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The True Value of a Medical Group in an Integrated Health System
The Retention Math Most Health Systems Still Get Wrong
By Jerry Penso, MD, MBA
Dr. Suzanna Fox on Advocate Health's Best Place to Care program
When I sit down with health system C-suite executives, workforce is almost always one of the top issues on their mind, often ahead of the financial pressures everyone expects to hear about. Recruitment, retention, and engagement usually get talked about as culture issues, but they are significant business concerns. In a complex, fast-changing environment, an organization's ability to deliver care depends on whether it can keep and properly support the people delivering it.
Replacing a single physician costs a health system roughly $1.2 million on average, including recruiting, start-up costs, and lost revenue, according to Weatherby Healthcare's analysis of turnover.1 That does not include the harder cost to measure: a patient who has to rebuild trust with someone new, often at a difficult moment in their care. Suzanna Fox, executive vice president and chief physician officer at Advocate Health, has spent years helping build a program against exactly that math, supported by an executive leadership team led by CEO Gene Woods and Chief Clinical Officer Dr. Scott Rissmiller that has consistently treated workforce engagement as a strategic imperative.
One Program, Three Different Businesses
Advocate Health's Best Place to Care program started with physicians, expanded to advanced practice practitioners (APPs), and this year extended to roughly 42,000 nurses. That expansion reflects a close partnership with nursing leadership. As Chief Nurse Executive Betty Jo Rocchio and her team have emphasized, creating the best place to care requires creating the best environment for nurses, who are central to both workforce stability and patient experience across the system.
Fox shared that each expansion required rebuilding the approach, not just widening its reach. "We believe the needs are similar, but the levers are very different," she told me. Physicians and APPs struggle most with administrative burden and autonomy, and the fix is removing friction, managing an overwhelming inbox, simplifying a documentation process, or eliminating scheduling constraints. Nurses experience the same underlying problem through a different lens: staffing, coverage models, the reliability of a shift, whether their break actually happens when it is supposed to.
For a system leader managing multiple workforces at once, that distinction carries real implications. A uniform, one-size answer to engagement will reach some of the workforce and miss the rest. What held every version of Advocate's program together was trust in local leadership, built through deliberate support and real involvement.
Scaling Across a System Built from Many Systems
Advocate spans academic medical centers, rural markets, and urban systems. Fox stated directly that no single design travels cleanly across all three. Each workgroup building out the program includes a nurse, a physician, and an APP representative, drawn from across the organization's geography, because the same underlying problem shows up differently depending on where you are standing. Any leader managing multiple markets will recognize this.
Fox named three things as the foundation for nearly every question about the program: trust, connection, and reducing friction, in that order. "I always put trust first," she said. How people are heard determines whether anything built on top of it holds, across a hundred different local contexts at once.
The Culture Conversation Starts Before Anyone Is Hired
Fox described a hiring process that treats fit as mutual rather than one-directional. Cultural questions come up at the application stage, not after an offer. Advocate wants to be the right fit for a candidate as much as the reverse, and she was clear that both sides have to arrive at that conclusion together for the relationship to hold, regardless of how the onboarding goes.
The heaviest investment lands in the first five years, the period Advocate has identified as the highest turnover risk, with structured mentoring, rounding, and post-onboarding surveys to catch problems early. A second, quieter investment shows up mid-career, a point she has learned can be a second common exit ramp that gets far less attention industry wide.
Treat Workforce Investment as Capital Allocation
Fox pushed back gently on the word burnout, saying it can obscure the more specific issues affecting well-being and work-life balance. Advocate has responded with practical changes, including ambient listening technology available to every physician regardless of employment status, tools to manage inbox burden, and a redesign of how the organization runs its networking events, shifting toward family-inclusive gatherings so people spend a long workday and time with the people they go home to on the same evening, instead of picking one.
The budget question every system leader eventually asks is whether this is worth the expense. Fox's answer reframes the question entirely. Advocate's executive team, up through the CEO, weighs this as a capital allocation decision against a known cost, turnover, disruption, and the $1.2 million figure cited earlier, reviewed the same way any other strategic investment gets reviewed. She meets with Advocate's board at least once a year to walk through engagement results, where the organization has improved, and where it still has work to do. "At the end of the day, we recognize that our people are our greatest strength, and we have a responsibility to create a workplace that respects, supports, and honors their profession," she said.
What Comes Next
Best Place to Care has already expanded from physicians to APPs and nurses, roughly 42,000 of them. The next expansion, still in early planning, extends the well-being platform to Advocate's full workforce, well over 100,000 people, through a partnership with HR alongside Fox's own team.
"Without the Trust, You Get Nowhere"
Asked what she would tell another health system executive just starting this work, Fox's answer was short. "Listen more than you speak. Listen to learn and understand and then respond. That is how trust is earned" she said. Start small. Make incremental improvements as you go. "Without the trust, you get nowhere."
The Number That Should Be in Every Board Deck
Best Place to Care took Advocate's physician engagement from the 45th percentile to the 85th percentile within a year of launch. That result came from treating workforce engagement as seriously as any other strategic investment and tailoring the approach to each specific workforce. Sustaining that progress has required alignment across executive, physician, and nursing leadership, reinforcing a shared belief that caring for patients begins with caring for the people who deliver that care.
Workforce engagement has earned its place as a strategic priority. Every C-suite executive I have spoken with this year already assumed it matters. The real question is simpler: Can your investment flex across a complex, multi-market organization, or does it support just one program wearing every workforce's name? I would like to hear how your organization is approaching this; comment below or reach out directly.
1 https://weatherbyhealthcare.com/resources/real-cost-vacancies-and-provider-turnover
I used AI tools to help develop this article from our conversation transcript. The ideas, questions, and editorial judgment are mine. Suzanna Fox reviewed and approved this article. I am grateful for her candor and time.
Jerry Penso, MD, MBA, is president and CEO at AMGA.
Originally published on LinkedIn.
