The Cost of Losing a Physician

Nobody puts $1.5 million on the budget line for "VP refused to return a phone call." But they should.

A new nephrology attending was struggling to get his practice off the ground. He asked to meet with the VP responsible for the service line. The VP declined. She would meet with a service line director instead, who would relay the findings.

Within a few months, the physician had given notice.

The loss of any physician — especially a proceduralist — generates institutional costs commonly estimated at two to three times their annual salary. Recruitment fees, tail coverage, locum replacement, onboarding, ramp-up time. These are real expenditures. The VP who generated them had no individual consequences. She moved on to her next decision, her paycheck unaffected.

I have tried to name another industry where a single decision-maker can generate a $1–3 million loss event with no repercussions. I have not found one.

The deeper problem is that without feedback and without skin in the game, she was oblivious to the waves she generated. The ripple effects — increased locum costs, population health impact, morale hit on the remaining staff — continued reverberating through the enterprise for months.

Physician recruitment is organizational health infrastructure. Physician retention is too.

If a VP can lose a physician through inaction and face zero accountability, what does that tell you about the system you are operating inside?