Trends in and Predictors of Physician Attrition From Clinical Practice Across Specialties : A Nationwide, Longitudinal Analysis.

Abstract

The United States faces a predicted shortage of 36 500 physicians by 2036, with an increasing proportion of physicians leaving clinical practice or expressing an intent to do so. Evidence is limited about the extent to which stated intent to leave clinical practice translates to actual attrition from clinical practice and which factors are associated with this outcome. To characterize rates of physician attrition from clinical practice and to describe the factors associated with a differential likelihood of attrition. Nationwide, longitudinal study. All clinical settings. Physicians who provided care to Medicare patients between 2013 and 2022. Attrition from clinical practice. The sample consisted of 712 395 physicians (70.8% male, 90.8% in urban settings). Unadjusted rates of clinical practice attrition increased significantly from 3.5% in 2013 to 4.9% in 2019 (rate difference, 1.4 percentage points [95% CI, 1.3 to 1.4 percentage points]). Rates of attrition increased across the study period for both male and female physicians, in both rural and urban settings, across specialties, across geographic regions, and in all groups of physicians aged 35 years or older. In adjusted models, female physicians and those practicing in rural areas were more likely to leave clinical practice. Caring for Medicare beneficiaries with a greater average risk score, a greater average age, and a greater percentage of dual-eligible beneficiaries was also associated with attrition. Focus on services provided to Medicare fee-for-service beneficiaries. Rates of clinical practice attrition have increased since 2013. Specific physician and patient characteristics are associated with a greater risk for attrition. These findings have implications for workforce planning and the design of interventions to sustain the physician workforce. The Physicians Foundation.