By Amanda (Mandy) Bates

Three years ago, a physician came to me and said his medical assistant was leaving our group to take a job as a receptionist at a tire outlet. I thought that was a travesty.

In addition to playing a vital role in physician success and a patient’s experience, medical assistants go through one to two years of post-high school health care education. Why would someone leave a job where they have opportunity to serve patients, be professionally challenged and apply skills for which they have toiled and studied?

With first-year turnover above the 75th percentile (the higher the percentile, the higher the rate of turnover), I knew we needed to change the game. We needed to find a reason for employees to stay with the organization, rather than a reason to leave.

According to Dr. Tait Shanafelt, chief wellness officer at Stanford Medicine, one of the biggest predictors of burnout among clinicians is when there is a resignation among a member of the care team. Even one vacant job can negatively impact how a team provides care to our patients.  Sure, there is some level of turnover that is inevitable as people move, go back to school or retire. But when turnover exceeds expected benchmarks, we need to examine why people are leaving and address those issues. Championing retention is one of the most important strategies we can provide as HR professionals.

Amanda (Mandy) Bates was the 2018 winner of the Ogletree Deakins Human Resources Professional of the Year award. Nominations are open for the 2019 award with a February 15 deadline. Learn more at

When we looked at the results of our annual engagement survey, we found the lowest rated item for medical assistants was “this organization provides career development opportunities.”

We heard loud and clear through exit interviews that medical assistants were often leaving the profession to take another job outside the medical field and outside IU Health, a job that paid more. We created a career pathway to keep medical assistants employed in our practice plan. We also developed a Medical Assistant Career Ladder program that provides promotional increases as medical assistants develop professionally and take on more responsibilities.

When we first rolled out the Medical Assistant Career Ladder, it was met with lukewarm reception. Participants needed to pay (out of their own pocket), study for and take their certification exam (a requirement of promotion to the next level). We learned studying at home was a common challenge. We decided to pre-fund the certification study program and provide an on-site coach to help participants study and stay on track.

Many of our medical assistants are parents, some single parents, with seemingly endless responsibilities once they got home. We encouraged leaders to grant a medical assistant study time of one to three hours a week on company time. Finally, we celebrated their success. We hosted a reception to honor and recognize each person who advanced a ring on the career ladder.  We invited family and friends who gave testimonials to how their loved ones worked hard to gain their skills and promotion.

As more and more medical assistants became certified, got promoted and invested in their professional development, our turnover began to drop. By mid-2018, our first-year turnover dropped to the 10thpercentile, a remarkable improvement from being in the 75th percentile three years earlier.

As our turnover dropped, so did our number of open jobs. In fact, our job openings decreased 41%. We improved our staffing by retaining talented, invested compassionate team members.  We gave our team members a reason to stay. The stability in our teams also helped provide continuity in patient care along with improved provider well-being.

In addition to the career ladder, there were a number of other retention strategies we put in place:

  • We train every leader on best practices in recruitment and retention
  • We provide each leader with onboarding program guidance to make sure we welcome each new hire and set them up for success
  • We ask each leader to pair their new hire with an ambassador. We find having a buddy to show the new hire the ropes is essential to their onboarding and acclimation
  • Hold 30- and 90-day reviews. The check-in process for new hires is essential. When you take a new job, you move from expert to “new kid on the block”. It is easier on the new hire for us to ask, “What else do we need to teach you?” rather than assume we have done a good job answering their questions about new processes and expectations
  • Make turnover data transparent. We send our executives a weekly list of who has left us with a reason why. Our executives discuss turnovers with our administrators once a week at our Thursday Huddle. There is accountability for leaders to understand the root cause of turnover in their areas, and be responsible for addressing it
  • Understand why people are leaving. We look carefully at our exit interview data. We discuss reasons for each individual departure. Knowing our obstacles for retention helps us develop strategies for reasons to stay
  • Diversity matters. We find the more we hire, retain and invest in employees from diverse backgrounds, the more we relate to all our different kinds of patients. This diversity makes our teams stronger and studies show better outcomes from diverse teams.
  • Leadership matters. Our exit interview data confirms that many individuals leave because of their boss. Investing in our leaders and setting expectations for how to lead well is an important part of retention

As HR professionals, we have incredible opportunities to impact culture and professional careers. Having a strong retention strategy leads to positive outcomes in staffing, operations, well-being and more. Let’s find a reason for employees to stay.

Author: Amanda (Mandy) Bates is the vice president of human resources and chief of staff for IU Health Physicians. She has over 25 years of experience leading efforts in human resources, leadership development and organizational development, primarily in the health care industry.   

Amanda (Mandy) Bates was the 2018 winner of the Ogletree Deakins Human Resources Professional of the Year award. Nominations are open for the 2019 award with a February 15 deadline. Learn more at