Press Ganey analyzed employee feedback from over a million respondents (at more than 300 healthcare organizations and 5,000+ facilities) across the U.S. to explore the drivers of retention and churn impacting the workforce. Our data reveals several key themes that highlight the need for organizations to prioritize and implement targeted employee experience strategies aimed at improving retention rates.
- Retention issues impact every group. The data points to a workforce that’s hurting across all positions, levels, identities, and lengths of service.
- APPs’ likelihood for turnover has soared. APPs who are unsatisfied with an organization’s staff recognition are 6.3x more at risk of leaving. And those who don’t feel involved in decision-making are 4.6x more at risk of leaving.
- Nonclinical employees need their voices heard. Over half of the healthcare workforce are nonclinical workers. But high levels of job stress, low activation, and difficulty decompressing make retention among this critical group more challenging.
- Younger and early-career employees are at a high risk of leaving. Fostering a sense of belonging is the most important strategy to improve retention among millennials, Gen Z, and newer employees.
- Female physicians are burning out. Female physicians are 17% more likely to leave than male physicians. In fact, the number of female physicians leaving the industry is growing every year.
- Managers need support. Leadership—particularly mid-level managers—are seeing scores fall more than previous years. They need additional training and coaching support to be successful in their roles, and come into their own as leaders.
Press Ganey’s platform and team of experts enables organization leaders and managers to dive deep into the data and identify and prioritize opportunities for the greatest levels of improvement based on the exact needs of their workforce.
Current state of the workforce
An employee's likelihood of staying at an organization
An employee's ability to recover quickly or adjust to difficulties
The degree to which employees connect to the meaning of their work
An employee’s ability to disconnect from work when they're not in the workplace
10.9% of all healthcare employees considered leaving their organization in 2022, an uptick from 8.8% the year before. Regardless of job function, gender identity, race and ethnicity, and length of service, retention scores have continued their downward trajectory. 7.6% of healthcare workers don’t think they’ll be working at their organization three years from now.
In fact, among healthcare employees, “intent to stay” has dropped more than 6% over the past three years, with the bulk of that decline happening over the last 12 months. Most notably, decompression and resilience have fallen across positions as well, on both the clinical and nonclinical side.
This trend is unsustainable. The future of healthcare depends on identifying individual employees and groups most at risk of turnover, then quickly course-correcting to get them to stay for the long haul.
Clinical employees report the lowest overall retention scores, but nonclinical employees are struggling too
Although clinical employees experience some of the highest levels of activation, retention among this segment suffers: Clinical employees report the lowest overall retention scores. Out of all healthcare positions, advanced practice providers (APPs), RNs, and physicians are the least likely to remain at their organizations three years from now.
In particular, APPs’ likelihood for turnover has soared. APPs who are unsatisfied with an organization’s staff recognition are 6.3x more at risk of leaving. And those who don’t feel involved in decision-making are 4.6x more at risk of leaving. APPs also saw the biggest decline in decompression scores among clinical workers—followed by nurses—with their scores also falling in resilience as well as diversity and equity perceptions.
Nonclinical employees are struggling too. They make up more than half of the workforce, and are an integral part of providing top-notch patient experience and care. Security saw a 4% decline in retention scores over the past year. Among all nonclinical employees, they report the highest risk of leaving in the next three years. They also have the lowest activation scores, and experienced the biggest decline in activation, compared to other roles.
Key recommendation: Leaders must set the tone for a culture in which everyone has the chance to speak up and speak out without fear of repercussions. When employees know their voices will be heard and valued, they feel empowered to proactively contribute to problem-solving. Making space for all workers (both clinical and nonclinical) to share ideas—and be involved in decision-making—is foundational to pride in one's work, as well as a culture of belonging and, as such, your retention efforts.
Younger and early-career employees are the most at risk of leaving
Across the board, younger generations are struggling the most, when you consider key indicators of retention. Millennials (born between 1980 and 2000) and Gen Z (born after 2000) experienced the largest drops in decompression, activation, and resilience in 2022.
Millennial employees have the lowest score when asked if they “would stay with this organization if offered a similar position elsewhere.” Looking at year-over-year trends, Gen Z’s retention rate has dipped more than other generation demographics. In response to the item “I would stay at this organization if offered a similar position elsewhere,” scores among Gen Z respondents dropped 3% compared to 2021 (from 3.96 to 3.48). Gen Z also scored lowest on the question “I would like to be working at the same organization three years from now” (3.73), with millennials at their heels (3.85).
Key recommendation: For millennials and Gen Z (as well as early-career employees), a sense of belonging with an organization and its culture remains closely tied to retention. This tends to form during the onboarding phase, which, especially in recent years, has been a particularly high-stress environment. Employees who feel they belong tend to be higher performers, more adaptable, and more resilient overall.
Female physicians and APPs are burning out
Retention gaps along gender lines are virtually nonexistent—the outlier being physicians and APPs. Female physicians are 17% more likely to leave than male physicians. And turnover among female physicians is seeing a snowball effect: In 2021, female physicians were 3% more likely to leave an organization than they were in 2020. In 2022, that number jumped to 8%.
Female physicians score lower than male physicians on intent to stay across medical specialties, age groups, and length of service surveyed*. And across key metrics, including retention, decompression, activation, and diversity, female physicians saw greater drops than males. Female physician’s ability to decompress is at an all-time low—at 3.05, compared to 3.17 in the previous year.
Female APPs, who make up a majority of the APP workforce, are also showing signs of burnout. Female APPs report greater declines in decompression scores vs. their male counterparts over the past three years, with current scores at 3.33 vs. 3.51.
Key recommendation: Addressing gender inequity is an ongoing pursuit that requires a multi-angle strategy. Leverage AI technology to break down silos and mine organization-wide data for common friction points and insights along gender lines. Commit to improving the pay gap, putting hiring and promotion systems in place to ensure fair employment practices. Our findings show that a focus on flexibility, respect, and advancement can not only reverse discouraging turnover trends among female physicians, but also help them thrive professionally, and personally.
* Specialties surveyed include anesthesiology, emergency, family, internal, OB-GYN, and radiology.
Managers need support
While managers and senior managers typically score higher than other positions for retention and intent to stay, retention for these groups has dropped in the last year.
Even though senior managers’ retention scores are dropping, they’re doing better than the rest of the healthcare workforce. But those in front-line management positions are struggling significantly, with retention down 3% year over year. Senior management and management reported some of the lowest decompression scores among all positions—at 3.35 and 3.29 respectively (with physicians being the lowest at 3.21).
Key recommendation: There’s no doubt leaders take on more responsibility in any hospital. That’s why understanding their need to decompress is so important for maintaining resilient teams. Encourage leaders to take time off, and set clear expectations that it means completely disconnecting. Implement support programs to help managers with self-care and provide psychological safety. Actively listen to them to understand what immediate actions, tools, and resources can help them do their job better, as well as improve their resilience and well-being. Invest in leadership development, with formal training and coaching programs that focus on the specific tools and skills they need to best lead their teams.
Best practices to strengthen retention in 2023
Healthcare organizations that have made important strides in improving EX (and reducing employee turnover) rely on a few tried-and-true best practices. Here are some additional tips and recommendations for reversing retention trends in the coming year:
- Listen to the workforce strategically and intentionally. Stay close to the pulse of workforce well-being by making listening and pulsing a part of your organization’s language. Engage staff on top-of-mind concerns not just once, but throughout the year.
- Collaborate with your employees. When employees are involved in problem-solving, they feel more connected to their work. Consider leveraging technology platforms to capture the employee voice, using pulse surveys, virtual focus groups, and crowdsourcing to gather meaningful insights and find innovative, collaborative ways to solve big problems.
- Scan for high-risk moments across the employee lifecycle. Seek out regular input from employees around hiring, onboarding, and other early-tenure milestones. And monitor exit interviews to discover points of disconnect, where your organization is most likely to lose—or fail to attract—needed talent.
- Pinpoint and prioritize. Press Ganey offers a leader index and team index to enable organizations to identify specific leaders and teams that may benefit from more support, and partners with organizations to build custom improvement framework based on best practices. Proactively rounding on managers gives you an idea, firsthand, about how they’re improving, and it helps you make sure they have the support they need to be successful.
- Build culture from the get-go. Rallying around a shared vision and mission helps new team members understand priorities, gives employees a sense of purpose, and provides a point of connection. Rethinking your onboarding process beyond the first few weeks not only helps foster a sense of belonging, but it can also drive identity formation and socialization in a high-stress field.
- Understand the human behind the data. Segmenting your data—by role and responsibility, age and tenure, race and ethnicity, gender identity, and more—helps to get at the heart of what matters to each person. Use AI and natural language processing (NPL) to dig deeper into responses and quickly identify who’s at risk of turnover. Then, measure the impact of the solutions you put in place, and iterate from there.
- Invest in leaders—present and future. Building resilient leaders that will stay with your organization requires investment. Develop leadership programs that focus on training and coaching managers—especially those that may need more support—as well as “rising stars” that represent your future leadership.
- Celebrate the wins. Champion high performers to show top talent how much you appreciate them—as well as set the bar for their peers. Recognizing successes along the way helps instill a sense of pride in one’s work and infuses joy into a high-stakes, high-stress job.
The healthcare workforce has endured extraordinary circumstances over the past few years. Staying connected to your people through listening has never been more critical, as the industry continues to face unprecedented staffing and retention challenges.
Reach out to our team of experts to quickly identify and address retention issues that may be occurring at your organization. We’ll help you leverage the right data, technology, industry benchmarks, learnings, and insights that will uncover concrete next steps to act, engage your front line, and scale your efforts.
About this analysis
Press Ganey’s retention score is a custom composite outcome, combining the scores of two items:
- “I would stay with this organization if offered a similar position elsewhere.”
- “I would like to be working at this organization 3 years from now.”