American Society of Regional Anesthesia and Pain Medicine August 2017 - 36

post-fellowship disposition remains in the forefront of the mind
of the postgraduate throughout their tenure. Although new pain
physicians have decades of education, many trainees have never
sought formal employment. Fellows go through undergraduate,
graduate, and postgraduate education with their destiny determined
by a computerized matching algorithm. Despite their chronological
age, graduating fellows have comparatively little experience in
evaluating prospective employers when considered against agematched peers outside of medicine.
As a result, the likelihood for physician turnover is highest around
the time of joining a new practice. Overall aggregate physician
turnover totals 25% within the first three years of signing an
employment agreement.1 It is unknown if these rates are higher
amongst graduating regional anesthesiology or chronic pain
trainees. The specialty indiscriminate cost of a physician vacancy
totals $4,000 to $6,000 per day.1 Not surprisingly, an unfavorable
employer-employee pairing is the predominant reason contributing
to a physician's decision to depart.

While many stakeholders have opportunities to ensure the success
of newly minted regional anesthesiologists and chronic pain
physicians, we recognized the opportunity and began a curriculum
to formally address challenges surrounding the transition to
practice, improved satisfaction of graduating trainees, and decrease
turnover. These monthly discussions surrounded commencing a
job search and included roundtables with physicians from various
practice models. Trainees engage speakers transparently in a
setting where no topic is considered taboo. We openly discuss
business planning, negotiation, and interview strategies. Contracts
are reviewed alongside employment attorneys and critiqued by the
whole group.
What we observed was an open discussion wherein fellows
presented their own challenges with a heightened degree of
introspection. It remains too early to determine the long-term
results on retention or satisfaction these discussions have made,
but they certainly have led to trainees asking more sophisticated
questions than I've seen in the past.

It is not entirely clear who is responsible for addressing job
satisfaction and retention of graduating trainees. Indeed, "practice
issues" and "broken promises" were the predominant contributors
to the mismatch between physician and employer expectations.1
Often, a more open appraisal of the employer and the candidate
could have identified these issues early on and saved both parties
the challenges associated with separation.

CONCLUSION
Whether starting a new pain fellowship or seeing trainees graduate
and move into independent practice, investing in our specialty
warrants fostering future pain physicians' success as they are
entering postgraduate training or transitioning to their next stage of
practice.

Whereas Baby Boomers value compensation, members of
the present generation remain with their employers because
they have opportunity to grow.2 Learning and advancement
deserve considerable attention since engagement, rather than
compensation, fosters retention. When compared to previous
generations, millennials (born between 1980s and 2000) ranked
as the least engaged generation.2,3 Only 27% of doctors reported
having a formal retention plan with their present employers, a
potential opportunity for practices to retain new hires.1

1.

Gramer J. Physician recruitment trends that can help shape a successful
strategy. Recruiting Physicians Today. 2015;23:1-3. Available at: http://www.
nejmcareercenter.org/minisites/rpt/physician-recruitment-trends-that-can-helpshape-a/. Accessed April 2017.

2.

Rigoni B, Adkins A. What millennials want from a new job. Harvard Business
Review. May 2016. Available at: https://hbr.org/2016/05/what-millennials-wantfrom-a-new-job. Accessed April 2017.

3.

Adkins A. Majority of U.S. employees not engaged despite gains in 2014.Gallup:
Employee Engagement. 2015. Available at: http://www.gallup.com/poll/181289/
majority-employees-not-engaged-despite-gains-2014.aspx. Accessed April 2017.

36

REFERENCES

American Society of Regional Anesthesia and Pain Medicine
2017


http://www.nejmcareercenter.org/minisites/rpt/physician-recruitment-trends-that-can-help-spahe-a/ http://www.nejmcareercenter.org/minisites/rpt/physician-recruitment-trends-that-can-help-spahe-a/ http://www.nejmcareercenter.org/minisites/rpt/physician-recruitment-trends-that-can-help-spahe-a/ https://www.hbr.org/2016/05/what-millennials-want-from-a-new-job https://www.hbr.org/2016/05/what-millennials-want-from-a-new-job http://www.gallup.com/poll/181289/majority-employees-not-engaged-despite-gains-2014.aspx http://www.gallup.com/poll/181289/majority-employees-not-engaged-despite-gains-2014.aspx

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