If it feels harder to keep the same doctor, you're not imagining it. Healthcare leaders say retirements, burnout and changing workforce expectations are making it complicated to keep experienced clinicians in place.
A new study published in the Joint Commission Journal on Quality and Patient Safety suggests the reasons go beyond staffing shortages. Leaders from four major health systems in one of the nation's largest metropolitan areas say generational shifts are reshaping who enters healthcare, who stays and why clinicians leave.
"We've talked about clinical workforce shortages as a numbers problem involving training and retention," said study co-author Dr. William Sage , founding director of the Texas A&M University Institute for Healthcare Access in Fort Worth. "What these leaders described was something more complicated, as healthcare organizations are struggling to meet growing patient needs while accommodating five distinct generations of clinicians with different needs and perspectives about work, well-being and career longevity."
Why keeping clinicians is getting harder
Study participants, 17 leaders from four major healthcare systems in the Dallas-Fort Worth metroplex, repeatedly described the departure of clinicians as one of their biggest concerns, whether the higher turnover now common among young physicians or an older physician's lack of transitional options short of full retirement. Some said replacing a highly experienced physician could require hiring multiple younger clinicians, given the way that the healthcare system measures and rewards productivity.
"When a veteran clinician leaves, healthcare organizations lose more than just a position," said Keegan Warren , co-author and the institute's executive director. "They can lose years of institutional knowledge, mentoring relationships and practical experience that are difficult to replace. For physicians in particular, departure carries a high institutional price tag. Treating clinicians as people whose lives and contributions matter is not just the right thing to do; it's a critical strategy for protecting both continuity of care and the financial health of the system."
Participants also pointed to burnout and shifting workplace expectations. Younger physicians and nurses are more likely to discuss mental health, work-life balance and scheduling flexibility, and they expect employers to play a major role in addressing those concerns.
Sage said the findings should not be interpreted as a simple clash between generations but as the shifting and mixing of expectations over time, including as the result of discrete events such as the introduction of work hours regulation for medical trainees, the reduction of physician-owned practices in favor of employment by hospitals and other large organizations and the COVID-19 pandemic.
"This isn't a story about one generation being right and another being wrong," Sage said. "It's about how the profession is changing and how healthcare organizations can adapt while continuing to provide excellent patient care."
Building the healthcare workforce of the future
The researchers say addressing these challenges will require more than simply hiring more clinicians.
The study identifies several approaches that could help strengthen the healthcare workforce:
- Create more intentional mentorship programs to transfer knowledge from experienced clinicians to younger colleagues.
- Reduce early career turnover through retention-focused benefits, continuous career development and workplace flexibility.
- Include multiple generations in leadership and decision-making, ensuring workplace policies reflect different career stages and perspectives.
- Give human resources leaders a larger role in workforce planning, retention strategies and succession planning.
- Develop flexible late-career roles for experienced clinicians, allowing them to continue mentoring and contributing even as they reduce clinical workloads.
- Improve communication across generations to address workplace tensions before they affect morale, retention or patient care.
A stable, capable clinical workforce is foundational to patient access to care, say the researchers, and if healthcare organizations can better support each generation of clinicians throughout their careers, patients will benefit.
"We're seeing healthcare organizations recognize that retention can no longer be an afterthought," Warren said.
"Clinicians are people first, with lives, families, identities and limits. They're not just 'providers' or FTEs. When leaders design roles and cultures that honor that humanity, they strengthen commitment, stabilize teams and build a more resilient healthcare system."
By Lesley Henton, Texas A&M University Division of Marketing and Communications
