When Dr. Todd Sheer left his gastroenterology practice at Mercy Hospital last summer, he was exhausted.
He wasn’t alone.
Nationwide, the strain of the COVID-19 pandemic on health care workers led to a mass exodus from the industry. According a study published this year in the JAMA Health Forum, the mean health care worker exit rate jumped significantly, from 5.9% in 2019, to 8.0% in the first quarter of the pandemic and remained elevated through 2021.
Sheer was saddling nearly the full load of patients in the Four Corners and burned himself out.
After he left, his former staff members would contact him periodically to share how much patients missed him.
“I had never heard such appreciation prior to that point,” Sheer said.
But by that point, he was feeling overworked and done with it.
“It’s incumbent upon us as a practice to make this the place that they want to practice,” said Dr. Sarah Goodpastor, a specialist in internal medicine and diabetology. She is also the regional medical director of the Mercy primary care practices.
At Mercy Hospital and its connected facilities, the pandemic unveiled some long-festering realities.
“People really wanted their workplace … to have some balance, to have some recognition that their life outside of work mattered, their mental health mattered (and that) their psychological security matter from a financial perspective,” she said.
When outgoing Mercy CEO Brandon Mencini started in October 2022, it was a “tough time,” he said. Staff members, such as Sheer, had left the community as turnover begot turnover.
In fall 2021, former physicians at Mercy raised the alarm about rising turnover rates, a trend that had begun even before the pandemic triggered mass resignations in the health care sector, they said.
When Sheer first took at job at Mercy in 2016 he was one of eight specialists in his field in the Four Corners at the time.
“There was an equal sharing of work and it was wonderful,” he said.
But over the years, people left the field, restricted their practices or moved. Despite efforts to find replacements for those who had left, Sheer said the hospital had little success in rebuilding the practice.
“I was the guy that everybody came to for all the hard and complicated stuff,” he said. “So I was exhausted. I was just literally exhausted and couldn’t do the one-man show anymore.”
On June 1, 2023, Sheer left and moved to Denver, where he started working at a private practice.
But by mid-November, he was back.
Quality of life in Denver was poor and the community of patients in Durango missed him.
Upon his return, Sheer set new intentions in his professional life. He said he would start taking lunches and cut back on the call schedule. And while it was not hugely important to him, Sheer also enjoyed the benefits of a new compensation structure announced in August that went into effect Jan. 1.
These sorts of physician-led changes – the ones that make Mercy a place where providers want to practice – are all parts of a broader response to a need for improved retention at the hospital.
And the strategy seems to be working.
Turnover can incite a self-perpetuating cycle sparked by the degradation of workplace culture and community. It is also expensive, Goodpastor points out. It generally costs a hospital over $1 million to lose and replace a physician.
With the financial data points and cultural demand for changes, Mercy was able to start turning the tide on physician and advanced practice provider retention. And the numbers show it, Mencini said.
The hospital’s practices have few vacancies. Leaders hope to add two spots in cardiology and already have nine physicians or APPs, five of which joined Mercy in the last two years.
Urology has one open physician spot and one open APP spot. Joining Sheer and his physician assistant in gastroenterology, Mencini said one doctor has verbally committed a position, and the hospital has interviews scheduled with candidates for both an additional role APP and physician.
Until recently, patients had to wait a year for a colonoscopy – now, the wait time is down to three or four months.
Nationally, the vacancy rate in nursing staff can reach upward of 10%. Mercy’s nursing vacancy rate was 0.3% in April, Mencini said, and has hovered between 0% and 4% for the last year.
That statistic is critical, Goodpastor said, because “staff retention is physician retention.”
A lot has to do with workplace culture, providers say.
Dr. Richard Converse is one of the cardiologists who started during Mencini’s tenure.
When he looked at a job at Mercy before the pandemic, he saw a fractured practice that had a lot of turnover.
But since he circled back and decided to give the hospital a second chance, he’s observed the opposite.
“We want to hire the right people that want to be here and are going to fit in,” Converse said. “You know, we’ve certainly looked at some people who maybe like the mountains (but) weren’t really going to mesh with the group.”
And, he said, the emphasis on culture and the kind of balance that Sheer said he would prioritize upon his return, do not just exist on paper at Mercy.
“There’s a lot of places that pay lip service to that and say, ‘Yeah, we get that, do some yoga or something. And here’s your schedule for next week, and we’ve had to increase it by 20% because we’re losing money,’” Converse said. “That’s not been the environment here since I started.”
As the CommonSpirit Medical Group – the regional physician enterprise unit that actually employs providers and runs clinics – and Mercy executives consider candidates, Mencini said he likes to involve himself from start the finish.
Early in the process, he likes to reach out and tap into what, beyond their work, a candidate might want.
“Is it somebody that is looking for a lot of land? We’ll get a Realtor connected with them and talk through different locations,” he said. “If it’s somebody that enjoys skiing, we’ll get them connected with people that spend a lot of time skiing out here.”
In the workplace, Goodpastor said she has seen a heightened focus, as the result of local demands, on ensuring that physicians and advanced practice providers feel empowered.
“This means that rather than physicians feeling like widgets turning out health care units who are dispensable, physicians are valued as the highly capable, innovative problem-solvers that they are,” she said.
Although the emphasis on recruiting people who want to be in Durango is important, there were also substantive changes implemented to the compensation system.
As of Jan. 1, physicians have a guaranteed salary based on the national median productivity of their peers. Previously, physicians had a guaranteed salary for the first two years. After that point, pay was based on bonuses and the relative value units – a way to standardize health care costs – generated.
The pay scheme meant that financial incentives felt disconnected from the work providers do outside the exam room that is considered a critical part of excellent health care.
At the end of the day, the actual salaries that people earn are unlikely to change much, Goodpastor said, but it was nonetheless a “huge shift” predicated on the concept that happy doctors provide quality care.
According to Goodpastor, the new contract system was an ideological statement: “We value you, we understand that your work is more than just seeing patients, and we want you to feel comfortable that you know what you’re getting to pay your mortgage.”
On top of a guaranteed base pay, providers in Durango were able to coordinate a push to reform the bonus structure such that the benchmarks used to determine bonuses were based upon local successes, rather than success in addressing regional challenges.
Providers were incentivized to lower the readmission rate of patients to CommonSpirit hospitals across Colorado – but Mercy’s rate was lower than that of Front Range hospitals that treat patients who may be more vulnerable to complications at a higher volume.
“When you mix it all together and you hold primary care physicians in Durango responsible for something that’s not in their control, it’s disheartening,” Goodpastor said.
The change was made at the Medical Group level at the urging, at least in part, of Durango physicians.
“It’s creating a lot more comfort versus having something complex that was hard to understand,” Mencini said.
Doctors Sheer and Converse say the new contracts were not enormous incentives for them – but they are thrilled nonetheless.
Converse called it the best contract system he’s been under in his entire career.
It also proves to Sheer that CommonSpirit is making an effort to recruit better candidates.
“I don’t know if we were ever going to hire anybody on the previous (contract),” he said, noting that it was never a particular issue for him but that the demand for labor has changed for early-career providers.
The new system makes space for schedule flexibility; it compensates providers for being more productive while providing a baseline stable income; and it incentivizes wraparound care and results in better patient outcomes.
“We are constantly innovating to meet the needs of our patients, which if you do that, then you meet the needs of your physicians and your APPs,” Goodpastor said. “Because, what they want is to serve the patients’ needs at the highest level.”
rschafir@durangoherald.com
