Choosing Between Retention and Recruitment of Surgeons Using a Cost-benefit Analysis

The decision between retaining a high-performing surgeon and recruiting a new one is often subjective because financial data are confusing or complex. This study creates a cost-benefit model using financial data to decide between retention and recruitment.

A scoping review of both medical and nonmedical business literature in PubMed, Harvard Business Review, Cochrane, and the internet was performed between 1995 and 2025. Search terms: "retention and recruitment" AND [("financial-modeling) OR ("cost-benefit analysis") OR "Strategic-hiring or retention"]. Expected average salary, hiring, ramp-up time, and retention costs were compared with assumptions of the productivity of the retained surgeon and the new recruit, using a cost-benefit formula. Three hypothetical clinical scenarios were chosen wherein hiring is easier, moderate, or more difficult, to reflect geographic variations. An Excel workbook was created to help clinicians use the equation by simply plugging in their numbers and generating a decision.

Literature on retention versus recruitment is limited. However, financial data for a cost benefit analysis is available from administrations to compare the 2 options. A sample sensitivity analysis identifying the most important variables in each specific scenario is provided as a supplement, to calculate the "maximum allowable retention cost," which includes the highest retention bonus one can offer a retained surgeon.

A cost-benefit analysis that incorporates financial data could provide an objective adjunct to other intangible factors when making decisions between retention and recruitment.