It's more than about money, though that is a biggie
By Lesley Henton, Texas A&M University
Edited by Robert Egan
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
health care, 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 health care 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 health care
systems in the Dallas-Fort Worth metroplex, repeatedly described clinicians'
departures as one of their biggest concerns, whether the higher turnover now
common among young physicians or older physicians' lack of transitional options
short of full retirement. Some said replacing a highly experienced physician
could require hiring multiple younger clinicians, given the way the health care
system measures and rewards productivity.
"When a veteran clinician leaves, health care
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 the introduction of work-hour regulations 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 health care organizations can adapt while continuing to
provide excellent patient care."
Building the health care 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 health care 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, the researchers say, and patients will benefit if
health care organizations can better support each generation of clinicians
throughout their careers.
"We're seeing health care 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 health care system."
More information
Andrew A. White et al, Generational Change in the Healthcare
Workforce: Perspectives from Health System Leaders, The Joint
Commission Journal on Quality and Patient Safety (2026). DOI:
10.1016/j.jcjq.2026.06.009