Why your doctors keep leaving

If it feels harder to keep the same doctor, you’re not imagining it. Health care leaders say retirements, burnout and changing workforce expectations are making it complicated to keep experienced clinicians in place.

A new study published in the Joint Commission Journal on Quality and Patient Safety suggests the reasons go beyond staffing shortages. Leaders from four major health systems in one of the nation’s largest metropolitan areas say generational shifts are reshaping who enters health care, who stays and why clinicians leave.

“We’ve talked about clinical workforce shortages as a numbers problem involving training and retention,” said study co-author Dr. William Sage, founding director of the Texas A&M University Institute for Healthcare Access in Fort Worth. “What these leaders described was something more complicated, as health care organizations are struggling to meet growing patient needs while accommodating five distinct generations of clinicians with different needs and perspectives about work, well-being and career longevity.”

Why keeping clinicians is getting harder

Study participants, 17 leaders from four major health care systems in the Dallas-Fort Worth metroplex, repeatedly described clinicians’ departures as one of their biggest concerns, whether the higher turnover now common among young physicians or older physicians’ lack of transitional options short of full retirement. Some said replacing a highly experienced physician could require hiring multiple younger clinicians, given the way the health care system measures and rewards productivity.

“When a veteran clinician leaves, health care organizations lose more than just a position,” said Keegan Warren, co-author and the institute’s executive director. “They can lose years of institutional knowledge, mentoring relationships and practical experience that are difficult to replace. For physicians in particular, departure carries a high institutional price tag. Treating clinicians as people whose lives and contributions matter is not just the right thing to do; it’s a critical strategy for protecting both continuity of care and the financial health of the system.”

Participants also pointed to burnout and shifting workplace expectations. Younger physicians and nurses are more likely to discuss mental health, work-life balance and scheduling flexibility, and they expect employers to play a major role in addressing those concerns.

Sage said the findings should not be interpreted as a simple clash between generations but as the shifting and mixing of expectations over time, including the introduction of work-hour regulations for medical trainees, the reduction of physician-owned practices in favor of employment by hospitals and other large organizations, and the COVID-19 pandemic.

“This isn’t a story about one generation being right and another being wrong,” Sage said. “It’s about how the profession is changing and how health care organizations can adapt while continuing to provide excellent patient care.”

Building the health care workforce of the future

The researchers say addressing these challenges will require more than simply hiring more clinicians.

The study identifies several approaches that could help strengthen the health care workforce:

• Create more intentional mentorship programs to transfer knowledge from experienced clinicians to younger colleagues.
• Reduce early-career turnover through retention-focused benefits, continuous career development and workplace flexibility.
• Include multiple generations in leadership and decision-making, ensuring workplace policies reflect different career stages and perspectives.
• Give human resources leaders a larger role in workforce planning, retention strategies and succession planning.
• Develop flexible late-career roles for experienced clinicians, allowing them to continue mentoring and contributing even as they reduce clinical workloads.
• Improve communication across generations to address workplace tensions before they affect morale, retention or patient care.

A stable, capable clinical workforce is foundational to patient access to care, the researchers say, and patients will benefit if health care organizations can better support each generation of clinicians throughout their careers.

“We’re seeing health care organizations recognize that retention can no longer be an afterthought,” Warren said.

“Clinicians are people first, with lives, families, identities and limits. They’re not just ‘providers’ or FTEs. When leaders design roles and cultures that honor that humanity, they strengthen commitment, stabilize teams and build a more resilient health care system.”

Who’s behind this story?

Robert Egan

Bachelor’s in mathematical biology, Master’s in creative writing. Well-traveled with unique perspectives on science and language.

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