Minick Advisory
Research, observations, and things worth knowing for the people responsible for keeping physicians.
Healthcare organizations come in every size, from four physicians in a small town to 200-physician health systems. The retention dynamics are the same. What changes with scale is the surface area. The framework adapts. The principles do not.
When an independent practice loses a physician at month 14, the leadership team almost always underestimates what the departure actually cost. The actual number is somewhere between $250,000 and $2.8 million depending on specialty. Nobody calculates it because nobody has the right framework for the math.
Most independent practices treat physician onboarding as a checklist. The checklist is not the problem. The assumption that the checklist is the work is the problem. The actual cost shows up 14 months later when the physician resigns.
The decision a physician makes to leave a practice is rarely made when they hand in their resignation. It is made in the first 90 days. It just takes another year to surface. The 90-day window is the highest-leverage period in the entire onboarding arc.
Most early physician departures are not about money. The pattern is almost always the same. A practice recruits a physician with promises of autonomy, speed, and partnership. The physician arrives. The first 180 days do not match the recruiting pitch. By month 14, they are gone.