OCTOBER 1, 2025
Originally published by our sister publication Anesthesiology News
HONOLULU—New research from Beth Israel Deaconess Medical Center, in Boston, has identified a series of factors associated with early staff turnover among attending anesthesiologists. The study found that attending anesthesiologists who left their positions early worked a disproportionate percentage of cases during non-regular work hours and on weekends.
The investigators said the findings may help institutions identify and
Originally published by our sister publication Anesthesiology News
HONOLULU—New research from Beth Israel Deaconess Medical Center, in Boston, has identified a series of factors associated with early staff turnover among attending anesthesiologists. The study found that attending anesthesiologists who left their positions early worked a disproportionate percentage of cases during non-regular work hours and on weekends.
The investigators said the findings may help institutions identify and quantify aspects of workload burden that contribute to staff turnover, ultimately helping them retain more anesthesiologists.
“A recent study suggested that among all medical specialties, anesthesia has the highest risk for provider turnover,” said Isabel Podolski, Cand. Med., a clinical research medical student at the institution. “In that study, almost every second attending anesthesiologist reported the intention to leave their own institution within the next two years.”
Perhaps the farthest-reaching effect of this phenomenon is its financial implications. Staff turnover has been estimated to cost healthcare institutions some $500,000 for each physician that leaves, adding further financial burden to the system. Yet despite these significant impacts, the external factors contributing to staff turnover among anesthesiologists have been largely unexplored.
“With this study, we really wanted to explore why anesthesiologists are leaving their positions,” Podolski said.
To do so, she and her colleagues assessed data from 131,354 anesthesia cases either performed or supervised by attending anesthesiologists in their respective first year at the institution between 2005 and 2023. They analyzed a variety of different case types, including solo cases (personally performed), handover cases, and the medical direction of certified registered nurse anesthetists or anesthesia residents.
At the same time, the investigators used literature review and an expert-iterative process to identify and define a series of variables potentially associated with higher staff turnover. These included provider gender, patient characteristics, temporal demand (surgery duration, case count per day of surgery, weekend cases, non-regular hours, total case count, OR days, occupational length), case type, patient comorbidity burden, case complexity and postoperative events.
“When we dug into the literature, we found that most previous research simply identified burnout as the cause of staff turnover,” Podolski said. “We took a different approach. We looked at what happens before the burnout. What do anesthesiologists do every day that may lead to burnout later on?”
In a presentation at the 2025 annual meeting of the International Anesthesia Research Society, Podolski reported that 236 attending anesthesiologists performed anesthesia care in the study. Of these, 56 (23.7%) terminated their work within the first 365 days of starting employment.
When comparing the workload characteristics of attendings who left and those who stayed, no meaningful differences were found in patient and case characteristics. Patient characteristics, comorbidity burden and case severity were distributed evenly between groups.
Perhaps most importantly, however, the analysis revealed that clinicians who left worked a greater percentage of weekends (mean proportion of total workdays, 6.1% vs. 4.7%; absolute standardized difference [ASD], 0.696) and cases during nonregular work hours, especially late shifts (13.3% vs. 7.4%; ASD, 0.774).
“I was surprised to see that case type wasn’t really associated with whether or not anesthesiologists left,” said senior author Maximilian Schaefer, MD, PhD, an associate professor of anesthesia at the institution. “I hypothesized that the providers who left early either did cases that are generally considered boring or even extremely stressful ones. But that wasn’t the case at all.
“Instead, the providers who left worked 30% more weekend shifts and almost double the number of late shifts,” he continued. “I think we have a scheduling system that tries to be fair, but obviously there are still variations in it.”
Addressing the factors that lead to early turnover will be an important by-product of the study, Schaefer continued, but one that will take considerable effort to achieve.
“I think being aware is the first part,” he said. “Obviously we cannot live without late shifts or call; we’re a specialty that has to do these shifts. But I think the key to retaining staff is making sure they are evenly distributed among our providers.
“I also think leadership needs to regularly check in with providers,” he added. “This way they can make sure everybody feels like their workload is manageable.”
Stephanie B. Jones, MD, the chair of anesthesiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital and Long Island Jewish Medical Center, found the study’s first-year turnover rate troubling.
“It’s such a big investment of time and money to bring on a new faculty member,” she commented. “So, what can we do differently?
“This study seems to point to schedule as the primary driver, with the departing group having the highest ASD for percent of emergency, weekend and off-hours cases,” Jones continued. “Based on what I’ve seen over the last several years, especially post-COVID, this does not come as a surprise. Staff expect transparency and equity; having to ‘pay one’s dues’ as a new staff member is no longer regarded as acceptable. The other side of that equation then becomes the more senior staff member. If there is no personal return on investment for their longevity within the department—increased salary, less call, more time off—how do you retain them?”
By Michael Vlessides
Jones, Podolski and Schaefer reported no relevant financial disclosures.
