Primary care physicians rank high for turnover from 2010 to 2020

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Primary care physicians were among doctors with the highest rates of moving their practices or leaving medicine from 2010 to 2020.

A new study used traditional Medicare billing data to examine physician turnover, which the researchers noted “may affect patient access and quality of care,” and may be costly when physician practices, hospitals, and health systems have to recruit new doctors.

Over a decade, the turnover rate had periods of increase and stability, although data from the first three quarters of 2020 did not indicate the COVID-19 pandemic caused a spike in moving or leaving, the study said.

Primary care physicians had a 4% annual moving rate, lower than hospitalists (5.4%) and surgical specialists (4.5%), but more than obstetrician-gynecologists, who had the lowest moving rate at 3.5%. Hospitalists also had the greatest percentage of doctors leaving (3.6%), with primary care physicians, OB/GYN, and hospital-based physicians all having leaving rates 3.1% to 3.2%.

Among other findings:

• Physician turnover increased each year from 2010 to 2014, rising from 5.3% to 7.2%. Physician turnover was steady at 7.2% to 7.3% in 2017, and grew to 7.6% in 2018.
• Younger physicians were more likely to move, with 5.6% of doctors aged 35 to 44 years moving in a given year, versus 2.6% of physicians aged 65 years or older.
• Older physicians were more likely to leave, with 9.8% of physicians aged 65 years and older stopping practice, versus 1.4% of physicians aged 35 to 44 years.
• Rural physicians were more likely to move (5.1%) compared to urban doctors (3.9%), but they often moved within a rural area. The study counted about 750 rural physicians leaving practices to work in urban settings, from 2013 to 2020.
• Rural physicians were more likely to stop practicing than urban doctors (3.8% vs. 3%). That could lead to additional workforce and equity concerns over time, but the researchers noted the data did not include nurse practitioners or physician assistants that have grown in the workforce in the last decade.
• Compared with male physicians, female physicians were 13% more likely to move and 38% more likely to leave. Caring for children and elderly parents often falls mostly on women, even in dual-income households, the study said.
• Regionally, the Northeast and Midwest lost physicians (2.4% and 2.3%, respectively), while the South and West gained doctors (1.4% and 3.1%, respectively).

“Physician Turnover in the United States,” published in the Annals of Internal Medicine, employed “a novel method using Medicare billing patterns to identify whether an individual physician moves or leaves a practice.”

The authors noted that figures would not account for physicians who remained practicing, but did not see patients using traditional Medicare. The numbers also could not measure burnout or correlate it with turnover.

However, the Medicare data can create a consistent estimate of national rates of physician turnover, whereas national surveys to measure it are expensive and may have low response rates, the study said.