It seems like everyone is talking about retention rates when it comes to clinical teams. But I think we’re missing something equally important: retention rhythm – how turnover behaves over time.
There’s an interesting parallel in the housing market.
Economists don’t just study home prices; they study housing price volatility. Two cities may have similar average home prices, but if one market swings dramatically month to month while the other remains relatively stable, the operational and psychological impact is completely different.
Volatility creates uncertainty, and uncertainty changes behavior. It becomes harder to plan, invest, allocate resources, or build confidence in the system.
I believe the same is true in healthcare workforce strategy.
This month’s Sisi’s Signals looks at turnover volatility by specialty across multiple health systems. Not just how much turnover is happening, but how stable or erratic it is over time.
We examined operational volatility across multiple large health systems, and here are the findings. When you break it down this way, four distinct patterns emerge:
Chronic Drain (high, predictable turnover)
Specialties like cardiology and primary care, for example, experience a steady, ongoing outflow. These are high-demand areas where sustained pressure gradually wears teams down, leading to continuous attrition rather than sudden shocks.
Acute Instability (high, volatile turnover)
Other specialties, including radiology and pediatrics, show sharp, irregular spikes in departures. In these specialties, turnover can accelerate quickly – often driven by market dynamics, compensation shifts, or specific triggering events – making it harder for leaders to anticipate and respond.
Stable (low, predictable turnover)
The specialties that fall into this category exhibit relatively low and consistent turnover patterns. Anesthesiology, oncology, and internal medicine are examples of specialties that tend to offer greater predictability, giving organizations a stronger foundation for workforce planning and a clearer understanding of what’s working well.
Watch List (low, volatile turnover)
Specialties like infectious disease may appear stable at a glance, but their turnover patterns are more erratic. These are often specialties where clinicians stay for long periods, until something shifts and departures happen quickly.
The takeaway: retention rhythm changes the problem you’re solving.
Two specialties may have the same annual retention rate but require entirely different strategies.
- Predictable turnover can be planned for, staffed against, and operationalized.
- Volatile turnover introduces risk, disrupting access, overloading remaining staff, and creating downstream operational strain with little warning.
Most health systems treat turnover as a single number. But in reality, the variation around that number is where the real risk lives.
With Clinician Retention Intelligence (CRI), leaders can see not just where turnover is high, but where it is unstable and intervene accordingly.
Because the hardest turnover to manage isn’t always the highest. It’s the least predictable.
This reflects a shift in how to think about workforce stability.
How does this look in your organization? What is your retention rate and rhythm?