Increases in Physician Attrition Rates Could Worsen Shortages

America's looming physician shortage is accelerating. A decade-long study reveals that the percent of physicians leaving clinical practice jumped from 3.5% to 4.9% between 2013 and 2019—a troubling trend that threatens to compound the nation's projected shortage of up to 86,000 doctors by 2036.

The nationwide analysis, published Oct. 7 in Annals of Internal Medicine, tracked more than 712,000 physicians caring for Medicare patients and found attrition rates climbing across every specialty, geographic region, and demographic group.

“Rates of attrition among physicians across specialties are increasing over the years studied,” says senior author Cameron J. Gettel, MD, MHS, assistant professor of emergency medicine at Yale School of Medicine. “This includes male and female doctors, those practicing in rural and urban areas, across all specialties and age groups.”

The researchers looked at reimbursement of clinical services to determine attrition. Physicians who did not bill for services over three consecutive years were considered to have left clinical practice.

Female physicians showed a 44% higher likelihood of attrition compared to male colleagues, whereas rural physicians faced a 19% increased risk compared to those in urban settings.

By specialty, psychiatrists and gynecologists showed particularly high attrition rates; psychiatry rates ranged from 7.4% in 2013 to 10.1% in 2019, whereas the attrition for physicians in obstetrics and gynecology soared from 6.1% in 2013 to 10.7% in 2019.

However, when accounting for patient complexity, hospital-based physicians emerged as the highest-risk group. Those with patients enrolled in both Medicare and Medicaid programs showed a 57% increased likelihood of leaving practice.

Behind these statistics are physicians stretched thin, trying to do right by patients with far too little time, Gettel says. Doctors want to give complex patients the attention they deserve, but in today’s system—where appointments often last just minutes—that’s nearly impossible.

“You know the right thing to do, but the system may not allow you to do the right thing. That’s moral injury and it can increase the risk of the physician leaving the workforce,” he says.

The study emphasizes that with current projections estimating shortages of up to 86,000 physicians by 2036—including 40,000 primary care physicians—the accelerating attrition trend poses serious implications for access to care.

"Since attrition is increasing compared to prior years and certain populations are at increased risk, that projected shortage could balloon even higher," Gettel says. "This requires systematic solutions."

The study authors identified several underlying systemic pressures that may drive physicians from practice, such as electronic health record burden, inadequate staffing, prior authorization requirements, and workflow constraints.

"The more an organization addresses those pain points and proactively prevents them, the more likely physicians are to remain in the workforce and continue providing needed care," Gettel says.

The researchers suggest targeted interventions, including enhanced caregiving supports, access to virtual resources, particularly for rural practitioners, and greater physician control over work environments, including shift schedules and patient loads.

"It all comes back to the patient," Gettel says. "These types of workforce studies are so needed because they're a big component of access to care, which is integrally linked to the workforce and availability."

Additional Yale School of Medicine co-authors are Zili He, MS; James Dziura, MPH, PhD; Arjun Venkatesh, MD, MBA; and Edward Melnick, MD, MHS.