A study published today in The Permanente Journal sheds light on what's driving physicians to leave clinical practice early — and how those reasons are shifting. Researchers from the American Medical Association (AMA) analyzed survey responses from 971 clinically inactive physicians across all specialties who completed residency between 2000 and 2022. Their findings offer insights into why physicians are stepping away from patient care — or not entering the clinical workforce at all — especially as the nation faces a growing physician shortage.
"We hope that by better understanding what drove these physicians away from the clinical practice of medicine, we might uncover meaningful insights that will help us improve physician professional satisfaction and retention," said Sea Chen, MD, PhD, the paper's corresponding author. Chen works for the AMA in Chicago. The paper, "Why Have All the Doctors Gone? Insights Into Early Clinical Departure Among U.S. Physicians: A National Survey," is the only study of its kind to be published in the United States in well over a decade. It is available open access.
Seeking to ascertain reasons for the "enlarging leak in the pool" of clinically practicing clinicians, the investigators found that a "somewhat surprising proportion" of participants were fully residency-trained physicians who never entered the clinical workforce. The researchers suggest that additional studies are needed to understand why.
Of those who entered clinical practice, the researchers identified a shift in motives among those who left the profession compared with earlier findings. Data from 2008 show that early departure was more likely to be due to personal health issues, rising malpractice insurance premiums, perception of hassle, and lack of professional satisfaction. Updated findings show that rationale focuses more on burnout, chronic workplace stress, administrative burden, and unrealistic patient expectations.
As Americans feel the strain of ongoing and anticipated physician shortages, the AMA research is timely, pointing to a need for hospital systems to bolster retention strategies.
"As the health care system works to further expand the physician pipeline by opening new medical schools and adding more residency slots, it's worth asking whether we should also focus on supporting physicians who are already trained," Chen said.
The researchers also evaluated gender disparities in physician decisions to exit clinical practice.
"The women in our study left clinical practice earlier than men, and they left due to pressures like caring for young children or other family members more often than men," Dr. Chen said. "Addressing these issues — through better childcare access, flexible work policies, and equitable treatment — could help retain more women in the physician workforce."
About The Permanente Journal
The Permanente Journal, published by The Permanente Federation, is a premier publication for content related to health care delivery science, value-based and high-value care, and clinical and applied research. A diamond open-access publication, The Permanente Journal has been publishing research on the practices of high-quality, evidence-based, equitable, and value-based and high value care since 1997.
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