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Why Do Podiatry Associates Leave?

In the past months, I have heard of many associates being fired, leaving their jobs for new ones or expressing general unhappiness about their work issues. This concerns me, not only because I am an associate but because it speaks to a common problem many practice owners experience. 

Associates leave practices for many reasons. Whether it is due to financial issues or more intrinsic factors, podiatrists seem to be leaving their employers at alarming rates. Finding and retaining talent is a major challenge for many organizations today. Employee turnover is costly, resulting in workforce instability, reduced efficiency and lower effectiveness, which negatively affects the bottom line.

Each practice has its own culture and there are varying thresholds for work ethic, tolerance, reimbursement, patient treatment, overhead and establishing concrete boundaries that affect both patient care and the employees. For instance, practice X may function like a “factory” with a high volume-to-time ratio. At this practice, one may see 60 or more patients a day with little time for breaks or even lunch. Those in charge expect the associate to work six days a week and be on call every other week. 

Practice Y functions at a much slower pace with five-day work weeks, seeing patients every 30 minutes, structured break time and more autonomy over work hours. These two scenarios are clearly different but are very telling about the psychological effects on the associate and staff, something many leaders fail to consider. 

With this said, I have categorized six types of situations associates typically experience.

“The Overworked Associate”

  • Expected to work six or more days a week 
  • No downtime 
  • Expected to do surgeries in his or her “spare time” 
  • Expected to see every add-on case
  • On call for most holidays 
  • Expected to stay late  

Potential outcome. In this case, burnout is real. The imbalance of work and family life will wreak havoc on mental and physical health. This disproportionate time can have a damaging effect on the associate and the bottom line. Associates in this situation may leave.  

“The Un-Incentivized Associate”

  • Low base salary
  • No or unobtainable bonus structures
  • No additional ways to increase income on a yearly basis

Potential outcome. A key role of a leader is to create motivating conditions so people feel successful and valued for what they do. Yes, money (salary) is one yardstick people use to feel respected and appreciated at their job. However, when they work overtime and/or are unable to increase their income, they often feel demotivated. Studies show that percentage-based associates tend to be more motivated, work harder and longer hours, and are more amenable to seeing more patients.1 The demotivated employee becomes toxic to the team and the practice and patient satisfaction levels decrease. Associates in this situation may leave.

“The Dead-End Associate” 

  • No opportunity for partnership
  • Lack of career or promotional growth 

Potential outcome. Not every associate is partnership worthy. Many associates are not interested in a partnership nor do they want to own a clinic. They are content to focus solely on patient care and leave the business headaches to the owners. However, many associates have a vision, a desire to be part of something larger. Associates without the opportunity for “skin in the game” will eventually leave. This loss has numerous short- and long-term effects on the practice. For example, not incorporating a younger, technologically advanced person could adversely affect marketing strategies, there may be loss of patients who could follow the departing physician and there are the costs that accompany the hiring of a new physician. Additionally, the loss of an associate who feels the practice is a dead end for career growth could jeopardize a succession plan.

“The Handcuffed Associate” 

  • Limited by the restrictions put in place by the business owner 
  • Not allowed to see new patients 
  • Only allowed to see Medicare patients
  • Only allowed to perform routine nail care
  • Not allowed to see surgical consults 

Potential outcome. The big question for business owners is do you really need an associate? Alternately, do you really want a glorified physician’s assistant who can do the things you do not want or are not willing to do? As a thought leader in the management field states, “If you want people to do a good job, give them a good job to do.”1 He goes on to say: “Deprive someone of a meaningful task, the capacity to exercise choice over what one does, social support, the chance to learn and demonstrate one’s competence, and that person will likely turn his attention to what he earns.”1 In this case, the employee remains focused only on extrinsic motivators.

When you micromanage an associate or any employee to do the bare minimum, do not expect the associate to do any more than what he or she has been given. What you create is what you get! 

“The Underutilized Associate”

This may sound like…

  • “We don’t do that here.”
  • “Our patients don’t come in for that.”
  • “We have done it this way for years.”
  • “You handle this.” (But the associate is not trained in that area.)

Potential outcome. Earlier, I mentioned that each practice has its own culture and issues related to motivation. To create motivating conditions, it is imperative that leaders fully understand their associates. This includes knowing their clinical strengths and weaknesses, the types of patients they desire to treat and, personal information, in other words, knowing what makes them “tick.” This knowledge allows one to properly evaluate if the associate is a good “cultural fit” for the practice. Far too often, unfortunately, leaders sacrifice the associate’s talents or try to fit the proverbial square peg in a round hole. 

“The Apprehensive Associate”

  • Fears retribution
  • Is talked to in a condescending manner
  • Is rarely asked for his or her opinion
  • Always at fault
  • Notes are often redlined

Potential outcome. It is often said that leadership is all about relationships, those with your associates, staff, product/service reps, and patients. The foundation of all relationships is trust. When you create a secure base with your associates and employees, there is an atmosphere in which your associates and staff feel comfortable talking to you about everything and anything. This bond leads to loyalty, security and mutual respect. When they feel fearful, they may leave.

In Conclusion

Restrictions, limitations, inflexibility and being micromanaged lead to troubled waters. Reportedly, 49 percent of people who quit do not quit the practice, they quit the person, the boss.2 Retaining talent will always be an issue for podiatry practice owners. Below are some questions you may want to reflect on:

  • Have you created a risk-free environment? 
  • Do you take an active interest in your associate’s feelings and perspectives? 
  • Are you creating motivating conditions for your associates to learn and grow successfully?
  • Are you communicating in a collegial manner?
  • Have you created a secure base?

 If you have yes to these questions, your associates will likely stay and be satisfied.

Dr. Levick-Doane is a Diplomate of the American Board of Foot and Ankle Surgery and the American Board of Podiatric Medicine. She is in private practice in Chicago.


1. Herzberg F, Mausner B, Snyderman BB. The Motivation To Work. New York: John Wiley & Sons; 1959.

2. Buckingham M, Coffman C. First, Break All The Rules: What The World's Greatest Managers Do Differently. New York: Simon & Schuster; 1999.

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