AUA 2023: Retention Strategies for Faculty

( 2023 American Urological Association’s Society for Academic Urology meeting featured a presentation by Dr. Christopher Gonzalez, highlighting the importance of and strategies to ensure retention of faculty in an academic department. According to the Association of American Medical Colleges’ 2022 data, there were 172,549 academic faculty employed for clinical work within US medical schools; 17,506 were surgeons, including urologists. He highlighted that interestingly, over the past 10 years, there has been an upward trend of clinical academic faculty, approximately 20%, without a corresponding rise in basic science faculty.

Next, Dr. Gonzalez addressed the projected physician workforce shortage as it relates to urology. Compounded by an aging population and aging workforce with a median age of 55 years, struggling with increasing burnout rates, the numbers of practicing urologists in the next several decades will not meet the needs of the US population. Further, currently, 62% of US counties do not have a urologist. There is approximately a 10:1 ratio of metropolitan to rural location of practicing urologists.

The 2021 AUA Census data demonstrated that 48% of urologists are employed, and further, 28% are in an academic practice. Attrition is a major issue in academics; overall attrition for first time assistant professors is approximately 40% in the first ten years of practice. In the first 3 years of practice, turnover rates are around 25%. This is an expensive issue – a surgical subspecialist takes about $800,000 to replace. A health system faces a loss around $550,000 per year for each clinician that leaves practice. Dr. Gonzalez underscored how important it is to remind administrators of this cost burden when seeking out resources to support the retention of department faculty.

Dr. Gonzalez then discussed potential reasons why academic faculty choose to leave their job. Lack of communication from leadership regarding expectations, performance, evaluations, and recognition can all contribute to dissatisfaction. Next, he outlined the importance of compensation review, as this has been shown to be related to surgeon satisfaction. Benchmarks are critical, and transparency is key. He also highly encouraged department leadership to closely examine salary trends by gender and race/ethnicity. Dr. Gonzalez cited lack of promotion as a next reason for attrition. The average time between assistant and associate professor promotion is about 6 years, and is closely related to compensation and career plans. He again stressed that ongoing performance reviews are critical to align timelines and expectations.

Factors that are more difficult for department leadership to control include personal and family reasons for a career change. Dr. Gonzalez did note that, especially post-pandemic, work/life balance in the setting of increasing clinical, teaching, and research expectations with less support have worsened burnout and contributed to faculty attrition.

Potential solutions to retain faculty include mentorship, career navigation, and skills development, both formal and informal. Promotion that is tied to compensation, prestige, and professional satisfaction can all help retain talent. Publishing often can help optimize faculty for potential reviews by the promotions committee. Dr. Gonzalez concluded the talk by suggesting that formal faculty or career development programs that cover mentorship, leadership, teaching, education, and scholarship have proven to improve retention rates for junior faculty, especially women and minority clinicians.

Presented by: Christopher M. Gonzalez, MD, MBA, FACS, Loyala University

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023

  1. AAMC Workforce Data and Reports, 2021.
  2. The State of the Urology Workforce and Practice in the United States, AUA 2021 Census Report.