Keeping Retention on the Agenda: A Committee Structure to Address Clinician Turnover

Clinician turnover can destabilize a primary care practice. It affects patient access, team morale, revenue, continuity, and a practice’s reputation in the community.^1,2 Turnover can have many causes, including physician burnout.^3,4 While many organizations have focused on targeted surveys to identify clinicians’ pain points and follow-up actions, the solutions are mixed and context dependent.^5,6 Further, retention work is often crowded out by the urgent demands of daily operations.

Our primary care group addressed this problem by creating a committee structure that makes recruitment, onboarding, well-being, professional development, and community engagement part of routine operational and strategic decision-making. This article is written for those who influence how a practice is run, which can include owners/partners, medical directors, and clinicians wanting to make a difference in their own work culture.

Our primary care group is made of eight locations, each led by a medical director, who serves as the direct supervisor of the clinicians at each location. Several years ago, we noticed an increase in clinician turnover at multiple locations. We spent six months characterizing the problem using several sources of data including 1) clinician departure data broken out by site, role, and reason for departure, where known, 2) results from the Association of American Medical Colleges (AAMC) Standpoint Faculty Engagement Survey, which identified clinician retention and well-being as critical areas of concern for our practice, 3) structured discussions with individual medical directors and the medical director team as a whole, and 4) when available, information from conversations with clinicians who had signaled they were leaving.

We found four primary drivers:

• Workload and clinic-related workflows,
• Inconsistent onboarding,
• Professional isolation and unclear advancement pathways,
• Disconnection from the reasons clinicians entered primary care.

Compensation was also raised as a factor, though less frequently.

Two features shaped our response to this data. First, the drivers were structural rather than individual. In other words, we could not resolve them simply by asking clinicians to change or become more resilient. This is consistent with evidence that organization-directed interventions to reduce burnout are more reliable than interventions aimed at the individual.⁷ Second, no one in our practice “owned” any of these themes. Each driver of clinician turnover was someone’s problem in principle and no one’s responsibility in practice. As a result, we concluded that a one-time intervention would not be enough; retention needed a durable operating structure.