Lessons from Duke’s Turnover and Turbulence Trends
The COVID-19 pandemic disrupted nearly every facet of healthcare, and clinical research was no exception. Amid the challenges, one academic medical center (AMC) demonstrated notable workforce stability. A recent study published in the Journal of Clinical and Translational Science by Stroo et al. offers a compelling look at how Duke University in North Carolina managed turnover and internal workforce movement—termed “turbulence”—among clinical research professionals from 2016 through 2024.
This blog explores the key findings and implications of the study which provide valuable insights for institutions aiming to build a resilient and responsive clinical research workforce.
Why Workforce Stability Matters in Clinical Research
Clinical research is inherently complex, requiring highly trained professionals to manage regulatory compliance, patient interactions, and data integrity. High turnover in these roles can be costly—both financially and operationally. The estimated cost of replacing a clinical research coordinator ranges from $50,000 to $60,000 (and may be even higher today, given rising inflation), not including lost productivity and the burden placed on remaining staff.
During the pandemic, the demand for clinical trials surged, while the workforce faced unprecedented stress and risk. Nationally, turnover rates for clinical research professionals soared, with some reports citing increases from 10% to 37% pre-pandemic to as high as 61% during the crisis. Yet, Duke’s experience tells a different story, signifying the importance of laying the foundation early to weather such storms.
The Power of Structured Job Classifications
In 2016, Duke implemented a competency-based job classification system for mapping all clinical research staff roles into 12 laddered job categories. This move laid the groundwork for robust workforce tracking, communication, and strategic human resources interventions.
By creating a well-defined clinical research professional population, Duke was able to:
- monitor turnover and turbulence trends in real time;
- implement tailored retention strategies;
- communicate bidirectionally and specifically with the workforce; and
- foster a sense of professional identity and community among clinical research professionals.
Turnover Trends: A Pandemic Stress Test
The study tracked 2,169 unique professionals over seven years. Voluntary turnover peaked at 19.1% in fiscal year 2021—during the height of the pandemic—but steadily declined to 15.5% by fiscal year 2024. Notably, this is lower than the pre-2016 average of 20.3%, suggesting that the structured job framework and inherent advancement opportunities helped buffer the workforce against pandemic-related shocks.
Most turnover occurred early in employment: nearly 80% of voluntary departures happened within the first five years. This aligns with the reality that many clinical research roles serve as stepping stones for individuals pursuing advanced degrees or exploring healthcare careers.
Turbulence: The Hidden Metric
While turnover is widely tracked, internal movement—or turbulence—is often overlooked. At Duke, turbulence was defined as professionals transferring between Clinical Research Units (CRUs), leaving a specific position without leaving the clinical research workforce. Though not always negative (e.g., taking the form of promotions or new opportunities), turbulence can disrupt study continuity and increase onboarding costs.
Turbulence at Duke peaked at 6.2% in fiscal year 2018 but declined to 3.1% by fiscal year 2024. There was not much turbulence observed during the pandemic, which may have been due to fewer opportunities for advancement during a time of hiring freezes, and it is possible that initially staff sought stability. The highest rates were observed among mid-career employees (with two to 10 years of tenure), highlighting the need for career development pathways and leadership opportunities to retain experienced staff.
What Drove Retention?
Several proactive strategies contributed to Duke’s workforce resilience:
- Market-Based Salary Adjustments: In fiscal year 2022, Duke conducted a market analysis and implemented salary increases across clinical research professional jobs to remain competitive.
- Job Security During Study Pauses: The staff were reassigned to available work, minimizing layoffs and maintaining engagement.
- Transparent Communication: Regular town halls and updates helped the staff feel informed and valued.
- Exit Surveys and Stay Interviews: These tools provided insights into employee motivations and areas for improvement.
Top reasons cited for leaving included career advancement (58%), lack of training/orientation (37%), and challenges with supervisors (32%). These findings are now informing ongoing efforts to enhance onboarding and manager training.
Lessons for the Broader Research Community
Duke’s experience underscores the importance of:
- Defining the Workforce: Clear job classifications enable meaningful data collection and analysis.
- Partnering with Human Resources: Collaborative relationships with human resources teams are essential for tracking trends and implementing responsive strategies.
- Investing in Early-Career Support: Improved onboarding and mentorship can reduce early attrition.
- Creating Mid-Career Growth Paths: Leadership development and recognition programs can help retain experienced clinical research professionals.
Final Thoughts
The COVID-19 pandemic tested the resilience of clinical research infrastructures worldwide. Duke’s structured approach to workforce management offers a blueprint for other institutions seeking to build a stable, engaged, and adaptable clinical research professional workforce.
By leveraging data, fostering community, and investing in professional development, AMCs can not only weather future disruptions but also strengthen the foundation of clinical research excellence.
Contributed by Denise Snyder, MS, RD, LDN, Associate Dean for Clinical Research, Duke University School of Medicine, Duke Office of Clinical Research; Stephanie Freel, PhD, Director of Clinical Research Education and Outreach, Duke University School of Medicine, Duke Office of Clinical Research; and Marissa Stroo, MS, Director of Clinical Research Operations – Data, Duke University School of Medicine.