Wave of turnover looms as nearly half of healthcare executives plan to exit in 2025

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Nearly half of healthcare executives say they plan to leave their organizations within the next year, a startling finding that underscores a widening turnover risk for hospitals and medical practices already grappling with cost pressures, staffing shortfalls and evolving patient needs.

B.E. Smith Leadership Solutions, an AMN Healthcare company, released its “Healthcare Leadership Trends for 2025” report pointing to a mixed outlook on job stability, coupled with persistent retention challenges. The survey of 588 healthcare executives, conducted in late 2024, shows improvements in recruiting efforts but ongoing concerns over leadership engagement and turnover intentions.

Retention risks remain high
About 46% of leaders say they plan to leave their organization within the next 12 months, mirroring last year’s data. Those with one to five years of tenure are most likely to consider leaving. Meanwhile, 74% of leaders report being approached with a new job opportunity within the past six months, and 17% pursued it. Leaders who are dissatisfied with their current roles were significantly more likely to explore outside opportunities.

Top factors influencing retention

Several factors contribute to a leader’s decision to remain with an organization:

• Organizational culture, cited by 44% of respondents overall and 52% of C-suite executives, emerged as the top factor.
• Colleagues ranked second at 39%.
• Compensation package was important for 38% overall, and 41% of director-level leaders identified it as their top factor.
• Flexible scheduling continues to gain significance.

Career advancement and barriers
While 43% of Millennial respondents believe their organizations are preparing them for advancement, only 22% of all respondents share that confidence—a decline from last year. Additionally, 20% say they must leave their current employer to advance. Common organizational barriers include limited change, smaller size, insufficient leadership development, cultural hurdles and a preference for external candidates.

Engagement gap persists
The survey reveals a sustained gap in engagement between leadership and clinical staff. Sixty-three percent of leaders describe themselves as highly engaged, compared to 30% of physicians and 29% of nurses. This discrepancy suggests a potential area of instability that could hinder organizational health.

Recruitment landscape improves slightly
Fewer respondents—43%—call it “extremely” or “very” challenging to attract high-quality leadership candidates, a 5-point drop from last year. However, smaller hospitals continue to face greater recruitment hurdles. Time-to-fill rates for executive positions have modestly improved, with fewer organizations reporting extended vacancy periods.

Financial and operational context
Healthcare financial metrics have rebounded somewhat from pandemic lows, but high labor, drug and supply costs remain a burden. Smaller and rural facilities face disproportionate challenges, potentially affecting job stability through organizational restructuring or compensation constraints.

Strategic growth and technology
Service line expansion (49%) ranks among the most popular strategic growth plans. Technology, including cybersecurity and artificial intelligence, is rapidly increasing in importance. Leaders say AI could significantly reshape managerial responsibilities within 2 to 3 years. The demand for specialized technology leadership could present both opportunities and vulnerabilities, depending on an organization’s ability to adapt.

Interim leadership as a strategy
About 28% of respondents used interim executives this past year, and 40% report they will definitely or possibly do so in 2025. While 83% say interim leaders help fill temporary vacancies, others use them to lead specific projects (20%) or mentor emerging executives (15%). This flexible approach could further shift the traditional leadership landscape.

Implications for practice administrators
These findings underscore the need for medical practice administrators to emphasize a positive organizational culture, strong colleague relationships and competitive compensation packages. Addressing the engagement gap between leadership and clinical staff is especially critical, as is providing clear paths for career advancement. As technology reshapes the industry and interim leaders become more common, administrators should remain adaptable to sustain job stability and effectively retain leadership talent.