Understanding clinician retention: Insights from a national anesthesia practice group

Anesthesia workforce shortages are intensifying, with facility-reported staffing shortages reaching 78% by 2023. Retention is thus critical for anesthesia practices, yet its drivers remain poorly characterized across career stages and clinician types. We hypothesized that retention would be associated with traditional satisfiers: higher compensation, lighter workload, shorter (daytime) hours, and desirable case mix. We tested this hypothesis using data from a large national anesthesia practice.

We conducted a database cohort analysis of 6273 anesthesia clinicians (2935 physicians; 3338 CRNAs) employed by U.S. Anesthesia Partners between January 2018 and December 2024. Modified Poisson regression with robust variance estimation identified independent predictors of attrition, expressed as prevalence ratios, stratified by career stage (early, mid, late).

Overall annualized retention of clinical personnel was 80-90%. Over the total 7 years, 36.7% of physicians and 41.6% of CRNAs left full-time practice with USAP. Physician partnership independently predicted lower attrition among early-career (PR 0.56) and mid-career (PR 0.58) physicians; this pattern reversed among late-career physicians, among whom non-partner status was protective (PR 0.77). Among early-career CRNAs, higher compensation relative to peer median independently predicted retention (PR 0.85).

Retention appears to depend more on organizational integration and career-stage-specific factors than on workload reduction or compensation. Practice leaders should prioritize transparent partnership pathways at recruitment and engagement-focused strategies over incremental compensation increases beyond competitive thresholds. The modest explanatory power of objective workforce metrics suggests unmeasured factors, including site-specific culture, local leadership, and perceived fairness, may be more important to retention than measurable objective variables.