“Associate Chair of Belonging” is a title that, just a few years ago, lived almost exclusively in organizational development decks. Today, physician leaders across health systems are stepping into roles like it as the data has left no other option.
The U.S. faces a projected shortfall of up to 86,000 physicians by 2036. Burnout already costs the system an estimated $4.6 billion annually, and replacing a single physician runs between $500,000 and $1 million. At that cost, workforce culture stops being a “people” issue and starts being a balance sheet issue.
The health systems pulling ahead understand that recruitment alone will not solve this. They are restructuring from the inside and treating belonging, psychological safety, and team cohesion as infrastructure.
The clinical case is just as urgent as the financial one. Burnout and team dysfunction have profound consequences for clinical teams, patients, and organizations. Burnout is not simply about exhaustion. It erodes connection, communication, empathy, and ultimately the sense of purpose that brings many of us into healthcare. When teams are struggling, collaboration suffers, trust can diminish, and individuals may begin to feel isolated despite working in highly interconnected environments. Over time, this impacts morale, retention, professional fulfillment, and potentially the quality and safety of patient care.
Team dysfunction also creates fragmentation in care delivery. Healthcare is inherently multidisciplinary, and no single person can deliver excellent care alone. When communication breaks down or team members do not feel valued, supported, or psychologically safe, it becomes more difficult to function cohesively during both routine care and high-stakes moments. Patients and families often perceive these dynamics as well.
Clinical leaders must be involved in creating solutions because they help establish priorities, allocate resources, model behaviors, and create environments where people feel heard and supported. Leaders are also responsible for ensuring that solutions move beyond symbolic gestures and result in meaningful systems-level change.
Why Culture Cannot Be Delegated to HR Alone
Culture change in clinical environments requires leaders who bring lived experience. A physician who has navigated ICU hierarchies and watched colleagues stop speaking up understands the stakes in a way a traditional HR function cannot replicate.
Physician-led belonging work carries a different level of authenticity and immediacy because it comes from someone who directly understands the realities, pressures, and culture of clinical practice. Clinical credibility and peer trust create psychological safety. Colleagues are often more willing to engage in vulnerable or uncomfortable conversations when they believe the person leading them has shared their unique pain points and deeply understands the clinical environment firsthand.
Research backs this up. Studies published by the National Institutes of Health and affirmed by the American Heart Association link psychological safety in clinical teams directly to improved patient safety outcomes, including reduced medical errors and increased error reporting. When team members feel safe enough to speak up, patients ultimately benefit.
What Structured Connection Actually Looks Like
Over the past year, we collaborated inside a large academic medical center to explore what happens when physicians are given consistent, structured space to connect, reflect, and shape their own team culture. What emerged went well beyond a morale initiative.
It looked like the beginning of a cultural operating system. The work did not ask anyone to perform vulnerability on demand. Instead, structured interactive experiences with low-risk and high-relevance became the mechanism for building the kind of trust that rarely forms over pizza at a quarterly all-hands. Colleagues began to see each other through a different lens.
Clinicians who had previously interacted only transactionally started to better understand each other’s experiences, challenges, and perspectives as people and teammates. That deeper understanding strengthened collaboration, psychological safety, and trust. People grew more confident in speaking their minds, asking for help, sharing ideas, and engaging authentically with both colleagues and leadership.
We saw meaningful improvement across team dynamics, job satisfaction, engagement, and psychological safety. More importantly, physicians told us they felt seen as people, not productivity units.
The ROI Executives Cannot Ignore
Physician turnover is a compounding financial problem. Recruitment costs, productivity losses during vacancy, and onboarding time add up fast. Industry data shows nearly half of all clinicians were considered “at risk” for turnover in 2024. The financial case for retention investment is no longer theoretical.
Physician-led belonging work is not a substitute for competitive compensation or reasonable call schedules. But it addresses the root of why physicians leave, which is often because they do not feel connected to the people around them or the mission in front of them.
For the CFOs and COOs who remain skeptical, the case is best framed in operational terms. The ROI is reduced turnover risk, improved team efficiency, and fewer failures in communication that drive downstream cost, delay, and negative patient outcomes.
Thus, trust and psychological safety are not “soft” variables. When teams function with higher trust, they escalate earlier, coordinate faster, and require less administrative energy to resolve friction. This translates into better patient care and more stable healthcare teams.
The Case for Moving Now
Stanford Medicine launched the first health system “Chief Wellness Officer” role in 2017. Dozens of academic health systems have followed. The role is evolving, from wellness to belonging, from individual resilience to team cohesion, from optional programming to clinical infrastructure.
But a title and an initiative without the tools to execute is theater. Physician leaders in belonging roles need infrastructure—platforms that help capture team sentiment, track culture change over time, and give leadership the longitudinal data to know whether the work is actually moving the needle. The role only works if it is resourced like any other clinical priority.
The health systems that wait for a crisis will spend far more, in dollars, in departure rates, and in a culture that took years to build. Belonging is foundational, allowing care teams to function, physicians to stay, and patients to receive what they came for. And right now, it needs a physician in the room with the tools to deliver measurable results.
Lauren Fitzpatrick Shanks
Lauren Fitzpatrick Shanks is the Founder and CEO of KeepWOL, an AI-powered team effectiveness platform helping organizations build belonging, psychological safety, and team cohesion through structured interactive experiences and longitudinal insights.
Nathan Delafield, MD, FACP
Nathan Delafield, MD, FACP, serves as Associate Chair of Belonging at a large academic medical center, where he leads physician culture and well-being initiatives alongside clinical practice.
