The survey results published by the American Medical Association (AMA) in January 2022 might make the steeliest spine shiver: One in five physicians said it is likely they will leave their current practice within two years, and nearly one in three said they intend to reduce work hours in the next 12 months.
Is the medical profession experiencing a Great Resignation? No, according to experts interviewed by Physician Leadership Journal in late 2022.
And, sort of, yes.
Physicians are not streaming out of their jobs at the pace the survey results suggest, but the turnover rate among physicians is higher than usual, many practices are short-staffed, and a physician shortage is looming.
The good news is that as effective strategies to reduce burnout and job dissatisfaction are emerging, organizations can improve physicians’ work lives and improve retention.
“There’s reason to be optimistic that the efforts are making a difference,” says Christine Sinsky, MD, vice president for professional satisfaction for the AMA.
Lay of the Land
When the Medical Group Management Association (MGMA) surveyed its members in spring 2022, it didn’t find 20% of physicians bolting for the door, says Halee Fischer-Wright, MD, MMM, the organization’s president and CEO.
She suspects that the more positive report reflects timing. The AMA survey, including 20,665 respondents from 124 institutions, was conducted during the last half of 2020 — the height of the COVID-19 pandemic. By the time the MGMA conducted its survey in spring 2022, work-life had improved for many physicians.
“That sense of ‘I’m so burnt out, I can’t even breathe’ has alleviated somewhat,” Fischer-Wright says. “That doesn’t mean it has gone away, but the ‘I’m getting out of here’ phenomenon doesn’t appear to be quite as acute.”
Aside from what physicians might want to do, she suggests, some are constrained by the stock market downturn, which makes retirement less attractive.
“At any given time, about 15–25% of the physician population are in the retirement band, but the appetite for retirement, given what the financial markets are doing right now, is not quite as hungry as it was,” Fischer-Wright says.
Still, the number of physicians taking early retirement is notable. MGMA’s Stat poll, taken August 23, 2022, found that 40% of medical groups saw physicians retire early or leave the practice in 2022 because of burnout. That was up considerably from a poll taken the previous year, when one-third of practices reported physicians leaving because of burnout.
Physician recruiters are trying to fill the vacancies. “Replacement of physicians is a big driver in the uptick in demand for recruitment services post-pandemic,” says Steve Look, president of the board of the National Association of Physician Recruiters (NAPR).
Historically, about 6% of physicians make a move every year, according to Tony Stajduhar, president of Jackson Physician Search. “Last year that number was up to 7%. Seems like a small percentage, but that is a lot of doctors, and I’ve heard rumors that we shouldn’t be surprised if it’s up to 8% this year,” he warns.
He predicts an estimated 25% increase in responses to job postings. “That doesn’t mean all those people are going to move, but they are getting their name out there,” he says. “And when we have done surveys recently, we are seeing an all-time record of people saying that they are not necessarily getting out of medicine, but they would consider a new employer if an opportunity availed itself.”
Who’s Leaving, Why, and Where
The American Association of Medical Colleges estimates a physician shortage of between 38,000 and 125,000 physicians by 2034. “Physicians retiring early, physicians leaving the profession for other professions, physicians cutting back their work effort to part-time as a coping strategy, all related to a decrease in professional fulfillment and increase in burnout, is worrisome,” AMA’s Sinsky laments. Sinsky, one of the nation’s top physician-burnout researchers has found burnout is one of the most important risk factors for a physician leaving a job.
Burnout and physician departures fuel one another. “Anecdotally, we know from many organizations that once a couple of physicians in a practice leave, more physicians tend to leave,” she says. “Data shows that when teams are understaffed, burnout is higher. Other physicians are left with a higher workload and, since workload is a risk factor for leaving, that exacerbates the problem.”
MGMA’s Fischer-Wright believes younger physicians are more open to careers outside of health systems. “Over the last decade, particularly the Gen Xers and Gen Yers have figured out that the skill set they learned in medical school and residency can be applied to a variety of other arenas,” she says.
Whereas they might have aspired to hospital administration in the past, she watches other careers — insurance case management, medical directorships at facilities, corporate advisors, entrepreneurial ventures — become more common.
Look, the NAPR president, is founder and principal of Paradigm Search Group. He observes younger physicians who want to practice medicine and are looking to escape traditional arrangements. “They are looking for a different employment setting, something that can be more manageable from a stress level and job satisfaction standpoint,” he says.
Some find telemedicine jobs, which can offer more flexibility and more control over working hours, to be attractive. Others gravitate to alternative practice models, such as concierge medicine, allowing physicians to operate outside the traditional insurance system and provide more comprehensive care to clients who can afford to pay out-of-pocket.
Retention Needs Work
“You hear people say, ‘everybody is leaving healthcare’ but that’s not it,” Stajduhar says. “They are not leaving healthcare, they are just leaving jobs.”
Despite the longstanding burnout crisis in medicine — and the connection between burnout and physician attrition — healthcare organizations have been slow to effectively address the problem. Indeed, it’s confusing to discern how hard organizations are trying.
An MGMA Stat poll in 2021 found only 14% of healthcare leaders reported a formal plan or strategy to reduce physician burnout. By August 2022, that had changed significantly: 34% of medical group leaders said they had a program in place.
But are their physicians aware of it? A Jackson Physician Search survey in 2021 confirmed MGMA’s findings — 15% of administrators reported they had a formal, written physician retention program in place — while another 55% said they had an informal unwritten program to retain physicians. But 83% of physicians reported that their employer had made no efforts to retain physicians.
Stajduhar, the company’s president, discovered that disconnect mirrored in another set of survey findings: 69% of physicians rated themselves as actively disengaged from their workplace, while administrators had a much rosier view of physicians’ engagement.
That tells Stajduhar that administrators may not have an accurate read on how their physicians feel about their working conditions, or what needs to be done to keep them on the job.
“They think they are coming up with these ideas, but they’re forgetting one really important source: getting the physicians on their staff engaged in the solution of how to make a better retention program,” he says.
Physicians do have ideas to offer. The 2022 Survey of America’s Physicians conducted by the Physicians Foundation found strong consensus, with more than 80% of respondents in agreement that specific actions would be helpful in supporting physicians in the workplace:
Removing low-value work, including too many EHR clicks and inbox notifications.
Providing more flexibility and autonomy around quality and patient experience goals.
Eliminating insurance pre-authorizations.
Eliminating unnecessary mandatory training requirements.
Eliminating the credentialing questions that ask about prior mental healthcare.
Ensuring mental healthcare services are available outside of employee assistance programs.
Physicians are charged with protecting the well-being of others, but often they are not trained with the skills to protect their own well-being. Without these skills, they often do not advocate for themselves and can run into roadblocks navigating their careers. Radiologist Jen Barna, MD, says many physicians only see all-or-none options: tolerate an unsatisfactory job as a physician or pursue a different career entirely.
“Most of us are not going to ever say anything — we’re just going to leave,” she claims. “That’s what’s happening right now.”
For many years, Barna was a partner in her practice, experimenting with entrepreneurship on the side, hoping that it would be her ticket out of medicine. It was only when she sought professional coaching that she realized she had other options, and she took one of them.
Today, Barna practices radiology part-time and co-hosts the popular DocWorking: The Whole Physician podcast. The podcast is affiliated with DocWorking, the company Barna founded in 2020 to normalize coaching as a part of ongoing professional development — with a scalable system that provides CME credits.
“There are skills that we can learn as healthcare professionals that can make a huge difference in putting ourselves in the driver’s seat of our own lives,” she says. “And this should be a normal part of our professional development.”
DocWorking markets itself to healthcare organizations as a physician retention strategy. “Without coaching, physicians can feel ‘I’m on a path that’s going to ultimately result in a crisis; therefore, I need to step off of this path,’ ” Barna says. “And they don’t realize that there are a lot of choices in between. Some people will still leave, but I have seen a number of people turn that thinking around very quickly to say, ‘Oh, I now see a way that I can stay, because I really don’t want to leave.’ ”
Reason for Hope
In 2014, 54% of all physicians were experiencing burnout; by 2020, that dropped to 38%. “And then we come to the second year of the pandemic when the rest of the country has moved on, when physicians are no longer lauded as heroes, and when the consequences of the pandemic are even stronger for physicians than the first year,” Sinsky laments. In 2021, more than 62% of America’s physicians reported symptoms of burnout.
But that six-year decline pre-pandemic suggests that the burnout epidemic in medicine is not an intractable problem, she says. So do successful efforts at individual organizations. For example, after the University of Colorado Health family physicians adopted team-based documentation, which provides that a medical assistant stay with a patient throughout the appointment, documenting physician notes during the visit, the burnout rate fell from 53% to 23% in one year.
Other organizations are paying attention. MGMA reports that the addition of scribes to help with documentation is one of the top strategies that practice leaders are using to address burnout. Others include:
Recruiting new physicians to reduce panel sizes and improve call coverage.
Addressing disruptive or violent patient behavior.
Doing regular check-ins with physicians and ensuring they take enough leave time or formal sabbaticals.
Increasing flexibility in employment packages.
Fischer-Wright encourages chief medical officers to consider three broad opportunities to improve physician satisfaction and increase retention. “A lot of what our physician colleagues are saying is they have no autonomy and no independence,” she says. “This is a great opportunity for CMOs and C-suites in general to find ways to give physicians more autonomy.”
Many administrative tasks waste physicians’ time and increase their frustration. “That’s a place where administrators can intervene to remove the things that don’t add value and aren’t clinically necessary,” Fischer-Wright says.
Particularly since the pandemic began, many physicians are experiencing isolation and a loss of community. “There is an opportunity for CMOs to build a sense of community within their institutions,” she advises. “The best way to do that is to start speaking with your colleagues to find out what they need, what they want, and how to build that together in collaboration.”
Those priorities are all supported by resources that Sinsky suggests:
The AMA’s Saving Time Playbook, a collection of podcasts, videos, and other resources to help medical practices improve working conditions for their physicians. The Playbook draws from more than 70 AMA Steps Forward educational toolkits, including 16 devoted to burnout and well-being topics, which provide step-by-step guides to improve medical practice and case studies that share details of real-world implementation.
The National Academy of Medicine’s Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being, which identifies practices in six domains– organizational commitment, workforce assessment, leadership, policy, the efficiency of the work environment, and support. “This concisely identifies for chief medical officers some of the best practices that they can adopt,” Sinsky says, “and it refers to resources to help with implementation.”