1. Retention and Recruiting:
Is there a right time to let them go?
Jeffrey B. Matthews MD FACS
Dallas B. Phemister Professor and Chairman
American College of Surgeons
Society of Surgical Chairs
2014 Annual Meeting

2. We Wear Many Hats Institutional Departmental Coach Mentor Advisor
Buster Keaton, in Steamboat Bill, Jr (1928)

3. Leadership paradox
If we are doing our job well, we are making our faculty successful such that they will become desirable targets for recruitment.
If we are doing our job well, we are growing the clinical and academic base of our institution are are able to retain profitable surgical volume and critical research grants.
How do we retain and grow our faculty, and at the same time prepare them for success beyond our walls?

4. Letting them go… Various scenarios
Outstanding faculty member who is being lured away
High-maintenance
Disgruntled
Multiple retentions
Underperformer
Problem child
Lateral move vs. promotion
Presentation Title Here |

5. Letting them go… Various scenarios
Outstanding faculty member who is being lured away
High-maintenance
Disgruntled
Multiple retentions
Underperformer
Problem child
Lateral move vs promotion

6. Real World Example
An NIH-funded academic cardiothoracic surgeon expresses frustrations with opportunities to grow his clinical practice or to advance administratively. In his early 40s, he aspires to lead a CT Division. His current chief is is an extremely busy cardiac surgeon in his mid 50s who is greatly valued by the institution.
A local community hospital has offered him leadership of CT with promise of support for research program.
He seeks your advice.

7. Real World Example
He is retained with additional salary and academic support. He redoubles his research efforts and obtains R01 funding. He takes on additional roles in department research strategy. He develops a clinical niche in arrhythmia surgery. He still wishes to become a Chief.
An outstanding academic medical center now begins heavily recruiting leadership of their Division of CT Surgery.
How should you work to retain him? Or should you encourage him to pursue the opportunity?

8. Considerations Aspirations? Skills and attributes?
Do their talents align with their goals?
Has there been career advice and counseling all along? Trust issues…
What are the opportunities for development in your institution?
Is career laddering possible? What types of roles?

9. Meeting the faculty member
Timing of the discussion? Theoretical? Offer in hand?
Has the faculty member been forthcoming with goals?
What is driving the decision (pushes/pulls; family; money; conflict; institutional issues, etc)?
What can be fixed? What is unfixable?
Greener pastures?
Is it a good job? Is it the right job?
“Two hats” conversation

10. Interactions with the other institution
What kind of conversation is appropriate between chairs?
When should this conversation occur?
Due diligence and reference checking
How forthcoming with praise, or with criticism?

11. Letting them leave
Difficult decision but sometimes the right one for the right reasons
Handling the exit is important
Retention of patient base
Lead time/ramp down
Transitional issues for staff
What “story” will be told
Maintaining a professional relationship
Impact on future recruitment
Impact on department morale
Reputations at stake

12. It’s expensive to recruit or to retain
Economic analysis can be complex
Department loses revenue but also the salary
Institution loses the cases but keeps the expenses
Recruitment costs
Ramp up, academic package, search expenses, moving expenses
Market considerations: may pay a premium
Reputational costs
Retention costs
Salary increase; additional programmatic support
Issues may not be solved by $$
Will you retain a second time?

13. Appendix: sample analysis of retain vs replace

14. Replacement vs. Retention Summary
Surgical case volume/ wRVU productivity/ Profee Revenue
Volumes & revenue not retained by program
New recruit ramps-up over 3-4 years
Volumes retained by program and may grow
No ramp-up required
Downstream clinical revenue
Lower volumes negatively impact downstream/ ancillary services
Downstream/ ancillary services volume intact
Malpractice
Savings with open position
No impact
Compensation
Increased expense
May tie to incremental volume growth
Other
Recruitment expenses (i.e. interviews, travel, hotel, moving)
Possible increased expense depending on retention package

15. Annual Surgical Case Volumes & Cumulative Losses
Clinical volumes are difficult to maintain after faculty departure
New hires require 3-4 years to ramp-up and generate higher cumulative losses.

16. Example: General Surgeon, > 67% clinical
Replacement: Over $1.7M cumulative loss generated years 1-4 during recruitment & ramp-up phase
Sources: MGMA Academic Practice Compensation and Production Survey for Faculty and Management (2013), MGMA Cost Survey for Single-Specialty Practices (2014), ISMIE.
Physician comp set at MGMA median
Omits cost of living adjustments
NPP & support staff continue after initial faculty departure
Excludes incremental staff hires as part of recruitment package

17. Option to link comp increase to incremental volumes.
Example: General Surgeon, > 67% clinical
Retention: $1.4M cumulative loss generated from comp increase from 50th to 75th %ile
Assuming flat volumes.
Option to link comp increase to incremental volumes.
Sources: MGMA Academic Practice Compensation and Production Survey for Faculty and Management (2013), MGMA Cost Survey for Single-Specialty Practices (2014), ISMIE.
Physician comp set initially at MGMA median and increased to 75th %ile for retention
Omits cost of living adjustments
Excludes incremental staff hires as part of retention package
Surgical volumes remain flat

18. Other Pro Forma Assumptions & References
Other Assumptions
Recruitment for a replacement faculty hire takes 1 year
Excludes downstream revenue (profee or facility) & research start-up expenses
References
(1) MGMA Compensation Survey Table 42: Surgery/Anesthesia Cases (NPP Excluded) for Academic Faculty with More than 67% Billable Clinical Activity: Surgery: General
(2) MGMA Cost Survey Surgery: General, Hospital, IDS Owned (per FTE Physician) Table 17.4a: Staffing, RVUs, Patients, Procedures and Square Footage: Physician Work RVUs
(3) MGMA Cost Survey Surgery: General, Hospital, IDS Owned (per FTE Provider)Table 17.6b: Charges and Revenue: Total Medical Revenue x (1 FTE physician FTE NPP)
(4) MGMA Cost Survey Surgery: General, Hospital, IDS Owned (per FTE Physician) Table 17.4d: Provider Cost: Total Physician Cost
(5) MGMA Cost Survey Surgery: General, Hospital, IDS Owned (per FTE Physician) Table 17.4c: Operating Cost: Total Support Staff
& MGMA Cost Survey Surgery: General, Hospital, IDS Owned (per FTE Physician) Table 17.4d: Provider Cost: Total nonphysician provider cost
(6) ISMIE risk class 16