Every growing practice has stretches when the business seems to be rolling along, growing, thriving, and then the crisis hits–in a relatively short period of time, several employees may decide to leave. What is going on?
It’s not the same as it used to be
I can think of several times in my thirty-five years of ownership when this happened. And nearly every practice owner I know has had a similar experience. In some ways this only makes sense. An organization with thirty or forty clinicians goes through many different stages before it gets to that size. And people join at one point only to have the organization change underneath them. Here are some of the events that triggered a mass exodus for us.
- when we changed the structure of our organization
- when we moved everyone from independent contractors to employees
- when we changed expectations about attending meetings
- when we promoted some and not others
- when BCBS reduced its fees, which meant working more hours for less pay
- when we got so large that it did not feel like a family any more
- when we had a change in leadership or leadership roles
You can see several things in common about these events. They all involved changes in the way that the organization operated. And may more importantly, they all changed the way clinicians conceived of themselves.
Some of these changes are actually a result of success and some a result of outside influences beyond our control. The reality is that no matter what stage an organization is at when you join, it will morph into something else. Inevitably that requires clinicians to change. Sometimes the required change becomes the tipping point for several to resign within a short time frame.
I always think that when anyone leaves, the leadership should do a debriefing, a post-mortem. We need to look hard at the possibility that the leaving was avoidable. We should listen to exiting people to learn about their experiences as an employee. We may just learn something that will help with future employees.
But of course we can err by being too hard on ourselves too and learn the wrong lessons. So how do we find the right level of responsibility to take? It helps if we know our tendencies. It helps if we are hearing themes from multiple sources inside and outside your organization. It helps if we have safe places to talk through our hypotheses of what we might have done differently.
And once we have settled on a needed adjustment, there is no harm in confessing the need for the changes to your remaining employees. We are giving a positive message to all when we show that we can change and learn from the past. Let us learn the right lessons from each crisis.
How to survive
Size makes a huge difference in how vulnerable an organization is when people resign. Obviously there is a huge difference when three people leave a group of ten (30 percent loss of productivity) than a group of thirty (10 percent loss of productivity). In my view, the organization with ten clinicians is at its most vulnerable time. The investments the owner has made to support ten clinicians is significant. And yet the margin for error is quite small. When smaller than ten, the costs are not as high. When larger than ten, productivity can remain high even when some leave.
The one benefit of the ten-person practice is that you can now show the bank a track record and they will generally be willing to loan you money to get you out of tough spots. That track record means a lot to a bank, especially if you can explain why the bad times happened and you outline a plan for digging your way out. They will not make loans for the newer or smaller organization because the owner and business have not yet proven themselves to be a good risk. Banks are inherently conservative and want assurance that they will see a return on their money. That is what they do.
Once you have size and a track record, the next big challenge is to resist the temptation to borrow too much. I have made this error. While it did allow us to grow faster then we would have without those loans, there where seasons when it became a struggle to repay those loans, leading to many tight months and years. My advice? Have a well thought out plan for repayment. It is far easier to borrow money than it is to repay it.
I have seen practices elect to downsize rather than borrow. In some of those cases, I think the decision to downsize, was both a money issue and a disillusionment with management decision.
And I have seen practices downsize and then thrive on a smaller scale. But sadly and perhaps more commonly, I have see practices that never got back to thriving. Once some key people left, the owners never figured out how to attract and keep enough employees for the practice to grow. Downsizing then was not what they wished for but it is what happened anyway.
Growing our way out
The way back on track is to find new employees to replace those that left. That means working on your hiring practices so that you get good at staffing your organization with excellent staff. Once you have corrected the correctable reasons that people left, then it comes down to finding good candidates, interviewing them, hiring them, and training them. I talk about how to hone that process in another post. What one cannot afford to do is to become bitter about those who have left. We have to move on, to focus on the parts we can control from this day forward. That is where growth is, where your joy, where stability is. Upward and onward.