A decade and a half ago, physicians who gave up practicing medicine well before retirement age said that personal health issues, rising medical liability insurance premiums, perception of hassle and lack of professional satisfaction were the reasons for hanging up the stethoscope.
Today, those reasons have shifted a bit, according to a recent study from AMA researchers published in The Permanente Journal.
More than 500 physicians participated in the study, “Why Have All the Doctors Gone? Insights into Early Clinical Departure Among Physicians in the United States: A National Survey.” The respondents had practiced clinical medicine after graduate medical education but were no longer practicing, and researchers asked them to look at a list of items and chose ones that led to their departure. The physicians all had been practicing medicine for less than 25 years, graduating residency between 2000 and 2022. Physicians could choose more than one item.
Here are the top four reasons cited and the percentage of physicians that selected the answer:
- Hassle factor: 44.7%.
- Too stressful: 44.5%.
- Increasingly unrealistic patient demands: 41.1%.
- Lack of professional satisfaction: 38.4%.
All the factors were associated with physician burnout, although study authors said they weren’t “necessarily suggesting a direct causative effect.”
Three of those top reasons—hassle factor, stress and lack of professional satisfaction—were all asked about in a survey done in 2008, said Sea Chen, MD, PhD, the paper’s corresponding author. Dr. Chen is the AMA’s director of physician practice sustainability.
“Increasingly unrealistic patient demands” was an addition to the list of choices this time around, and two out of about every five physicians cited it as a contributing factor.
“Items such as patient portal messages, patients that are receiving direct marketing coming in to say ‘Hey, I want this,’ or AI saying ‘Hey, you need to look at this,’ is resulting in the patient driving the agenda more than what we’ve seen in the past. And it’s the unrealistic position that they say ‘Hey, Doc, this is what I have, and this is what you need to give me,’ versus ‘Hey, I need help.’ I think those are two different asks from a patient,” Dr. Chen said.
As the leader in physician well-being, the AMA provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout, and rediscover the Joy in Medicine®.
Addressing physician shortage
Overall, 971 respondents were included in the study. Among that larger group, 11% reported that they never practiced medicine after graduate medical education, while 35.3% were practicing fewer than 20 hours a week.
Dr. Chen and his colleagues found that among the group of 521 physicians who had practiced medicine but then stopped, the average age was just 48.1 years old. That’s nine years younger than researchers observed in 2008 when they looked at a similar group of physicians that gave up clinical careers early, suggesting that “physicians who have left practice early have had shorter clinical careers than in the past,” according to the study.
The study’s authors noted that these findings come at a time when the nation is already facing a growing physician shortage, with the Association of American Medical Colleges projecting that the nation will be short between 13,500 and 86,000 physicians by 2036.
“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,” Dr. Chen said.
The study by Dr. Chen and his colleagues says that retaining the current workforce by reducing burnout, improving organizational factors and increasing the number of residency positions have previously been identified as ways to mitigate the projected shortage.
This paper—the only study of its kind to be published in the U.S. in well over a decade—gives further insight on the issue.
“As the healthcare 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,” Dr. Chen said.
He also said the findings indicate the need for further studies on why physicians are leaving early and why some are not practicing at all after residency, as well as the need for a closer look at the gender divide researchers discovered.
More women leaving
Among the 971 participants in the study, 63.9% were women. The study found that of the 521 respondents who left clinical practice, women physicians were likelier than men to have done so. Their reasons included:
- Caring for family members—7.9% versus 0.6% for men.
- Caring for young children—21.7% versus 4.2%.
- Health concerns—13.8% versus 3.8%.
- Too much stress—31.7% vs. 12.9%.
Looking at how to close those gender gaps is especially important because helping women physicians stay in practice will likely have “an outsized effect on the magnitude of the workforce shortage,” the study authors wrote.
Women have been an increasing proportion of those entering medical schools over the past decade. In 2023–2024, women comprised 55.4% of matriculants and the proportion of active residents who were women was 48.2%
“Studies show that physicians who are women have fewer leadership roles, earn less money and experience mistreatment and discrimination in their profession more often than physicians who are men, factors that likely disproportionately contribute to a stressful work environment,” the authors wrote. “Evaluating and correcting any of these gender disparities is a first step and should be a top priority for all organizations.”
Learn more about the AMA Women Physicians Section, which seeks to influence and contribute to AMA policy and program development on issues of importance to women physicians, and to increase the number and influence of women physicians in leadership roles.
