Posted January 25, 2016

The Real Cost of Emergency Department Physician Turnover

By Sachin Shah, MD, MBA, FAAEM

According to a May 2015 poll released by the American College of Emergency Physicians, three-quarters of the more than 2,000 physicians surveyed reported higher emergency visits from the previous year1. In an already fast-paced and at times, stressful environment, this increase in patient volume can contribute to physician stressors. Time constraints, longer practicing hours, reduced work/life blend, can all lead to decreased physician engagement, satisfaction, burnout and turnover.

The median annual salary for an emergency department physician is $261,054, as reported by salary.com2. While estimates on the actual cost of emergency physician turnover ranges from $50,000 to $500,000, depending on the types of cost included (lost revenue from previous physician; recruiting costs – such as advertising, interviewing, moving & signing bonuses; hiring; training; reduced productivity during learning curve; etc.), a conservative estimate is about $160,000.

Let’s say an emergency department physician generates $1.2 million in revenue annually. According to Cejka Search, a physician recruiting company, the average recruitment costs are $64,0003 including potential signing and recruiter fees. If we add in emergency physician training costs, including ED specific orientation, shadowing/joining peers during shifts, billing/coding courses, hospital required orientation and so on, that adds another $10,000 to $20,000 in training costs. During the onboarding process, productivity of the newly hired physician is typically around 80 percent for the first four months, which results in a loss of around $20,000 a month. As a result of these factors, it ends up costing the organization around $164,000 to replace one physician.

So how can we improve physician satisfaction and reduce turnover? Establishing a solid recruiting and selection process is a good place to start. Medical experience and skill are important, but so is personality, how well they work with potential colleagues and if they are committed to the mission, vision and values of the organization.

Senior Leaders can gather reward and recognition opportunities through Rounding on Patients and Staff and share specific feedback in thank you notes or by managing up physicians in front of peers. This lets the physician know that his or her efforts do not go unnoticed and reiterates they are a valued member of the care team.

At Studer Group, we’ve found that physicians are eager for data and feedback about their performance. Through regularly scheduled conversations, leaders and physicians can review patient experience scores, comments from Senior Leader Rounding, and discuss opportunities for improvement. This is also a good time to ask physicians if they have the tools and equipment they need and any development or training they would like to consider.

Additional resources:

  • The Provider Feedback SystemSM combines Studer Group’s results driven coaching with metric alignment software to improve clinical and operational performance.
  • The Emergency Department Excellence and Physician Partnership Tracks at Studer Conferences offer customized content for physicians.


  1. American College of Emergency Physicians (ACEP). ER Visits Continue to Rise Since Implementation of Affordable Care Act. May 4, 2015. http://newsroom.acep.org/download/2015+ACEP+ACA+Poll+Report+FINAL.pdf
  2. Physician – Emergency Room Salaries. Salary.com. http://www1.salary.com/ER-Doctor-salary.html
  3. Cejka Search and AMGA 2012. Physician Turnover – What You Don't Know Can Cost You white paper

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