Part 1: A Role Built at an Inflection Point
When Todd Smith, MD, stepped into the newly created Chief Physician Executive role in 2023, Sutter Health had roughly 4,300 physicians. In three years, that number has grown to more than 6,100 physicians. We recently spoke with Dr. Smith about what it has taken to hire at that pace, what keeps physicians at Sutter once they arrive, and where technology has actually reduced the work rather than added to it.
He started with the conditions that made his role necessary in the first place, which aligned with the arrival of Sutter Health President and CEO Warner Thomas a year earlier.
"When Warner arrived, Sutter was at an important inflection point," Smith said. "We had a strong foundation, but our physician workforce had been relatively flat, and in some areas we had lost ground. If we were going to grow and better meet community needs, we needed the physician voice more directly connected to the decisions that shape care."
Both Smith and Thomas believe strongly in dyad leadership, acknowledging that better decisions are made when physician and administrative leaders work together well. That mentality shaped how Smith’s role was scoped: shared responsibility, alongside the Chief Operating Officer, for operations that directly touch patients.
"The role needed to be more than advisory...because our strategy depends on physician leadership," Smith said.
Conversation Takeaways
Growth Requires New Recruiting Infrastructure:
Sutter grew its physician workforce by rebuilding its recruiting operating model and replacing reactive hiring with disciplined workforce planning.
Sustainable Growth Requires Guardrails:
Practice readiness — onboarding, leadership support, team structure, space, workflows — determines whether a new physician can succeed. Sutter watches time-to-fill, engagement, access, and turnover to catch gaps early.
Two Themes Behind Departures:
Smith said two reasons come up again and again when physicians leave: too little voice, or work that has become too hard to sustain. Recruiting more will not be enough if burden goes unaddressed.
Start With the Problem, Not the Technology:
Sutter focuses AI investment where the pain point is obvious and relief can be felt quickly, beginning with documentation burden and expanding to Epic optimization and digital workflows.
Training Is a Retention Strategy:
Knowing that physicians are more likely to practice where they train, Sutter prioritizes the conversion pipeline. It aims to create a pathway for physicians to not only train to be excellent clinicians but also to build long-term careers at Sutter and in the community.
Part 2: Rebuilding How Sutter Recruits
To add over 1,800 physicians in three years, Smith acknowledged that it "took much more than posting more jobs. We had to build the recruiting infrastructure to support that kind of scale."
In practice, that meant right-sizing recruiting teams, creating a more consistent operating model across medical groups, and coordinating sourcing, marketing, conference strategy, and workforce analytics so recruiters could spend more time understanding candidates and local needs. Sutter also moved to more disciplined workforce planning with medical group and strategy leaders: where to grow, which specialties were hardest to recruit, and how long building capacity would take.
Visibility helped, too. Smith credited Thomas's external storytelling about where the organization is going. "Candidates want to know that the organization is investing in growth, innovation, physician leadership, and the communities it serves," he said.
The Guardrails on Growth
Smith was explicit that headcount is not the only measure. "Growth only works if it is sustainable," he said.
To Smith, getting better looks like connecting recruiting to clinical and community need, and confirming the site itself is ready to welcome new physicians through onboarding, leadership support, team structure, and other important operational details.
"Move with urgency, but do not outrun the infrastructure, culture, and support that make growth successful," Smith said.
Part 3: What Actually Moves Retention
After hiring, organizations must turn their attention to retention, which includes moderating burnout and supporting physician well-being. The national baseline is sobering: 43% of physicians report burnout. But according to Sutter’s own fall 2025 Experience of Work survey, burnout was only 25% for both medical group and hospital-affiliated physicians and APCs, a rate Smith said has been improving year over year.
When asked what has moved the needle, Smith emphasized that it has been a combination of strategies. He did note that, "One of the most important has been elevating physician leadership and strengthening dyad partnerships. Physicians need to be at the table when decisions are made about care delivery, operations, quality, and the practice environment."
Sutter has also invested in well-being at the medical group and system levels: clinician care committees, 24/7 mental health support, peer support after difficult events, and a systemwide Office of Well-being.
Why Physicians Leave
When asked about physicians who can’t be retained, Smith identified two main themes: “they do not feel they have enough voice, or the work has become too hard to sustain.”
The first is what dyad partnerships are meant to address. "When decisions feel disconnected from the realities of practice, frustration builds," he said.
The second is burden, which includes documentation, in-basket management, prior authorizations, regulatory requirements, and constant change. Smith tied that back to the growth strategy:
Fortunately for Sutter, their employee sentiment points the other way. Sutter reports that 85% of employees recommend it as a great place to work, putting the system in the top quartile nationally. Smith attributed that to mission clarity, visible investment in people, and the "One Sutter" work of connecting people to something larger than their own team.
Part 4: Giving Time Back
Technology enters the conversation as a way to help reduce the burden Smith described above. Sutter reports returning roughly 1.5 million hours to care teams over the past year through digital tools, AI, and workflow improvements.
Ambient documentation is "one of the clearest examples," Smith said, because it addresses "a pain point physicians feel every day: time spent documenting." The tool listens during an encounter and drafts a note, which the clinician reviews, edits, and finalizes. "Early results show meaningful reductions in time spent, with some measures showing a 15% to 20% decrease,” he noted. More than 1,300 ambulatory clinicians have gone live, and more than 250,000 notes have been created since launch.
Underpinning that is a broader Epic optimization effort: moving toward one integrated platform across ambulatory, acute, home health, ambulatory surgery centers, and pharmacies. Sutter measures time savings through workflow analytics, usage data, and documentation time. But Smith did not treat those measures as simply a numerical optimization exercise.
Earning Physician Trust
However, none of these technology investments pay off if physicians do not use the tools, and Smith was sympathetic to why some would not.
"Physicians are right to be skeptical of tools that promise to reduce burden but create one more thing to manage, " he said. Sutter’s approach is to start “with the problem, not the technology.”
Clinicians need to understand what the tool does, what it does not do, and where the physician remains accountable. "AI should support clinical judgment, not replace it," Smith said. Physician champions matter, too. As he explained, "clinicians trust other clinicians who have used the tool in real practice settings."
Deciding where technology should replace a task versus support a clinician doing it differently comes down, in Smith's account, to a short set of questions. If a technology helps patients, reduces burden, simplifies a workflow, and preserves the clinician-patient relationship, then it can create real value. Smith noted that repetitive, administrative, and rule-based work is a candidate for automation; diagnosis, care planning, patient communication, and moments requiring judgment are not.
"If [technology] adds complexity or pulls clinicians farther from patients, we need to rethink it," he said.
Part 5: Training Physicians Where They Will Practice
Recruiting and retention both circle back to supply, which is where Sutter's investment in graduate medical education comes in. Sutter reports it is on track to become the largest community-based healthcare training institution in Northern California, with 221 physicians entering residency and fellowship programs next year. Smith framed that as a response to shortages in California and nationally, particularly in primary care and key specialties.
"If we train physicians in our communities, they are more likely to understand those communities and the patients we serve," he said. "Physicians are more likely to practice in the region where they train, and we see that at Sutter."
The current retention rate for recent graduates of Sutter residency programs is 40.5%. Sutter is also tracking where graduates end up practicing as their programs mature.
Holding all of this together across Sutter's footprint runs into a different constraint: balancing local identity with enterprise consistency. "A cohesive physician culture does not mean every market looks the same," Smith said. "We will not build culture by forcing uniformity." Trust, he said, comes from follow-through: physicians need to see action on the barriers they raise, and to understand the rationale when decisions are made at the system level. He also emphasized that the "'say-do' ratio matters."
A Final Leadership Lesson: Assume Positive Intent
"One lesson I come back to often is that most people are trying to do the right thing, even when they are approaching the issue from a different vantage point," Smith said. When he feels stuck, he steps back, assumes positive intent, and reconnects the conversation to the "why."
"The bigger the challenge, the more important it is to slow down enough to make sure people understand where we are going, why it matters, and how their voice is part of the solution," he said. "That time up front almost always saves time later."
His advice to first-time physician leaders is direct. "Stay humble, stay curious, and listen first," he said.
Recruiting, retention, technology, and training are not separate initiatives at Sutter. Rather, they are different expressions of the same “whole practice environment” that Smith upholds. Each initiative aims to make physicians’ daily work more sustainable and make patients’ care more supportive. As Smith emphasized, the goal was never simply to get bigger; it is to get better as they grow.