Leader-member exchange (LMX) and workforce outcomes in radiation oncology: A preliminary generational comparison.

Abstract

9038 Background: Job satisfaction and turnover intention remain crucial outcomes for healthcare organizations incurring substantial costs associated with recruiting and training new employees. Continual workplace stressors continue to challenge retention efforts across clerical and clinical settings. Leader-member exchange (LMX) theory provides a relationship-based framework for understanding these outcomes, emphasizing the quality of the manager-employee relationship. As healthcare workforce increasingly spans generational cohorts, differences in career expectations and workplace values may influence how leadership relationships are perceived. This study examines the association between LMX quality, job satisfaction, and turnover intention, with specific attention to generational differences between older (Baby Boomers and Generation X) and younger (Millennials and Generation Z) employees within a Radiation Oncology department. Methods: This quantitative study surveyed healthcare professionals (> 18 years) in a Radiation Oncology department at an academic medical center using purposive sampling. An anonymous, web-based survey was distributed via email and included standardized measures of leader-member exchange (LMX-7), job satisfaction, and turnover intention (TIS-6), along with demographic items. After electronic informed consent was obtained, the average for survey completion was 7.5 minutes. Data was collected over three months, de-identified, and analyzed using RStudio. Results: The survey achieved a 74% response rate, indicating broad representation of the department. Mean LMX scores were comparable between older (M = 4.04, SD = 1.06) and younger (M = 3.91, SD = 1.13) employees. Job satisfaction was modestly higher among younger respondents (M = 4.18, SD = 0.73) compared with older respondents (M = 4.00, SD = 0.82), whereas turnover intention was slightly higher in the older group (M = 1.56, SD = 0.87 versus M = 1.45, SD = 0.83). LMX was positively correlated with job satisfaction in both older (r = .58, p = .002) and younger (r = .59, p < .001) professionals. LMX demonstrated an inverse association with turnover intention in both groups, reaching statistical significance among older employees (r = -.57, p = .003) but not among younger employees (r = -.32, p = .069). Conclusions: Higher-quality LMX was associated with greater job satisfaction and lower turnover intention among both older and younger healthcare professionals. This emphasizes the importance of leadership relationships in workforce development and stability. These findings support the value of authentic leadership practices grounded in mutual respect and trust. Additionally, these findings highlight the need for future analyses to examine individual generational groups (e.g., Generation X versus Millennials) to better understand variations.