Robert M. Nelson Jr., MD, MS
Senior Associate Dean for Faculty Affairs
Office for Faculty Affairs
University of Texas Rio Grande Valley School of Medicine
Faculty attrition continues to be a significant problem for many medical schools. Although accurate comparison data for faculty turnover is difficult to find, about 5% per year attrition seems common. The cost of each faculty replacement can exceed half a million dollars. Several studies published suggest that faculty leave for multiple reasons; these may include supervisory relationships, a sense of too much emphasis on a mission inconsistent with the faculty member’s career goals, and a lack of growth opportunities.1 Exit interviews of departing faculty are one mechanism to determine why faculty leave your institution. Such data can suggest ways to decrease attrition.
Who Does the Exit Interview?
Human resources may do the exit interview, but their focus is often on their checklist for faculty and employee separation (keys, patient medical records completed, etc.). The offices of faculty affairs should take the lead in doing the exit interviews because the departing faculty may be more open and honest with someone who isn’t their supervisor. Also, the faculty affairs interviewer may be more experienced in difficult and confidential conversations.
What Questions Are Asked?
While every institution should customize specific questions, my school frequently includes:
- Why are you leaving your position with us?
- What was the most significant factor that led you to accept the new position?
- How aligned was your position with your personal goals?
- Was your chair (dean, division chief) effective in their position?
- Was pay or fringe benefits an issue?
- Fill in the blank: I don’t know why the school of medicine doesn’t just _______.
When Do You Hold the Interview?
Ideally, have the exit interview while the faculty member is still engaged with the organization; waiting until the last day or two may result in quick and less thoughtful answers.
Exit interview studies also suggest that face-to-face interviews can yield more information if there is a follow-up meeting one to two months after the faculty has left your institution.2,3,4 In academic medicine, a similar approach has been used to gain information from former students or residents. This format likely provides less emotionally tinged information. However, many faculty affairs offices may not have the resources to accomplish this format.
In-Person Interview or Online Survey?
Both in-person interviews and online surveys are used, and each format has advocates. Face-to-face interviews allow more specific and higher-quality data. The completion rate is also high. A face-to-face format requires faculty affairs staff who are well-trained and experienced to do the exit interview. Due to its nature as an open-ended interview, it may be subjective, and thus hard to summarize results in a meaningful way.
On the other hand, online surveys are the least costly format. They are easy to analyze but may not capture the real reason a person is leaving. Online surveys also have a lower completion rate.
The Do’s and Don’ts During the Exit the Survey
| Do: | Don’t: |
|---|---|
| Be patient and friendly. | Display authority. |
| Pose open-ended questions. | Make them defend their choices. |
| Frame things positively. | Overshare. |
| Ask for additional thoughts. | Propose solutions. |
| Express excitement about their new opportunity. |
For exit interviews to be effective, you need to summarize data collected in the interviews and share it with leadership. Some investigators have suggested comparing the data with AAMC Standpoint Surveys (previously Faculty Forward). Such analysis allows the school of medicine to check progress between the AAMC surveys regularly.
The results need to be interpreted in a local perspective. For example, my school is new, now just over four years old. We have grown from approximately 20 to 150 faculty. We are just now starting exit interviews. If we have 6% attrition during the coming year, we will interview eight to 10 faculty — a small sample size compared with an established school with 500 or more faculty. Most schools of medicine have unique characteristics related to their geographic location and community served, which may be specifically important to understand; Customize questions to these characteristics. For my school, these characteristics include its location in a border community that is low-resource and has a bilingual population.
In summary, faculty exit interviews provide valuable information to faculty affairs offices as to the strengths and challenges of the school as viewed by exiting faculty. Such information can be shared with school leadership so they can work to improve the environment for their faculty. For additional resources, email robert.nelson@utrgv.edu.
References
- Pollart SM, Novielli KD, Brubaker L, Fox S, Dandar V, Radosevich DM, Misfeldt ML. Time well spent: the association between time and effort allocation and intent to leave among clinical faculty. Acad Med. 2015;90(3):365-371.
- Spain E, Groysberg B. Making exit interviews count. Harvard Business Review. 2016;94(4):88-95.
- Klotz AC, Bolino MC. Do you really know why employees leave your company? Harvard Business Review. https://hbr.org/2019/07/do-you-really-know-why-employees-leave-your-company. Published July 31, 2019.
- Zimmermann EM, Mramba LK, Gregoire H, Dandar V, Limacher MC, Good ML. (2020). Characteristics of faculty at risk of leaving their medical schools: an analysis of the StandPoint™ Faculty Engagement Survey. J Healthc Leadersh. 2020;12:1-10. doi:10.2147/JHL.S225291.