Two years into the COVID-19 pandemic, healthcare organizations in the U.S. are dealing with major staffing shortages. Clinician turnover is high, staffing costs have risen, and even when organizations are able to hire new providers and staff, the need to train them can strain existing employees, explains Lauren Manzione, a project analyst for KLAS Research, and author of a new report, Clinician Turnover and the EHR Experience. She said these staffing challenges result in overburdened clinicians, millions of additional dollars spent by healthcare organizations, and ultimately a diminished capacity for patient care.

At the beginning of 2020, KLAS began asking clinicians in its Arch Collaborative survey how likely they are to leave their organization in the next two years. More than 59,000 clinicians have responded to date. The data sheds light on which clinicians are likely to leave and what related factors healthcare organizations can influence to improve clinician retention and resolve clinicians’ concerns. This survey included physicians, advanced practice providers (APPs), nurses and allied health professionals. 

According to the survey, the top seven drivers for leaving a health system include:

   • Feeling burned out
   • Chaotic work environments
   • Spending too much time on bureaucratic tasks
   • Frustration with the electronic medical record
   • Lack of effective teamwork 
   • Too heavy of a workload
   • Lack of shared values with organization leadership

Why are clinicians most likely to leave?

The percentage of clinicians reporting they are likely to leave their organization has fluctuated somewhat over the two years the question has been asked during the pandemic. The highest percentage of clinicians said they wanted to leave in the third quarter of 2021. Compared to other clinical backgrounds, nurses are the most likely to have plans to leave in the next year.

In the first part of 2021, 26% of surveyed nurses reported plans to leave. This was the period with the highest reported percentage, with more than a quarter of nurses saying they were ready to switch jobs. This spike could be attributable to a number of factors, including the increase in acute COVID-19 cases at the time, more prevalent cultural and political antagonism toward healthcare, and the resulting strain on healthcare workers. Clinician burnout similarly grew in Q1 of 2021, Manzione explained.

Beyond clinical background, the Arch Collaborative also asks about other factors such as burnout, training and various aspects of the EHR experience. By breaking clinicians into groups based on their answers to these and other survey questions, the Arch Collaborative has identified the clinician cohorts most likely to leave.

The report also identifies some actionable factors by healthcare organizations in attempts to stem the number of resignations.

Burnout is the top reason why clinicians are likely to leave

The KLAS study found the biggest reason why clinicians want to leave their jobs is that by feel burned out. This is what 60% of respondents said, and was by far the largest common reason shared across respondents.

This burnout was linked in many case back to inefficiencies with their hospital electronic medical record (EMR). About 35% of clinicians said they strongly disagree their organization has done a great job implementing, training on and supporting the EMR. These same clinicians said they are strongly dissatisfied with the overall performance of their EMR. Many said they did not receive adequate training and found patient data and test and imaging results were not easily accessible. 

About 32% of respondents said the EHR vendor did not have a well-designed system. This included 30% of nurses who said they spent more than 5 hours a week in lost productivity due to unproductive charting. 

Frustration beyond the EMR also cited as reasons to leave healthcare jobs

Two of the biggest drivers for frustration include 47% reporting chaotic work environments, and 46% saying they spend too much time on bureaucratic tasks. 

Between 35-38% report lack of effective teamwork in my organization, no personal control over workload and lack of shared values with organization leadership. More than 20% reported issues with required after-hours workload, the EMR impacting efficiency, and lack of autonomy in the job. 

Surprisingly, despite the survey being taken during the pandemic, only 15% said they would consider leaving clinical positions to move somewhere else due to work-related concerns about COVID-19.

All levels of burnout associated with attrition risk

Burnout is the indicator most strongly correlated with how likely clinicians are to leave their organization in the next two years, explained Manzione. The KLAS’ 2021 Clinician Burnout report found a link between burnout and attrition, especially among nurses. This report has identified that as burnout increases, so does likelihood to leave. This suggests that addressing the problems of burned-out clinicians could help reduce turnover. 

Attrition could also be lowered by preventing clinicians from becoming severely burned out in the first place. While clinicians who are completely burned out are most likely to leave, attrition likelihood grows rapidly beginning with those who report definite symptoms of burnout.

This, coupled with the sheer number of clinicians who report they are under stress, suggests that there is real opportunity to reduce turnover by addressing burnout in early stages and preventing it from getting worse, Manzione said. Examples of how some health systems worked to overcome burnout include UW Health, which used a strategy of adopting virtual scribes to help reduce burnout. Spectrum Health prioritized clinician wellness to reduce burnout of its employees. 

KLAS said they saw similar trends on burnout and other contributing factors in their recent reports on COVID-19 related
burnout and nurse burnout.

Read about more impacts of COVID on healthcare