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Cited by 400Healthcare professionals’ stress and burnoutStress and Burnout ResearchOccupational Health and Burnout

Burnout and health care workforce turnover

Open access
Willard-Grace, Rachel, Knox, Margae, Huang, Beatrice, Hammer, Hali, Kivlahan, Coleen, Grumbach, Kevin·2019·The Annals of Family Medicine
DOI 10.1370/afm.2338PMC PMC6342603
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Abstract

PURPOSE: Levels of burnout among primary care clinicians and staff are alarmingly high, and there is widespread belief that burnout and lack of employee engagement contribute to high turnover of the workforce. Scant research evidence exists to support this assertion, however. METHODS: We conducted a longitudinal cohort study using survey data on burnout and employee engagement collected in 2013 and 2014 from 740 primary care clinicians and staff in 2 San Francisco health systems, matched to employment roster data from 2016. RESULTS: Prevalence of burnout, low engagement, and turnover were high, with 53% of both clinicians and staff reporting burnout, only 32% of clinicians and 35% of staff reporting high engagement, and 30% of clinicians and 41% of staff no longer working in primary care in the same system 2 to 3 years later. Burnout predicted clinician turnover (adjusted odds ratio = 1.57; 95% CI, 1.02-2.40); there was also a strong trend whereby low engagement predicted clinician turnover (adjusted odds ratio with high engagement = 0.58; 95% CI, 0.33-1.04). Neither measure significantly predicted turnover for staff. CONCLUSIONS: High rates of burnout and turnover in primary care are compelling problems. Our findings provide evidence that burnout contributes to turnover among primary care clinicians, but not among staff. Although reducing clinician burnout may help to decrease rates of turnover, health care organizations and policymakers concerned about employee turnover in primary care need to understand the multifactorial causes of turnover to develop effective retention strategies for clinicians and staff.

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  • In the preliminary study, the 12-month turnover rate between the 2017 and 2018 surveys was 16%, matching healthcare industry estimates.

    “The preliminary study had a 12-month turnover rate of 16% between the 2017 and 2018 surveys, consistent with estimates for the healthcare industry [34].”

    From The Work-life Check-ins randomized controlled trial: a leader-based adaptive, semi-structured burnout intervention in primary care clinics (2024) · cites this paper as [34]

    The Results describe surveys conducted in 2013 and 2014, not 2017 and 2018, and report turnover of 30% among clinicians and 41% among staff over 2–3 years, not 16% over 12 months. The Discussion gives national annual estimates of 6.8% for physicians and 11.5% for advanced practice clinicians; it does not identify 16% as a healthcare-industry estimate. (LLM, conf=0.91)

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Research works printed but not linked: 3

  1. [14]14. Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J; Career Satisfaction Study Group. Physician job satisfac- tion, dissatisfaction, and turnover. J Fam Pract. 2002; 51(7): 593.
  2. [15]15. Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medi- cine: the consequences of physician dissatisfaction. Med Care. 2006; 44(3): 234-242.
  3. [27]27. American Medical Group Associates & Cejka Search. 2007 Physician Retention Survey: Supplemental Edition. https: //c.ymcdn.com/sites/ aspr.site-ym.com/resource/resmgr/imported/2013-02_2007-AMGA- Physician-Retention-Survey.pdf. Published 2008. Accessed Jun 10, 2018.

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Authors
Willard-Grace, R., Knox, M., Huang, B., Hammer, H., Kivlahan, C., & Grumbach, K.
Affiliations
University of California, San Francisco (US)
ORCID
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2019-01
Volume
17
Issue
1
Pages
36-41
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.2338
PMC
PMC6342603
OpenAlex
W2911242397
Cited by
400
References
27
Citations by year
2026: 54 · 2025: 56 · 2024: 62 · 2023: 87 · 2022: 60 · 2021: 48 · 2020: 22 · 2019: 10
FWCI
47.72
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
Keywords
burnout, employee engagement, primary care providers, primary care staff, clinician retention
MeSH terms
Burnout, Professional, Humans, Personnel Turnover, Primary Health Care, San Francisco, Prevalence, Physicians, Primary Care

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