Physician turnover grew in the decade leading up to the COVID-19 pandemic

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The number of physicians leaving their practices rose from 2010 to 2018, although it’s not entirely clear why.

A new study quantified doctor turnover and found the period from 2010 to 2018 had a measurable increase in the annual rate that physicians left their practices. The annual turnover rate rose from 5.3% to 7.6%, a total change of 43%, according to a news release.

“While the percentage change from year to year seemed somewhat modest, the percentage change over time was quite large,” coauthor Lawrence Casalino, MD, PhD, said in a news release. A 20-year primary care physician, Casalino is professor emeritus of population health sciences at Weill Cornell Medical College.

Health care trends

The years from 2010 to 2014 had most of the turnover resulting from doctors who stopped practicing. Was the adoption of electronic health records (EHR) to blame? Those were the years when EHR became a requirement, said coauthor Lawrence Casalino, professor emeritus of population health sciences at Weill Cornell Medicine.

“Some prior studies have suggested a link between electronic health record use and physician burnout, and it may be that burned out physicians are more likely to stop practicing or move to another practice,” Casalino said in a news release.

After 2014, turnover rates were stable through 2017, with a slight increase in 2018. During the COVID-19 pandemic, turnover rates in the second and third quarters of 2020 were slightly lower than the same periods the year before. To measure turnover in the wake of the pandemic, Casalino noted researchers must look at the next year or two of data to search for trends.

The researchers noted the data could be useful in identifying effects of other trends: the growth of private equity investment in health care and hospital acquisition of physician practices.

Who left when?

There were other noticeable characteristics in physician turnover:

• Rural physicians were more likely to move or stop practicing medicine than their urban counterparts.
• Female doctors were more prone to turnover than male doctors.
• Turnover was greater for physicians in larger practices, but less likely for those in single- or two-physician practices.
• If doctors took care of more patients eligible for Medicare or Medicaid, turnover was greater.

New data

The figures were based on the Medicare Data on Provider Practice and Specialty, which includes details on physician age and sex, specialty, and tax identification numbers of practices. Previous estimates relied on surveys, which potentially could be unreliable.

“I think this method may become the gold standard to identify turnover in the years to come,” Casalino said. He noted studying physician turnover is important because when doctors leave, it can hurt the continuity and quality of patient care.

“There’s a lot of mutual trust that builds between a doctor and patient over time that’s difficult to replace,” Casalino said. “Once we know the reasons behind doctor turnover, individual practices or hospitals can better develop programs to retain their providers. That’s why we’re making our algorithm public for other researchers to use.”