Why so many doctors are quitting

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 redesign—especially autonomous use of advanced practice providers—before a physician turnover crisis does hit in earnest.