learn more about a fundamentally different type of clinical practice: rural or urban, academic or community, urgent care or other sub-specialty. Staff members seeking to move to different geography or practice type deserve your best assistance. Introductions to colleagues elsewhere or referrals for informational interviews through the network of other directors and leaders you may know gives evidence of your support for the individual physician and enhances the likelihood that the departing physician will speak well of your practice. Assisting those individuals who are determined to leave also demonstrates to those who remain that you are interested in their individual careers. And, that’s the key to retention: Support the individual physician and his/her unique career aspirations.

Many resident graduates who you have recruited will need individualized attention if you wish to retain them on your staff. Much has been said in other venues about whether or not newly graduated residents are worth recruiting and I don’t intend to discuss the pros and cons here. Suffice it to say that after more than 20 years of preparing residents to go out into the world, I also actively recruit both our own graduates and graduates of other residency programs, but I’ve learned that newly minted residency trained emergency physicians do require additional effort on the part of practice leaders. That practice is not like residency seems obvious, but for the residency graduate who enters practice in a different environment, the experience may be more unsettling than is initially apparent.

So, starting today and regardless of your past failings, set aside the time to meet with individual staff members and learn their aspirations. For those physicians who tell you they only want to come to work and make a living, consider enumerating the opportunities available in your local environment, through professional associations at the state or national level or in sub-specialty niches. I’ve listed just a few of the many niche opportunities in Table 1.

Consider breaking down the problems you face into “bite-sized” pieces and sharing them with your restive staff members, along with your support and hand-holding to get the problem solved. It may take you longer, but you will have developed a new level of interest and commitment. For still others, you may wish to encourage exploration of the competitive landscape with the request that you want to know what they learn so that you can maintain your practice’s competitive position.

A theme mentioned several months ago: the pyramid of medical staff development also provides a tool to re-engage restive staff members. Begin by articulating a consistent set of expectations for practice members, but move to evaluation in light of those expectations quickly for those most restive. Your goal here is not truly to evaluate, but rather within the structure of your clearly articulated expectations, shore up the understanding of those expectations and allow for the most restive—and perhaps outspoken—to share their misgivings and concerns. The goal is personal attention to the individual and creation of an opportunity to turn inward looking staff members into engaged colleagues, concerned, as all should be, for the well being of the practice, hospital and the community. When staff members are engaged in improving the well being of the practice, the hospital and the community served, retention comes naturally.

Lastly, fair compensation and benefit arrangements accompanied by humane working conditions with sufficient staffing, the opportunity for meal breaks and arrangements for call-in staffing when overwhelmed can go a long way to assuring your staff and colleagues that you want them with you for the long-haul.

Table 1: Niche opportunities in emergency medicine

Air Medical Transport
Emergency Medical Informatics
Continuous Quality Improvement
Critical Care Medicine
Cruise Ship & Maritime Medicine
Disaster Medicine
Emergency Medical Services
Emergency Medicine Practice Mgmt and Health Policy
Emergency Medicine Research
Emergency Ultrasound
Hyper-baric Medicine
Injury Prevention and Control
International Emergency Medicine
Pediatric Emergency Medicine
Rural Emergency Medicine
Short-Term Observation Services
Sports Medicine
Toxicology