Physician turnover: it’s not just about burnout

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Physician turnover is a major problem in health care and is usually ascribed to high rates of burnout. But while burnout is a significant factor, a recent study presents a more complex picture as to why doctors leave their jobs.

The study’s authors conducted in-depth interviews with 13 physicians who had voluntarily left their positions at a large, multi-specialty ambulatory practice network between 2018 and 2021. The goal of the interviews, which took place between October 2021 and April 2022, was to understand the factors motivating the departures.

The explanations the interviewees gave for leaving their positions fell into three broad categories, or domains: general trends in health care delivery, the leadership and culture of their former employer, and personal considerations. Specific reasons cited in the first category included:

• compensation models,
• emphasis on metrics,
• the corporatization of medicine,
• electronic health records,
• inbox burden, and
• unrealistic patient expectations

Specific complaints in the practice culture/leadership category included:

• lack of leadership visibility and support,
• personal values not aligned with those of practice leadership,
• absence of teamwork,
• inadequate staffing, and
• lack of opportunity for professional development and/or promotion opportunities

Personal considerations included:

• family support/happiness,
• poor work/life balance, and
• feelings of isolation/stress/burnout

The authors note that while most participants included burnout and/or EHR-related burden as factors in leaving their job, none said it was the primary reason for their departure. Instead, they cited a desire for more time off, flexibility, and autonomy. Some said that even additional compensation wouldn’t have persuaded them to stay.

Based on their findings the authors suggest several steps practices could take to reduce physician turnover, including:

• distributing more responsibility across team members so as to better address documentation requirements and patient expectations,
• ensuring adequate staffing across disciplines and roles, and
• considering alternative payment models

The researchers also note that neither “workplace design” nor “resources to support wellness were mentioned frequently by interviewees. “This could indicate that practice leaders seeking to retain their physician workforce should prioritize leadership visibility, staffing, and advancement programs over ‘wellness programs’ and aesthetic office design,” they say.