Burnout and Health Care Workforce Turnover
- Rachel Willard-Grace, MPH1⇑,
- Margae Knox, MPH1,
- Beatrice Huang, BA1,
- Hali Hammer, MD2,
- Coleen Kivlahan, MD, MSPH3 and
- Kevin Grumbach, MD1
- 1Department of Family & Community Medicine, University of California San Francisco, San Francisco, California
- 2San Francisco Health Network, San Francisco, California
- 3University of California San Francisco School of Medicine, San Francisco, California
- CORRESPONDING AUTHOR: Rachel Willard-Grace, MPH, Department of Family & Community Medicine, University of California San Francisco, 1001 Potrero Ave, Ward 83, San Francisco, CA 94110, Rachel.Willard@ucsf.edu
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.