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Cover Focus | June 2021

Staff Retention and Turnover

Strategies for retaining employees and controlling costs.

During the current pandemic, staff retention and turnover is a bigger problem than ever. Almost every conversation I have with colleagues includes discussion of the woes of losing and hiring staff. The pandemic has added a layer of complexity to an already significant issue in most practices. Despite strong efforts to keep our team together by holding virtual town hall meetings, continuing to pay health insurance, and connecting with weekly updates, we lost six of our 30 employees during the lockdown and closure of our practice from March 20 to May 4, 2020. That’s 20% of our staff in less than 2 months, and almost every area of the office was affected. Most of these employees left because of fears about working in a health care environment, some left to oversee the education of their children who were now learning virtually, and others took advantage of the opportunity to change careers.

The business ramifications of hiring, training, and losing an employee are enormous. According to a 2021 report by the US Bureau of Labor Statistics, the annual turnover rate in 2020 was 57.3%, and the cost of replacing an employee ranged from 16% to 33% of the employee’s annual salary.1

Calculating a practice’s turnover rate is relatively easy. The number of staff members who have left the practice (for any reason) over the past 12 months is divided by the total average number of staff members employed. With this formula, the turnover rate and the direct financial cost to the practice can be calculated quickly.

There is also an indirect cost to be considered. When an employee leaves, coworkers may have to take on additional responsibilities, patient schedules may have to be adjusted, staff may need to work longer hours or train new employees, morale may drop, and patients may sense these added stressors to the practice.


Hiring the best staff is one of the biggest challenges faced by any practice. Once high-quality employees are hired, they must be retained. Every practice should have an effective employee retention plan. Several key components can reduce turnover and improve a practice’s bottom line.

No. 1: Start with employee selection and the onboarding process. I recommend hiring employees based on their personalities as much as their skill sets. A new employee with the wrong personality can quickly reduce the morale and motivation of your existing staff. Sometimes, hiring a person with the right disposition and teaching them the skills they need is better for the practice. They may take longer to get up to speed, but they are likely to be more committed to the job, loyal to the practice, and accepting of its culture.

One of the most successful recruitment methods we use is to give a monetary reward to staff members for referring potential hires. Having staff refer friends or colleagues can enrich and strengthen the practice culture by bringing in people who share similar qualities.

Early in the process, new employees must learn the practice’s mission, values, and culture, and they must identify what they believe they may uniquely contribute to the practice. Equally as important is establishing these employees’ career goals and communicating to them both the pathway to achieving these goals and the practice’s commitment to supporting them (see No. 3). This requires a clear job description and clear communication about the manager’s goals for them. It also requires employees to identify their personal goals in the workplace. Assigning a buddy to a new hire can ease their transition and help them feel supported.

Providing a new employee with a written job manual helps to avoid the accidental omission of important training skills that can occur when one employee is asked to do their own job while training a new hire. This manual shows the practice’s commitment to a new employee’s success, gives them a clear reference for their job and the practice’s expectations, and serves as a tool for evaluating their growth and success during the training period.

A 90-day introductory period for new hires and current employees moving to new positions allows all parties to evaluate the success of the transition, identify areas for improvement, and end the relationship before either party is overly committed.

No. 2: Establish an effective leadership and management team with a clear chain of command. Employees need to know whom they should approach with questions and problems. Establishing team leaders for each area of the office allows employees to have their voices heard. Employees are often intimidated by physician bosses and unlikely to ask questions of, share a concern with, or accept correction in a positive way from a physician boss. An effective team leader can constructively engage, motivate, and encourage employees.

The management team should receive training and strong support and have opportunities to learn effective communication skills, leadership skills, and strategies for building relationships. They should feel empowered to manage, organize, praise, recognize, and inspire their staff. Positive feedback and team building by a practice’s leaders can strengthen a team and improve productivity and job satisfaction. Team leaders also need to have a clear pathway to communicate the challenges and successes of their team to management.

No. 3: Establish a clear pathway to career development. Part of a successful onboarding process includes acknowledgement of an employee’s career goals. Both the management team and the employee should periodically reevaluate these goals and affirm that they are being met and still align with the practice’s goals.

Timely evaluations with abundant feedback and performance-based raises recognize employees’ achievements and provide opportunities for growth and advancement. This is a good time to check on the progress of their career development. An employee’s goals can change or evolve, and skills they develop may point them toward new opportunities or directions within the office.

Similarly, providing skills training courses for staff with certification can keep them learning and excited about their jobs (Figure 1). Offering professional development through certification with reimbursement of expenses and achievement-based raises is a win-win for a practice and its employees. The practice gets better trained, more motivated employees, and employees can master skills and become more invested in their career development.

Figure 1. Staff members show their certifications.

No. 4: Boost workplace enjoyment and establish a culture of recognition and appreciation. It cannot be said enough that communication is key to staff retention. Employees should be informed in a timely manner of changes in staffing, scheduling, and structuring. No one likes to be surprised or to feel like they don’t know what to expect from day to day. This is where a good management team becomes vital. Monthly staff meetings are essential, but team leaders should meet with their staff regularly to communicate the impact changes may have on them.

An established method of recognizing staff members’ significant professional and personal events can foster unity and support. Parties, social media announcements, and congratulatory emails can be used to share achievements and recognition throughout the entire team (Figure 2). TInvolving everyone in the practice can develop a sense of belonging.

Figure 2. A staff appreciation event.

Staff appreciation is surprisingly simple but easily overlooked during a busy clinic day. At the end of every day, I make a point to walk around the clinic and thank every single person in the office for their hard work that day. This approach may not be practical in a large practice, but I thank 30 people every day. Many of my staff members have shared with me how much my expressions of gratitude mean to them. The effort costs me nothing but 15 minutes of my time. The benefit is that my staff ends the day feeling valued, respected, and appreciated. Sometimes, it generates a conversation that gives me insight into challenges and frustrations that I would otherwise have been unaware of. When that happens, if necessary, I take time to address them.


No matter a practice’s size and whether it is a private or academic institution, attention to staff satisfaction is essential to reducing turnover and related expenses. More importantly, a positive office culture improves the patient experience and overall growth of the practice. These are more important now than ever before.

1. Economic news release. US Bureau of Labor Statistics. March 11, 2021. Accessed May 7, 2021. https://www.bls.gov/news.release/jolts.t16.htm

Lisa K. Feulner, MD, PhD