|SYMPOSIUM: LEADERSHIP AND TALENT MANAGEMENT IN ACADEMIC MEDICINE
|Year : 2016 | Volume
| Issue : 1 | Page : 46-51
Retaining talent at academic medical centers
Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, PA, USA
|Date of Submission||18-Nov-2015|
|Date of Acceptance||27-Dec-2015|
|Date of Web Publication||2-Jun-2016|
St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015
Source of Support: None, Conflict of Interest: None
Background: Faculty turnover is a major problem at academic medical institutions. A minority of medical school graduates choose academic careers and those that do have a high rate of attrition.
Methods: We conducted an in-depth review of the medical and business literature to determine high-frequency reasons for faculty attrition, and explored what strategies have been suggested or employed to reduce this trend.
Results: Medical and business literature demonstrate that faculty morale, perceptions of work-life balance, support from the institution, faculty development, rewards, protected time, relationship with superiors, and role clarity all play a role in faculty decisions to leave an institution. Institutions have shown some success in reducing attrition through recruiting to retain, formal mentorship programs, novel reward programs tied to longevity, faculty development, and attention to faculty professional and personal goals.
Conclusions: Academic medical centers should conduct retention analyses to determine commonly cited reasons for attrition at the global and departmental level. Measures to improve retention can be taken at every step of the recruitment, training, and seasoned employee level. Retention efforts are guided and enhanced by open and frequent communication between faculty and administration.
The following core competencies are addressed in this article: Professionalism, Practice-based learning and improvement, Systems-based practice, Interpersonal skills and communication
Keywords: Faculty attrition, faculty development, faculty morale, faculty retention, leadership development
|How to cite this article:|
Jeanmonod R. Retaining talent at academic medical centers. Int J Acad Med 2016;2:46-51
| Introduction|| |
Faculty turnover creates a tremendous burden on medical centers. Less than 10% of physicians currently entering the workforce choose academic careers. Studies demonstrate that up to a third of faculty resign from their academic positions within 3 years of hire, and 50% of clinical faculty leave their academic institution within 10 years.,, Of the physicians currently employed in academic practice, 10–50% are considering leaving their medical center in the next several years.,,,, For those that leave their academic position, 80% leave academic medicine altogether.
| Turnover Costs and Benefits|| |
The financial burden of faculty turnover is significant. In nonmedical business fields, the cost of recruiting, interviewing, choosing, and training an individual for a given position often exceeds 100% of the annual salary of the position being filled. There is also potential cost in the form of severance pay or accumulated sick or vacation time paid to the leaving individual and the cost associated with compensating other employees to perform the leaving employee's tasks. In medical fields, the lost clinical revenue (e.g., from fewer elective surgical procedures being performed) must also be taken into account. One study performed over 5 years demonstrated that the cost to replace clinical faculty ranged from $115,554 for a generalist to $587,125 for a surgical subspecialist, with the annual turnover cost to their departments of medicine and surgery exceeding $400,000 each. Other financial implications of faculty turnover are listed in [Table 1].
|Table 1: Financial costs to a medical institution incurred as a result of faculty turnover|
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The cost of faculty attrition is not just financial. Turnover reduces the diversity of the academic faculty. Minority groups and women, both underrepresented in academic medicine, are more likely to resign than men and majority groups, reducing the pool of mentors for female and minority students and junior faculty.,,,, Faculty that leave academic centers often are experienced leaders, and their loss results in loss of organizational memory. The leaving faculty may have a skill set that is rare or not easily reproduced, thus reducing the clinical and educational diversity available at an academic medical center. Further, loss of key faculty can adversely affect the morale and satisfaction of remaining faculty, causing them to consider other career options, as well.,
Not all turnover is harmful. Turnover gives an institution an opportunity to hire a faculty member from outside the medical center with fresh ideas or new and unrepresented skill sets., Turnover also may give a department an opportunity to restructure or to allow promotion from within the medical center, giving other faculty members opportunity for advancement and improving their job satisfaction., In addition, hiring a less experienced faculty member may represent a cost savings to the medical center in reduced salary or may allow the institution to help shape the new faculty member's skill set to fill a specific role.
| Why People Leave|| |
In order to implement effective strategies to mitigate faculty attrition, it is important to assess the underlying reasons for faculty resignation and determine which of those reasons are amenable to intervention. Not all turnover is preventable. It is helpful to think of turnover in terms of that which is unavoidable versus that which is avoidable.
Unavoidable turnover is turnover that is related to factors outside of the medical center, and sometimes even the employee's, control. This may be related to personal or family health issues, promotion or transfer of a spouse, or geographical needs of the extended family. These factors are by definition not modifiable, and medical centers will not get a significant return on their investment to prevent this kind of turnover.,
Avoidable turnover may be related to dissatisfaction with a current position, attraction to a perceived better position, planned turnover tied to specific goals (for instance, intending to leave a group after completion of training that would qualify the employee for a promotion) and impulsive turnover that is secondary to an unforeseen and sudden event. Although these are conceptually helpful when designing a comprehensive program to enhance retention, the most useful predictor of resignation is faculty intention to leave or engagement in leave-taking behaviors, such as looking at job postings or organizing one's curriculum vitae , Intention to leave is closely related to faculty morale, with perceptions of work-life balance, support from the institution, faculty development, rewards, protected time, relationship with superiors, and role clarity all playing a role.,,,,,,,,, Salary is only weakly involved in decisions to leave, although other benefits, such as protected time and research support, may contribute.,,,,,,, [Table 2] lists commonly cited reasons for faculty attrition.
| Why People Stay|| |
In all situations of faculty turnover, there are faculty members in similar jobs at the same academic institution who choose to stay. Understanding the personal and institutional factors that predict retention are a necessary consideration to preventing unwanted avoidable turnover.
In nonmedical business models, individuals are less likely to leave their employers if they are embedded within the company and the community. In other words, a person who has a sense of connectedness to his/her co-workers and superiors, as well as a social group within the community at large, will find leaving difficult, because it involves breaking important bonds., Collaboration, network reach, and collegiality are recognized as important contributors to academic physician job satisfaction as well, and when these items are judged favorably, it predicts faculty retention.,,
Faculty are less likely to leave an academic institution if their professional priorities and those of the institution are aligned and they feel they have the commitment of and are valued by the institution.,,,, Many academic leaders chose their careers for humanistic or intrinsic reasons,,,, and had their institution afford them protected time to fulfill this mission is important to their job satisfaction., Academic medical providers who feel they have an appropriate time allocation among their various patient care, research, teaching and administrative responsibilities are also less likely to leave their institution. In the same vein, faculty are more likely to stay within an institution where they have opportunities for advancement and professional development, and where they feel those opportunities are fair and equitable., 9, ,,
Beyond professional priorities, faculty are more likely to stay at an institution that supports their work-life balance. Female faculty, in particular, are more likely to opt for nontraditional or part-time employment in order to better balance the demands of their homes and their work, and institutions that strive to assist in obtaining this balance are more likely to retain these employees.,,,, Other reasons for faculty retention are listed in [Table 2].
| What Academic Centers Can Do|| |
Faculty retention starts with recruitment [Table 3]. When recruiting faculty for a specific job, choosing a person whose goals, skill set, and personality align with those of the academic center is important.,, Academic centers should provide accurate, detailed descriptions of job expectations including clinical work, research, teaching, and administrative responsibilities. Role clarity has been shown to correlate with worker retention. Therefore, the process of recruiting as well as all aspects of the position should be as transparent as possible. The academic center should communicate the culture and the values of the institution during this process, as these things may not be readily apparent to the applicant but are important aspects of determining how well he or she “fits” into the organization., The process of recruiting academic talent is addressed in detail elsewhere in this symposium.
|Table 3: Strategies academic medical institutions can employ to aid retention of faculty|
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Provide adequate compensation
It is imperative that academic medical centers provide competitive compensation to their faculty. Although lower salary is not highly predictive of faculty attrition, it does have a weak relationship. Skilled faculty are occasionally offered positions at other academic centers when they are not actively seeking new employment. A faculty member who feels he/she is adequately compensated for his/her work is less likely to be tempted to leave the institution for a better offer from elsewhere., Competitive salary is also crucial in those faculties actively looking for new positions, as salary is a concrete measurable variable that is easy to compare across institutions, while many other variables are categorical and not as easy to quantify.
Beyond salary, academic medical centers should be externally competitive in other compensation, such as health and dental insurance, disability and malpractice insurance, continuing medical education, paid vacation, and retirement packages. This compensation is also largely financial, and can be itemized and compared by faculty looking for new careers. Medical centers should be familiar with compensation of other academic institutions in their geographic region to remain competitive within the market.
Academic institution should seek to provide compensation in other novel ways, such as covering travel costs for faculty presenting research or didactics, providing statistical or manuscript writing support, pilot funding for research, and debt management support. These items are less quantifiable and are unique, but may be important considerations for productive academic faculty leaders when choosing a job.
Foster connections at work and at home
Academic centers should encourage links among faculty with one another. Medical centers should promote collaboration and working in teams, whether within a single department or in a multi-departmental fashion., This can be done formally through, for instance, regular faculty meetings, group grand rounds, or through financial support for research contingent upon involving multiple departments. This can also be done in a more informal manner, through bonding days or multi-departmental social events. On a smaller and more personal scale, medical centers should support formal mentorship within their departments to assist young leaders with advancing their own careers and understanding where they fit in the global institutional mission.,,,,,
Academic centers can support faculty embeddedness within the community through encouraging home ownership (through home buying assistance, e.g.,) or volunteerism. Promoting activities involving the academic institution and the community at large may also foster a feeling of connectedness between faculty and the community.
Support faculty development
Academic institutions should strive to develop their established leaders. The relationship between a leader and those he/she supervises is an often cited reason for job dissatisfaction in academic medicine as well as other fields.,,,, Institutions should provide or require formal leadership training for any faculty who is in a supervisory role and assess these leaders for proficiency. Ineffective leaders should be removed and replaced.
Academic institutions should also actively seek to develop junior faculty members. Regardless of supervisory function, faculty should be provided time, money, incentives, and opportunity for personal career development.,,,,, This has been cited by physicians as being important to their job satisfaction,,, and faculty development programs have been demonstrated to improve faculty academic productivity and retention.,,, Developing faculty may make them more marketable for other career opportunities at other medical centers, tempting those faculty to move elsewhere for promotion. This may be ameliorated by tying faculty development to promotions or rewards within the home academic institution, thus reducing any temptation to leave. A detailed discussion of faculty development is provided elsewhere in this symposium.
Provide rewards and opportunity for advancement
Academic institutions should provide recognition, reward, and opportunity for advancement. Particular attention should be paid to part-time faculty and female faculty, who report that lack of opportunity for advancement and promotion is a common reason for dissatisfaction and job attrition.,,, Compensation and reward structure should be equitable and fair, with requisites for advancement clearly communicated., Attention should be paid to bonus structure and benefit requirements, which often penalize part-time employees. When possible, rewards and advancements should be tailored to individual faculty needs and preferences. For example, Stanford University has developed a unique time-banking reward plan where physicians can use earned time credit from performing under-reimbursed activities, such as mentoring, for concrete services, such as babysitting or housecleaning. Other institutions have allowed for job sharing among faculty or extension of benefits with lower total full-time equivalents. Some institutions will allow faculty to have part-time clinical status while maintaining full-time academic status, allowing part-time employees the full promotional consideration of their academic position even while reducing their clinical workload. This sort of novel and personal reward system gives faculty a sense that the medical center is invested in them and cares about their individual needs. This investment has been shown to enhance faculty members' perception of their work-life balance and their regard for their institution. Rewards can be tied to longevity to enhance retention (e.g., tenure track or academic vesting process).
Assess and reassess faculty goals and satisfaction
Medical centers should provide periodic reviews, both to inform the faculty member of his/her performance as well as to assess the faculty person's overall satisfaction with his/her position. Positive feedback for a job well done not only allows the faculty member to feel valued by the institution, but also gives the impression that the medical center is quality driven, and may increase the esteem in which the faculty holds the institution., Regular meetings also create dialogue and engagement between faculty and administration, which fosters more interpersonal connectedness in the workplace and supports establishment of common goals.,,,
The importance of assessing for faculty satisfaction cannot be overestimated. Faculty engagement in their work, regard for their institution, and sense of loyalty are the biggest predictors of faculty morale, and faculty morale is the most significant factor in faculty decisions to leave their academic institution. Once faculty start to engage in leave-taking behaviors, such as looking for jobs or organizing their CVs, they have a very high likelihood of leaving their positions., In other words, once a faculty member starts looking at other jobs, he or she is already gone. Therefore, it is of critical importance that administrators check in with faculty to assess their engagement in their work: Specifically, whether they have enthusiasm for their positions, whether they feel satisfied and intellectually stimulated, and whether they are meeting their own professional goals. There is no “correct” proportion of time devoted to clinical practice, research, teaching, and administration that suits all faculty, but faculty who spend <20% of their time on the activity they find most meaningful have a higher incidence of burnout. Academic institutions should maintain some flexibility for faculty members to engage in meaningful work related activities as long as the fundamental needs of the institution are being met.
Academic medical institutions should conduct exit interviews of faculty who are resigning from their positions to determine the modifiable factors that were involved in the decision., Retention analyses should be conducted for the institution as a whole to seek systemic problems that might be addressed globally to enhance retention., Turnover analyses should seek individual themes involving turnover (e.g., leaving for another institution that provides more protected research time) that might require a more focused approach.,
| Conclusions|| |
A proactive approach to faculty retention begins at recruitment. Competitive compensation, benefits, faculty development, work-life balance, and appropriate protected time are important features to promote retention. Retention efforts are guided and enhanced by open and frequent communication between faculty and administration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]