Psychiatry, primary care, and OB/GYN subspecialties hit hardest by physician attrition

A nationwide, longitudinal study characterized how physician attrition rates from clinical practice have changed and the factors associated with a differential likelihood of attrition. The study found that the rate of physicians’ attrition from clinical practice has increased from 2013 to 2019. Female physicians, those practicing in a rural area, and those practicing outside of the Northeast region had a greater risk of clinical attrition. The findings are published in Annals of Internal Medicine.

Researchers from University of California at San Francisco, University of California at Los Angeles, and Yale School of Medicine studied data from 712,395 physicians caring for Medicare beneficiaries across six broad specialty categories described in the Medicare Data on Provider Practice and Specialty documentation: primary care, medical specialty, surgical specialty, obstetrics and gynecology, hospital-based specialty, and psychiatry. The primary outcome was attrition from clinical practice, defined as exit of a physician without reentry for at least three years. The researchers found that unadjusted rates of attrition increased overall from 3.5% in 2013 to 4.9% in 2019. Attrition rates increased among both male and female physicians, those in urban and rural areas, across all geographic locations, and across all specialties. Practicing in psychiatry, primary care, and obstetrics and gynecology were associated with greater risk for attrition compared with a hospital-based specialty. Medicare beneficiary factors associated with a higher risk of attrition included greater average beneficiary risk score, greater average beneficiary age, and greater percentage of dual-eligible beneficiaries. These findings underscore critical challenges related to sustaining the physician workforce amid known physician shortages and difficulties with access to care.