“Very few organizations have defined ... who’s accountable for retention.” That single observation stopped Daniel Williams, senior editor and host of the MGMA Insights Podcast Network, mid-conversation. For an industry consumed by staffing shortages, physician turnover, and escalating labor costs, the idea that accountability for retention is often undefined bordered on paradox.
His guest, Carey Goryl, CEO of the Association for Advancing Physician and Provider Recruitment (AAPPR), didn’t hesitate. “That’s really the first missing piece,” she said. “You have all these different layers… and yet, no one has decided who’s ultimately responsible to carry this plan through the finish line.”
Their discussion pulled back the curtain on a dysfunction that many practice leaders recognize, but few have systematically addressed.
A Fragmented System in Plain Sight
Goryl described what AAPPR uncovered in its latest research, conducted with CHG Healthcare: “Only about four in 10 — about 40% of the health organizations we surveyed — said they actually had a formal retention strategy.”
But that figure came with caveats. Another roughly 40% reported “retention activities depending on the department… depending on time and money and space.” The remaining organizations — roughly 15% to 20% — admitted, “No, we don’t have a strategy.”
What makes this fragmentation particularly insidious is that effort exists, but cohesion does not. Goryl noted, “There’s a lot of great effort being done by individuals, departments, small and large organizations,” but those efforts “seem to live in disparate silos at the moment.”
The "Maturity Continuum" Framework
AAPPR’s research introduced a framework that many organizations are experiencing without articulating: a “maturity continuum” for retention strategy.
“Regardless of where an organization fell on this continuum, there’s the next step,” Goryl explained. Even organizations without a formal strategy are not starting from zero.
“You can start with documenting what you think the organization is already doing," she said. “Look at maybe who is the official or even unofficial person in charge of those activities,” she said.
From there, the work becomes organizational rather than conceptual: assembling a cross-functional group that includes “HR… recruitment… operations… clinical leadership… and executive leadership” to define ownership and metrics.
The lack of a natural progression may help explain why three-quarters of organizations without a strategy still say they want one. “It’s the structure and lack of clear ownership,” Goryl said.
HR Isn’t Leading — And That’s a Surprise
One of the more counterintuitive findings from the research challenged a common assumption: that HR drives physician retention.
“Our respondents were telling us that HR was least involved,” Goryl said, calling the finding “very interesting," because the distinction lies in the population being studied. “We were only talking about physician and provider recruitment.”
Instead, retention activity often centers on compensation practices — bonuses, incentives, and contract structures — alongside operational and clinical workflows. “They’re using compensation as a retention strategy,” she noted, pointing to foundational levers like pay and incentives.
Compensation is only part of the equation. Organizations are also looking at mentorship, scheduling flexibility, practice structure, and administrative support. As one source put it: “Are they offering mentorship programs?… How they look at scheduling and structure… are they allowing for administrative tech?”
As Goryl explained, retention is influenced by whether physicians feel “like they are a part of the organization and not just a widget within the organization.”
Yet even these efforts remain fragmented in the absence of shared accountability or measurement.
Metrics Are the Missing Language of Retention
“Certainly, a key thing is we don’t have any data,” Goryl said bluntly. “Not enough organizations are looking at days to fill… cost to hire… what is your retention rate? First year, five year?” These are considered foundational operational metrics. Yet without them, retention strategies can't evolve, nor can organizations link interventions to outcomes.
Goryl emphasized the need to connect metrics across the lifecycle. “Are we actually improving retention?" she said. "Is all of our retention activity perhaps decreasing our days-to-fill because we’ve become a more attractive employer?”
This integrated view reframes retention from a reactive concern into a strategic lever.
The First Week Determines More Than You Think
While organizations often focus on long-term retention, Goryl pointed to a critical — and often overlooked — window: The first week.
“The first week of onboarding can really make or break how a provider feels,” she said.
From logistics to communication, early signals shape long-term perception. “How organized are they? How transparent? What sort of supportive structures do they have in place? Am I getting information? Is anyone listening to me?”
In many cases, those impressions form even earlier. “Honestly, they’re happening in the recruitment process,” Goryl noted, citing responsiveness and communication quality as signals of organizational culture.
Although compensation may close the deal, “it really is that onboarding, that first three to six months… that sort of determines ... whether a physician is going to be sticking around.”
Humanizing Onboarding in a Highly Automated World
Despite growing pressure to streamline operations, Goryl cautioned against over-automation during the onboarding experience.
“Don’t hyper-automate. Don’t keep it so transactional,” she said. “There’s so much to process and things going on.”
Instead, she urged organizations to recognize the magnitude of transition physicians are undergoing. “A person has just radically changed their life,” she said. “That first week is with you and your organization and your team.”
This shift in perspective reframes onboarding as a human-centered process rather than a checklist. And in the absence of a formal program, organizations can improve outcomes by focusing on simple principles: responsiveness, clarity, and personal connection.
“Even if you don’t have all the structures in place,” Goryl added, “you remember that this will be a good start.”
Retention Starts Before Day One, and Extends Beyond Year Three
While formal data remains limited, Goryl pointed to patterns observed across organizations. “Anecdotally, it seems to be that residents stay… three years and then there’s turnover.”
At the same time, onboarding leaders report that early signals are predictive. “The first three to six months… likely determines whether a physician is going to be sticking around for a while.”
In effect, retention operates on two timelines:
- Immediate perception: Formed in weeks or months
- Career trajectory: Often shifting around the three-year mark
Both are influenced by organizational experience — not just compensation. From recruitment responsiveness to team integration, each touchpoint either reinforces or weakens a physician’s commitment.
A Leadership Problem Disguised as an HR Issue
Compensation is only part of the equation. Organizations are also looking at mentorship, scheduling flexibility, practice structure, and administrative support. As one source put it: “Are they offering mentorship programs?… How they look at scheduling and structure… are they allowing for administrative tech?”
- Define ownership
- Audit existing efforts
- Align cross-functional teams
- Establish baseline metrics
- Humanize onboarding
Yet, as Goryl’s research shows, most organizations haven’t taken these steps in a coordinated way.
“What are the metrics? Do we have something in place already? Can we get something in place?” she suggested, outlining a practical starting point. “Then you’re going to evaluate… Were we able to bring this together?… Did we hit it?”
As more organizations move along that maturity continuum — defining ownership, aligning teams, measuring what matters, and humanizing the onboarding process — retention becomes less a persistent challenge and more a strategic advantage.
Resources
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