Physicians who left clinical practice in a recent national survey were nearly a decade younger than physicians in a similar cohort studied in 2008, according to findings published in The Permanente Journal.
The study, led by Sea Chen, MD, of the American Medical Association, analyzed survey responses from 971 physicians who had completed residency between 2000 and 2022 and were no longer practicing clinical medicine full time. Invitations were distributed to 61,289 physicians in May 2024, and 7,358 responded. Researchers reported that respondents were reasonably representative of the source population with respect to age and gender.
Among the 971 eligible respondents, the mean age of physicians who were no longer practicing clinical medicine was 48 years, compared with 57 years in a comparable 2008 survey. The cohort included 521 physicians who had practiced and then stopped, 107 physicians (11%) who had never practiced following graduate medical education, and 343 physicians still practicing fewer than 20 hours weekly.
Researchers noted that physicians who completed training but never entered clinical practice may represent an understudied contributor to workforce shortages.
These findings arrive amid continued concern about physician workforce supply. The Association of American Medical Colleges has projected a shortage of 13,500 to 86,000 physicians in the US by 2036. Prior modeling cited in the study suggested that a 2-year reduction in average physician retirement age could lower projected physician supply by approximately 40,000.
Among the 521 respondents who had previously practiced, the most commonly cited reasons for leaving were "hassle factor" (45%), work being "too stressful" (45%), increasingly unrealistic patient demands (41%), and lack of professional satisfaction (38%).
The findings differed from those of the 2008 survey, in which the leading reasons for departure included personal health issues, and rising malpractice premiums. In the current study, malpractice premiums were cited by only 11% of respondents, suggesting a meaningful shift in the drivers of early attrition over the past 15 years.
Researchers noted that the leading reasons aligned with recognized components of burnout, although the study design did not establish a causal relationship. Qualitative analysis identified four dominant themes: overwork; pursuit of nonclinical careers; frustration with health system structures and administration; and profession-related personal concerns including burnout, moral injury, and loss of autonomy.
Women represented 64% of all eligible respondents, compared with 51% of the original physician sample — a disproportion the researchers suggested may reflect women's greater representation among those disengaged from clinical medicine.
Among the physicians who had stopped practicing, women had shorter clinical careers than men, with a median practice duration of 9 years vs 12 years. Women were also significantly more likely than men to report leaving practice to care for young children, care for other family members, address personal health concerns, or because work was too stressful. Men were more likely to report no longer being interested in clinical medicine.
Limitations included the low response rate, retrospective self-reporting, and the study’s focus on physicians who had already left or substantially reduced clinical practice.
"Understanding the attributes of early attrition from the clinical workforce can help stakeholders and policymakers tailor interventions to support a more sustainable physician workforce," the researchers wrote.
Disclosures: The study was funded entirely by the American Medical Association. The researchers reported no conflicts of interest.
Source: The Permanente Journal