THE OUTLOOK FOR HEALTH CARE IN 2023:

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October 25, 2022

Why so many doctors are quitting

Daily Briefing

    A report published Thursday by Definitive Healthcare found that nearly 334,000 health care providers—including 117,000 physicians—left the workforce in 2021, with many citing burnout and pandemic-related stressors, Mari Devereaux writes for Modern Healthcare.

    Nov. 9 webinar: The physician landscape trends we're watching

    Report findings and key details

    In the report, commercial intelligence firm Definitive Healthcare estimated that 333,942 health care providers left the workforce due to retirement, burnout, and other pandemic-related stressors.

    Overall, physicians experienced the largest loss, with 117,000 departures in 2021, followed by nurse practitioners, with 53,295 departures, and physician assistants, with 22,704 departures.

    Among physician specialties, internal medicine saw the most departures, losing 15,000 providers in 2021, followed by 13,015 providers who left family practice, and 10,874 who left clinical psychology.

    The report also found that many physical therapists and licensed clinical social workers left their roles in 2021.

    The report found that South Carolina experienced the highest level of staffing shortages, with almost 29% of hospitals reporting a critical staffing shortage. Similarly, about 20% of hospitals in Georgia, Vermont, Delaware, and Michigan, experienced critical staffing shortages in 2021. 

    What might be driving departures?

    Covid-19 has taken a toll on the United States' aging physician population—which is especially concerning since providers in most specialties are generally between 50 and 60 years old, said Todd Bellemare, SVP of strategic solutions at Definitive Healthcare.

    "There is the current worry of being able to backfill as physicians retire or move out of the workforce," Bellemare said. "The ability for people to get into the healthcare profession, how do we make that easier?"

    According to Bellemare, many health care workers said they were less satisfied in their roles because they aren't working at the top of their licenses.

    "If you're one of the best pulmonologists there is, but 20% of your time is spent doing administrative tasks, then you're going to get burnt out," he said. "The thing that hospitals, health systems, physician groups, surgery centers, and any type of facility management should be looking at is, 'How do you hold tight to your people and make them happy?'"

    Bellemare also noted that many rural hospitals and health systems experienced high levels of staffing shortages, which were often driven by a lack of money or resources to compete with urban health systems that can provide higher salaries, sign-on bonuses, and additional benefits to attract and retain workers or hire contract workers.

    "In 2020, large hospitals with more than 250 beds spent an average of $11 million on contract labor, versus facilities with 25 beds or fewer spending about $460,000," Devereaux writes.

    Data from the October 2021 Medicare cost report found that hospitals spent a total of $97.3 million on worker and physician salaries in 2020, compared with $82.7 million in 2016. (Devereaux, Modern Healthcare, 10/20)

     

    Advisory Board's take

    This data isn't telling the whole story—but you need these 3 physician engagement messages anyway

    By Sarah Hostetter

    Our team has been watching physician turnover trends closely across the last two and a half years, questioning whether we'd see the same spike in physician turnover we have in other roles, like nurses and medical assistants. We previously speculated that we may see a latent impact on physician turnover after Covid-19, as physicians were able to take a step back from their in-the-trenches fight against the virus and truly assess their burnout level.

    This recent data from Definitive Healthcare may seem like confirmation that the turnover dam has broken—but we have a few questions keeping Advisory Board researchers from agreeing that we're in the midst of a physician exodus.

    For starters, we're skeptical of the data. The report is using a broad definition of providers and physicians, as the "physician specialty" with the third highest turnover is clinical psychology, which is comprised of PhDs, not MDs or DOs.

    It's also unclear whether the report uses voluntary, involuntary, or combined turnover. The annual rate of combined physician turnover usually hovers at around 10%, with 7% being voluntary. So, if this report is indeed citing a combined rate of 11-12%, that's only a 1-2% increase over previous years—which doesn't really amount to the tidal wave of resignations some headlines would have you believe.

    Finally, and perhaps most significantly, when looking at physician turnover stats, we should consider the median turnover, not just the average. We know there's a huge range in turnover rates between specialties and geographic regions, which is why the median may be a better measure of this trend than the average, which can be swayed by outliers. Another recent report on physician turnover by the Association for Advancing Physician and Provider Recruitment (AAPPR), found a similar average rate of turnover of 12.7%, but a median of only 6.8%. Looking at AAPPR’s data year-over-year, we see the median hovering between 6-7% over the last six years, and the average ranging from 8-10% over time—so consistent with this recent data from Definitive.

    Regardless of the data nuances, we have three key messages for executives on the retention and engagement of their physician workforce:

    1. Physicians are burned out: Around half of physicians reported feeling burned out last year. While it may be tempting to associate this with the pandemic, physicians consistently report that more evergreen issues like administrative burden, time at work, and lack of autonomy are the biggest drivers of their burnout. It is past time for physician executives to take a more meaningful approach to the organizational drivers of burnout, rather than focusing on emotional support alone.

    2. Physicians are not loyal: With half of physicians consistently considering changing employers and this recent data that may suggest a percentage point or two uptick in turnover, we need to operate with the assumption that physicians are willing to change employers—and that historic tactics like contracting aren't enough to retain them. Instead, we suggest a three-pronged approach to becoming the physician employer of choice: meaningful autonomy, ample time, and seamless support.

    3. Impending retirement is the bigger trend to watch: It is likely that any uptick in turnover in this recent data is due to retirements, some potentially early. The percentage of active physicians aged 55+ increased from 38% in 2008 to 45% in 2019. And some specialties are feeling this more acutely, including two listed in this report—internal medicine (46%) and family practice (47%). This could leave us with a gap that incoming physicians alone may not be enough to fill. In addition to traditional recruiting and backfilling techniques, we suggest implementing meaningful care team redesignespecially autonomous use of advanced practice providers—before a physician turnover crisis does hit in earnest.

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