Burnout and Health Care Workforce Turnover

TLDR

Primary‑care clinicians and staff experience alarmingly high burnout and low engagement, yet little evidence links these factors to workforce turnover, making the problem of high turnover a compelling concern. A longitudinal cohort of 740 primary‑care clinicians and staff in two San Francisco health systems was followed from 2013–2014 survey data on burnout and engagement to 2016 employment records. Clinician burnout (53%) and low engagement (32%) were common, and burnout increased the odds of clinician turnover (OR 1.57) with a protective trend for high engagement (OR 0.58); neither burnout nor engagement predicted staff turnover, indicating burnout drives clinician but not staff attrition.

Abstract

<h3>PURPOSE</h3> 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. <h3>METHODS</h3> 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. <h3>RESULTS</h3> 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. <h3>CONCLUSIONS</h3> 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.