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During my talk at the Illinois MGMA Fall Financial Conference a couple weeks ago, I asked a simple question:
“How much are your physicians required to work?”
I heard all kinds of answers: some clear, some complicated, some hesitant.
There’s no right or wrong answer to the question—it depends on a lot of factors, after all—but you do need to have an answer.
Some days, it feels like you’re doing everything you possibly can to improve things in your practice, but nothing seems to change.
I know many medical practice leaders who feel this way. You try to keep physicians happy, balance financial pressures, improve patient access, and meet an ever-growing list of organizational goals. All at the same time.
To get it all done, you try pulling every lever you can think of …
… and it feels like, instead of taking one step forward, you’re stuck in the same place. Or one step back.
I’ve seen this happen so many times in so many practices and I’ve come to realize that the answer isn’t yet another shiny new initiative.
You offered the signing bonus. You approved CME funds. You gave them a flexible schedule. Maybe you even let them set their own hours. And still, the physician left.
If you’ve been in practice leadership long enough, this probably sounds familiar. You’ve tried to make the job more appealing, you’ve bent over backwards to keep physicians happy, and it can feel frustrating when none of it seems to be enough. You’re doing everything you can, but you can’t seem to keep physicians.
You know when a physician isn’t pulling their weight.
Leaders like you work hard to set your physicians up for success. You clarify expectations, provide support, and try to compensate fairly. And that effort usually pays off.
But sometimes, a physician will continually fall short in ways that harm colleagues, staff, or even patients. You have to hold them accountable. Otherwise, everything you’ve worked so hard to build will start to crumble.
The promising candidate who tells you they’ve accepted another offer. The long-time physician who hands you their resignation letter. The quiet sinking feeling that you’ll have to start all over again.
That’s the physician shortage. It’s not just an abstract headline or a talking point for policymakers; it’s your reality.
You’re competing for a shrinking pool of physician talent. No matter how hard you work, it can feel like you’re always one step behind.
Changes happen all the time in your practice. And whether it’s a new schedule, a new metric, a new compensation model, or an operational improvement like reducing no-shows, success always hinges on physician buy-in.
I’ve seen many leaders try to sell changes by focusing on how they address the practice’s needs: “We need to do this because we need to grow.” “We need to open up more patient access.” “We need to improve our margin.”
But this is a mistake.
A few months ago, strange looking patches started showing up on my son’s skin. We took him to his pediatrician and left with a prescription for antibiotics and more questions.
That night, my wife and I talked about what to do. We felt like we had jumped right to treatment without really understanding what was causing the issue (which, the doctor admitted, could be a number of different things that would all need to be treated differently). We were concerned about giving my son medication that he didn’t need. So, we took him to a specialist, who did a proper work up, and the plan changed completely.
I see this happen in medical practices all the time, when leaders jump straight to rewriting physician compensation plans or setting new targets. Yes, you may end up doing those things, but if you don’t start with a real diagnostic, you may end up going down the wrong path.
Is your practice’s physician comp model incentivizing higher volume?
If your answer is yes, my next question is this:
Do you have enough staff, enough space, and enough slack to take on that higher volume?
In many practices I’ve worked with, there’s a disconnect between the compensation plan and the operational reality. The comp plan says “do more,” while the practice says “good luck.”
This gap isn’t just frustrating. It can quietly undermine your goals and put your practice’s future at risk.
One of your physicians just gave notice. Ugh! What will you do next?
Your first instinct might be: What does the physician’s employment contract say?
Your second thought should be: What does this physician’s notice and our reaction to it say about our culture?
I’ve seen practices—both hospital- and physician-owned—panic and fall back on policies that feel more like punishment than professionalism. They accelerate termination. Deny earned bonuses. Restrict patient access. Withhold support. Threaten litigation. Legally allowed? Perhaps. A good idea? Rarely.
Are you trying to improve performance in your practice? Whether you’re focused on patient access, provider productivity, resource use, or anything really, try to resist the urge to start with a spreadsheet or to jump right into a new compensation model.
I’ve found that most lasting improvements are rooted in a deep understanding of what’s happening on the ground, not just the 30,000-foot view offered by a dashboard or a shiny new comp model.
That’s why I recommend that you start with a conversation.