Oregon’s healthcare workforce turnover includes many employees in leadership positions


Shane Ersland


Many workers are leaving the healthcare industry as stress and burnout continue to present workforce challenges in Oregon. 

Health leaders discussed workforce issues at the 2023 Oregon State of Reform Health Policy Conference. Dr. Tao Li, an associate professor of health management and policy at Oregon State University, was the lead author of the Oregon Health Care Workforce Needs Assessment, which was released in February

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The assessment found that over 70 percent of Oregon primary care providers reported mental stress, which was an all-time high, Li said. More than 60 percent of all nurses reported anxiety, stress, and burnout, he said. 

“Nationwide, over 30 percent of all nurses who left their job reported burnout as the main reason,” Li said. “Improving healthcare workforce resiliency and well-being is essential to increase workforce retention.”

Shannon Surber, executive director of staffing systems and strategy at Kaiser Permanente, said  the national vacancy rate for nurses was five to seven percent prior to the COVID-19 pandemic. That number climbed to 17 percent in 2021, and continues to climb, she said. 

“Shifting to turnover rates, we’ve seen a similar story,” Surber said. “Nurses across the country, pre-pandemic, saw about a 15 percent turnover, which climbed to 27 percent in 2021.”

Stephanie Castano, senior transformation manager at the Oregon Primary Care Association, discussed workforce challenges federally qualified health centers (FQHCs) have been facing.

“What we are hearing from FQHCs, in general, is that the system feels unstable. And it feels fractured. Team dynamics have changed. There’s more documentation, (and) there is more stress on providers and clinic teams to do more, and to do it with limited resources. So leadership within our FQHCs are really thinking thoughtfully about how we change our systems and improve our systems to become systems of healing.”

— Castano

Castano described a unique circumstance for FQHCs. In the last four years, 50 percent of FQHC CEOs or executive directors have turned over, she said. 

“So there’s been a huge shift in leadership,” Castano said. “Many of those leaders had been in those organizations for decades. So sustainability in leadership has been a challenge.” 

LifeWorks President and CEO Mary Monnat said she has noticed turnover in leadership positions as well.

“I think what happened during the pandemic is we lost a lot of very seasoned managers,” Monnat said. “A lot left for their own health during the pandemic. So we have this combination of really green, committed new people, and we used to pair them with the managers. And they’re not there. So I worry about quality.”

Monnat said healthcare employers need to focus more of their attention on who they’re hiring.

“If you are hiring people and they have a lot of experience, look at how long they’ve been in jobs. Because I think we’re doing a lot of circling around the same problem employees. I’m seeing a lot more (human resources) activity. I think we need to [train] managers faster because of that loss of seasoned leaders. Collectively, we could do better training our workforces.”

— Monnat

Surber said Kaiser Permanente Northwest implemented a new staffing structure a couple years to address staffing challenges it has had since the pandemic.

“We’ve created centralized hiring structures for our high-priority physicians,” she said. “That’s been really helpful in reducing our time to hire. We also started hosting hiring events, which have been incredibly successful.” 

Li’s assessment issued recommendations as well, including sustaining a positive work environment and culture, making the workforce more welcoming for diverse providers, and supporting healthcare workers seeking mental healthcare. 

“We also recommend increasing compensation and reimbursement to attract new individuals and increase retention,” he said. “It is also very important to invest in Oregon’s education pipeline.”