Facing a physician exodus, an ACP panel offers blueprints to help internists stay in practice

Ankita Sagar, MD, MPH, FACP, and Elizabeth Cerceo, MD, FACP

The headlines about a looming physician shortage are growing louder, but for internal medicine physicians on the ground, the reality is already here — and it’s taking a toll.

At the American College of Physicians (ACP) Internal Medicine Meeting 2025, health system leaders and frontline clinicians came together to explore the root causes of internist attrition — and what can actually be done about it.

The session, “How to Encourage Internal Medicine Physicians to Stay and Thrive in Clinical Practice,” offered both hard data and deeply personal reflections on burnout, depression, administrative overload, and why even passionate doctors are reconsidering their place in medicine.

“Really, it’s instability of the workforce,” said Ankita Sagar, MD, MPH, FACP, assistant vice president for clinical standards at CommonSpirit Health and outgoing chair of ACP’s Council of Early Career Physicians. “We’ve all heard of early retirements. We’ve heard about quiet quitting. Well, it’s not so quiet anymore. It’s pretty loud and clear.”

By the numbers

According to Sagar, nearly 20,000 primary care physicians could be missing from the U.S. workforce by 2036. “The likelihood of leaving [one's] current position in the next five years… between 54 to 64 years old, about nine out of the 18 said they were somewhat likely to leave,” she noted. “Less than 54 years old — same story.”

But it’s not just about numbers. “Lifestyle and well-being… were top [priorities]” in recent survey data, she said. “I know compensation [and] incentive structures are listed at the top, but really, when you get down to the questions… it was really in lieu of having that lifestyle [to support] family needs.”

Burnout, redefined

Burnout is nothing new in health care — but defining it remains elusive. Elizabeth Cerceo, MD, FACP, FHM, associate professor of medicine at Cooper Medical School of Rowan University, said even the prevalence varies wildly. “In a more recent systematic review of 182 studies… [with] 142 different definitions… depending on the definition, a huge prevalence could range from zero to 80%,” she said.

She also challenged the sharp division between burnout and depression. “People didn’t want to say that it’s depression because the symptoms are occurring in the setting of a dysfunctional workplace… But modern DSM doesn’t differentiate environmental [triggers].”

A systems-based approach to physician wellness

To address burnout in a meaningful way, Cerceo introduced the idea of “multi-solving” — a systems-thinking framework borrowed from climate health. “What we want to do is pull in all of these petals together and come up with really elegant solutions that will have cascading benefits,” she said, referencing a “flower model” of overlapping organizational and environmental stressors.

At her institution, programs like structured peer support and new-hire social communities are building camaraderie. “We started doing virtual tequila tastings and virtual chocolate tastings,” Cerceo said. “That’s been very, very successful.”

Sagar, too, emphasized the power of community. “We have an art therapy event that is in person,” she said. “But then we do other things… just to accommodate [schedules].”

Redesigning the day-to-day

Sagar walked attendees through practical interventions to make physicians’ workdays more manageable — and more humane. “There’s so much layered complexity in our system,” she said. Her institution has deployed “inboxologists” to triage incoming messages and ensure physicians are practicing at the top of their license.

Other changes include pre-visit checklists, scheduling follow-ups during the current appointment, and switching to 90-day prescriptions. On the latter, she urged colleagues to think strategically: “Get a new patient in that spot… you get a lot more reviews, and you’re going to perform much better on your value-based properties.”

Sagar also described her team’s use of artificial intelligence (AI) automation to prep charts prior to visits. “It’s not going to save us all,” she acknowledged, “but… it has saved countless minutes… so that you can have these really important conversations with your patients.”

Licensing, stigma, and asking for help

Even with all of these operational fixes, Sagar said, the emotional landscape of medicine needs attention — particularly around stigma and access to care. “Credentialing and medical licensing questions should be worded in such a way that it allows physicians to be able to ask for help,” she said.

She cited an ACP toolkit that offers sample language and advocacy resources, encouraging physicians to push for reform in their own states. “Here’s what I need to do, here’s how I can advocate for it,” she said.

Not all burnout is equal

Burnout doesn’t hit everyone the same. “It’s going down to about 42% in men [and] actually going up to about 54% in women,” Cerceo said. “Within six years of completing training, about 75% of women are thinking about cutting down their hours because of work.”

She pointed to inbox disparities, emotional labor, and what’s often called “office housework” — tasks like scheduling meetings or managing logistics that are rarely recognized but disproportionately fall to women. “We really need to pull [these tasks] out and recognize [them],” she said.

Reframing the physician experience

Cerceo urged physicians to reconnect with purpose. “If you’re an introvert and have no quiet space to do your notes, that’s exhausting. If you’re an extrovert and you’re always in front of a computer, that’s also exhausting,” she said. “So, there can also be smaller ways that you can tweak your practice.”

Sagar encouraged attendees to create a personal mission statement — something to guide career choices and set boundaries. “Sometimes we just need to stop,” she said. “We just need to breathe and be okay with that.”

Shared responsibility

The session closed with a call to action at both the individual and institutional level:

For individuals:

• Seek mental health care early and often
• Engage in coaching or peer support
• Reconnect with meaning and community
• Set boundaries and prioritize well-being

For organizations:

• Reform credentialing questions to reduce stigma
• Build flexible, equitable leave structures
• Eliminate administrative pain points
• Implement peer support and team-based care
• Leverage automation and AI where appropriate

“We control nothing, but we influence everything,” Sagar said. “… that’s incredibly valuable.”