Leadership Behavior, Values Alignment, and Future Objective Turnover Among Physicians

Importance: Although US health care organizations are attempting to improve physician retention, national data indicate that physician turnover is increasing. There are minimal data on the associations between physicians' assessment of their immediate supervisor and alignment of individual and organizational values and objective turnover. Objective: To evaluate the association between individual responses from physician surveys evaluating named immediate supervisor and alignment of individual and organizational values with objective turnover during the following 2 years. Design, Setting, and Participants: This cohort study included practicing physicians completing organizational surveys at a large, academic medical center between October 3, 2016, and May 1, 2024. Standardized instruments were used to assess leader behavior, alignment of individual and organizational values, burnout, and professional fulfillment at 5 survey time points. Individual survey responses were paired with human resources records on objective turnover. Exposure: The 9-item Mayo Clinic Leadership Impact Index, Stanford Values Alignment Scale, Stanford Professional Fulfillment Index, and a measure of self-reported intent to leave within the next 2 years were administered. Main Outcomes and Measures: Objective turnover was determined from human resource records. Multivariable Cox proportional hazards regression models were used to evaluate the association of leader behavior and alignment of individual and organizational values with turnover, adjusting for age, sex, survey year, and occupational well-being measures associated with turnover (ie, burnout and professional fulfillment). Results: In aggregate, 7351 survey responses from 3124 unique physicians (1528 [48.9%] female) paired with 2-year objective turnover were available. The participation rate exceeded 50% in all survey years (2016: 1281 of 2392 [53.6%]; 2019: 1285 of 1924 [66.8%]; 2020: 1479 of 1909 [77.5%]; 2022: 1553 of 2251 [69.0%]; 2024: 1654 of 2498 [66.2%]) Each 1-point higher score (range, 0-10) for leader behavior (hazard ratio [HR], 0.89 [95% CI, 0.85-0.93]; P < .001) and values alignment (HR, 0.90 [95% CI, 0.86-0.94]; P < .001) was associated with decreased objective 2-year turnover. After adjusting for age, sex, survey year, values alignment, occupational burnout, and professional fulfillment, each 1-point difference in leadership behavior score (HR, 0.88 [95% CI, 0.83-0.94]; P < .001) remained associated with objective 2-year turnover. The association between values alignment and 2-year objective turnover was no longer present in these analyses. On paired individual-level data from physicians completing consecutive surveys and adjusting for baseline score, each 1-point increase in leader behavior (HR, 0.82 [95% CI, 0.76-0.90]; P < .001) and values alignment (HR, 0.86 [95% CI, 0.79-0.93]; P < .001) score between surveys was associated with reduced turnover following the second survey. On multivariable analysis adjusting for age, sex, and survey year, respondents indicating moderate (HR, 3.22 [95% CI, 2.41-4.31]) or likely to definite intent to leave (HR, 8.58 [95% CI, 6.43-11.44]; P < .001) were at higher risk of objective 2-year turnover. Conclusions and Relevance: In this cohort study, physician evaluation of immediate supervisor behavior and alignment between individual and organizational values on organizational surveys were associated with subsequent objective turnover. These findings suggest that organizations seeking to promote physician retention should conduct leadership assessments, attend to leadership development, and foster values alignment with their physicians.