Emergency department factors associated with physician turnover in a large national group

When emergency physicians leave clinical practice at an emergency department (ED), the turnover is costly and disruptive to staffing.

We examine ED characteristics associated with site-level physician turnover.

We performed a retrospective cohort study of EDs staffed by a national physician group from 2022 to 2024. We studied the ED-level physician turnover rate, defined as the proportion of staff physicians, excluding locum tenens and travelers, who left a site in an observed calendar quarter and did not return within six months. We used a multivariable correlated random-effects (CRE) linear model at the ED-quarter level to assess associations between ED characteristics and physician turnover.

Across 177 EDs, the mean quarterly physician turnover rate was 12.5% (SD 7.0). In adjusted analyses, operational factors associated with higher turnover, between calendar quarters within the same ED, were a higher ED transfer rate (β 0.82, 95% CI 0.16 to 1.49), a lower proportion of advanced practice provider (APP) hours among all APP and physician hours (β -0.16, -0.30 to -0.03), and lower patients per hour (PPH) (β -0.85 per 0.1 PPH, -1.26 to -0.43). Other factors associated with higher turnover were a higher percentage of female physicians (β 0.14, 0.05 to 0.22), metropolitan vs. non-metropolitan location (β 3.12, 1.09 to 5.16), and location in the South (β 3.50, 1.22 to 5.79). Higher boarding was not associated with physician turnover.

Several factors were associated with increased ED-level physician turnover, including higher transfer rates, lower APP staffing, lower PPH, higher percentage of female physicians, and metropolitan and Southern locations.