Trends in turnover and turbulence at a large academic medical center before and during COVID-19: Analyzing structured clinical research professional roles.

Introduction: High workforce turbulence has plagued clinical research, becoming intensified during the COVID-19 pandemic, especially for patient-facing workers. In a time of great uncertainty and risk among healthcare workers, researchers included, the pandemic also brought increased demand for research studies in volume, speed, and complexity, triggering elevated staff turnover. This has posed significant hurdles for employers, especially research sites, where retaining skilled patient-facing clinical research professionals (CRPs) is pivotal for sustaining medical innovation. Lack of job standardization and advancement pathways has been noted to play an important role both in turnover and contributes to the inability to accurately measure workforce trends. To address these factors, Duke University adopted a competency-based job classification system for CRPs in 2016. Methods: Since that adoption of competency-based jobs, employee-level staffing data for all CRPs have been tracked monthly, creating a master data file from September 2016 through June 2024. This study updates previous analyses, evaluating turnover and turbulence rates, and demographic changes in the CRP workforce over this period. Results: Over the last six years, the Duke CRP workforce remained relatively stable. Voluntary turnover rates fluctuated, peaking at 19.1% in FY 2021 during the COVID-19 pandemic, and have steadily declined each year since then. Conclusions: Despite national workforce challenges exacerbated by the pandemic, our data indicate that proactive measures to standardize clinical research jobs and assess the resultant well-defined site-based employee data may have mitigated extremes in workforce turnover at Duke University. Turbulence rates, while stabilizing, signal areas for further study.