Why satisfied physicians still feel disengaged

Most physicians say they feel satisfied with their jobs. Far fewer say they feel engaged. That gap is quickly becoming one of the most overlooked risks facing health systems today.

CHG Healthcare’s 2025 Physician Sentiment Survey, based on responses from more than 900 physicians across the U.S., the survey found that, while three-quarters of physicians report job satisfaction, only 18% meet the criteria for being highly engaged at work. That disconnect matters because engagement, not satisfaction, is what drives retention, trust in leadership and willingness to advocate for an organization.

Bill Heller, chief operating officer at CHG Healthcare, recently joined Medical Economics on Off the Chart: A Business of Medicine Podcast, to unpack the survey and what the findings suggest about engagement, retention and leadership communication in today’s health care organizations.

The following transcript was edited for style, brevity and clarity.

What’s driving the disconnect between physician satisfaction and physician engagement?

I’d say two things. First, that 75% satisfaction number isn’t something leaders should get too comfortable with. There’s a hidden vulnerability there, because satisfied employees are still at risk of leaving, which creates turnover risk.

Second, a lot of what we’re hearing are the same frustrations we’ve heard for years and haven’t fixed. Physicians are spending too much time on documentation and administrative tasks. They’re often dealing with understaffing, whether that’s clinical support staff or physician shortages. And communication continues to be a major issue. Physicians want more input. They want to be heard. Those are some of the key factors showing up when you look beneath the satisfaction number.

The data also show that highly engaged physicians are much more likely to say their leadership is transparent and communicates openly. What kinds of day-to-day behaviors actually build that trust?

It all starts with communication. That’s true in any industry, and it’s certainly true in health care. Physicians want to be heard. They want to know that administration is asking questions like, “How can we make this better?” and “What can we do to support patient care?” They want visible conversations.

Physicians also want to understand the “why” behind decisions. If leadership is going to make a decision, especially a difficult or controversial one, explaining the rationale goes a long way. When the why is clear, it’s easier to bring people along.

Frequent check-ins matter too — on protocols, staffing, compensation models. And feedback loops are critical. If leadership asks for input, physicians want to know what was heard and what’s being done, even if the answer isn’t what they hoped for. Closing that loop builds trust.

Some of these things are easier than others. Listening and communicating better is relatively straightforward. The harder issues involve finances, margins and staffing shortages that pull physicians away from patient care. But physicians often have great ideas about those challenges if leadership is willing to ask and listen.

The survey shows a clear trust gap. Physicians tend to trust their direct supervisors much more than executive leadership. What’s driving that divide, and what’s one thing executives could do to close it?

That dynamic exists in a lot of industries, not just health care. Proximity matters. Physicians trust their direct supervisors because they’re there every day. In our study, 57% of physicians said they trust their direct supervisors, compared with 41% who trust executive leadership.

Executives can sometimes appear detached from day-to-day realities. If they’re not asking questions or listening, they can come across as tone deaf. Direct supervisors are seen as more involved and more caring simply because they’re present.

Executives can close that gap by being more visible, checking in on daily operations, holding listening sessions and humanizing themselves. When leadership feels distant, trust erodes. When leaders show up and engage, trust improves.

The survey’s net promoter score was -8, meaning physicians are unlikely to recommend their organization and may even discourage colleagues from joining. What message should health systems take from that?

Internal net promoter scores are often more challenged than external ones, especially in tough industries. Physicians may also be factoring in how hard it is to be a physician in general, not just their specific organization.

That said, a negative 8 is still tough to swallow. Net promoter score has become a strong indicator of loyalty and satisfaction, and leaders shouldn’t ignore it.

About a third of respondents fell into the “passive” category — not promoters, not detractors. That’s actually an opportunity. Moving passives to promoters is meaningful work. Those are physicians who are on the fence, who might recommend their organization if certain things improved.

Focusing on communication, trust, listening, patient care support and reducing administrative burden can move that group toward being strong advocates. Those small improvements can make a real difference.

Most physicians say they want a voice in decisions that affect their work, but only a minority feel their input is actually asked for or used. What’s the simplest way leaders can change that?

Seventy-two percent of physicians want input, but only 40% say they’re asked for it. And even then, less than half say their feedback is meaningfully incorporated.

It can start with very simple actions. Leaders walking the floor and asking, “How are you doing today?” or “What’s your biggest challenge this week?” makes a difference if it’s genuine.

More formally, organizations can create interdisciplinary forums to discuss protocols, patient care, processes, administrative burden and technology. You’d be surprised how strong and actionable physician input can be.

Not every idea can be implemented, but many can. The key is dedicating the time to listen to the people who make the organization run.

Where do organizations often go wrong when trying to involve physicians in decisions about policy, technology or compensation?

If you’re going to ask for input, it has to be meaningful. Too often, surveys or consultations are done late in the process, when the decision is already 85% made. Physicians can see that, and it undermines trust.

Get their opinions earlier, when they can actually inform the decision. And follow through. Even if physicians don’t like the final answer, explain what was decided and why. That follow-through matters just as much as asking for input in the first place.

The survey found that 31% of physicians are considering work outside medicine and 30% are considering moonlighting. Only 10% of highly engaged physicians plan to change jobs, compared with 25% of others. What should leaders take from that?

There’s a lot behind those numbers. Economic uncertainty plays a role. There’s uncertainty in the broader economy, in health care policy and in hospital consolidation. That drives people to think about protecting themselves financially.

But the engagement gap is striking. Highly engaged physicians are far less likely to leave. Engagement is a retention tool. Compensation matters, but it’s only part of the equation.

Physicians want flexibility, time with patients and a sense that their work is valued. If organizations can deliver on those things, they can significantly reduce turnover risk.

Sixty-five percent of physicians say they’re more worried about the economy than they were a year ago. What does that say about the role engagement plays when the environment feels unstable?

Uncertainty causes people to scenario-plan. Physicians aren’t immune to that, even though there’s a perception that they’re financially insulated.

They’re highly recruited, have lots of opportunities and are affected by the same economic pressures as everyone else. Engagement matters even more in uncertain times. Physicians need to feel supported, heard and valued just like any other workforce.

Documentation and administrative work came through as major pain points. What leadership behaviors made those pressures feel more manageable for highly engaged physicians?

Forty-five percent of respondents spend more than 15 hours a week on paperwork, and 35% cite understaffing. Leaders can’t fix everything, but acknowledgement goes a long way

Physicians appreciate when leadership recognizes the burden and communicates what’s being worked on — what’s in flight now and what’s on the roadmap. Too often, physicians are the last to know.

It’s also important to unburden physicians from unnecessary meetings and bureaucracy. Put them in settings where they can add value and be heard, and limit time-wasting activities. Representation matters — one physician doesn’t always need 12 others in the room.

Many physicians believe artificial intelligence (AI) can improve efficiency, but far fewer think it will give them more time with patients. What does that tell us about how AI should be implemented?

Physicians are genuinely excited about artificial intelligence and see its potential. At the same time, they’re concerned that efficiency gains will simply lead to higher patient volumes rather than better care.

What physicians want most is more time with patients and less churn. They’re hoping AI can help give some of that time back. How AI is implemented will determine whether it strengthens engagement or adds to burnout.

Is there one clear message physicians are sending through this survey?

Physicians want leadership to be visible, to listen and to act in ways that reinforce their value. They want input, concern for their well-being and more time for patient care.

Burnout and frustration are off the charts. Small, sincere actions can make a big difference.

Is there anything else from the survey you’d like to share?

Despite all of this, administrators are doing a lot of things well. Running a health care organization is a difficult balancing act. Small improvements can go a long way, and a happy, engaged physician workforce can solve many of these challenges, or at least make them more manageable.