The struggle of medical staff retention and turnover is not new to many practices and health systems. Depending on the size of a practice, staff turnover as low 20%, in our experience, can disrupt the clinic, leading to workflow inefficiencies, adding stress to the remaining staff and clinicians, affecting patient care, and impeding team-based care and transformation efforts.¹ The financial cost to replace staff members has been estimated at about 20% of their salary.² Non-financial costs can include losses in quality, continuity of care,^3,4 and time as practices train new staff members in clinic workflows, protocols, EHRs, and clinician expectations.

The staff turnover rate in many medical practices was already high pre-COVID-19. One cross-sectional analysis of 77 family medicine practices found a two-year turnover rate of 53% for staff (e.g., nurses, medical assistants, and office staff).⁵ The mass exit of employees during the COVID-19 pandemic, commonly referred to as the “Great Resignation,” has only made matters worse. As of late February 2022, only 22% of primary care practices reported being fully staffed, 52% reported having changed staffing ratios with fewer staff per clinician, and 68% reported having open positions they cannot fill.⁶

WHY STAFF LEAVE

Staff members choose to leave their positions for a variety of reasons.^5,7 Some staff leave for personal reasons. For example, they may want to pursue educational or professional opportunities, or they may have a personal expectation regarding the appropriate length of tenure at a specific position or location. Staff may also leave due to family reasons, housing costs, school districts, commute times, availability of public transportation, etc.

These departures are difficult for practices to prevent. However, many staff elect to leave for reasons directly related to their organization: