Why Faculty Leaders Leave a School of Medicine?

Faculty attrition at academic health centers (AHCs) is significant at about 11% nationally, with one in five physicians intending to leave, and replacement costs averaging $500,000 per physician. Attrition among AHC faculty leaders is inadequately studied. This study compares reasons to leave between exiting faculty leaders and faculty non-leaders at the University of New Mexico School of Medicine (UNM SOM). The SOM deans interview all exiting faculty using a structured exit survey. 329 faculty non-leaders and 58 faculty leaders left UNM SOM between July 2017 and June 2022. Distributions of each variable were analyzed for statistically significant differences between the two groups using Fisher's 2-sided exact test. Text comments by leaders were analyzed qualitatively for content using a team-based, iterative process. As compared to non-leaders, exiting faculty leaders were more likely to be professors (51.7% vs 16.7%, p<0.001), and hold tenure (32.8% vs. 12.2%, p=0.001). Faculty leaders were more likely than non-leaders to cite high-level leadership as a reason to leave (41.4% vs. 24.3% p=0.01) and better leadership as a critical issue in development and retention (51.7% vs. 36.8% p=0.04). Qualitative analyses of textual leader comments showed a similar distribution of themes as the quantitative variables when examining open text related to the survey questions related to reasons to leave and the most critical issues. In addition, when asked what would need to change for them to return, qualitative data showed open-ended responses by exiting faculty leaders were twice as frequent to include leadership comments than those by non-leaders (34.2% vs. 16.2%). Exiting faculty leaders disproportionately cite high-level leadership as a reason to leave. The mediatory factors for this association are not known. Investigations to determine the causes for the study findings, and data-driven intervention strategies to retain faculty leaders at SOMs are needed.