Leadership Behavior, Values Alignment, and Future Objective Turnover Among Physicians.
5 affiliations
- 1Department of Medicine, Stanford University, Palo Alto, California.
- 2Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California.
- 3Department of Pediatrics, Stanford University, Palo Alto, California.
- 4Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, California.
- 5Stanford WellMD & WellPhD Center, Stanford School of Medicine, Palo Alto, California.
Abstract
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.
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BibTeX
@article{shanafelt2026leadership,
title = {{Leadership Behavior, Values Alignment, and Future Objective Turnover Among Physicians.}},
author = {Tait D Shanafelt and Linda Boxer and Maryam Makowski and Mary B Leonard and Brian T Bateman and Euan Ashley and Hanhan Wang and Mickey Trockel},
journal = {JAMA network open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.38946},
url = {https://europepmc.org/article/MED/42873500},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Leadership Behavior, Values Alignment, and Future Objective Turnover Among Physicians.
AU - Tait D Shanafelt
AU - Linda Boxer
AU - Maryam Makowski
AU - Mary B Leonard
AU - Brian T Bateman
AU - Euan Ashley
AU - Hanhan Wang
AU - Mickey Trockel
PY - 2026
DA - 2026/10/01
JO - JAMA network open
DO - 10.1001/jamanetworkopen.2026.38946
UR - https://europepmc.org/article/MED/42873500
AB - 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.
SN - 2574-3805
ER -