Physician Turnover Trends Up, But Not As Bad As Expected During COVID-19

Physician turnover is on the rise, although the cause behind doctors moving practice and leaving healthcare altogether is still unknown.

In a new Annals of Internal Medicine study, researchers from Weill Cornell Medical College used an innovative method of measuring physician turnover to find the annual rate increased by 43 percent between 2010 and 2018. The rate went from 5.3 percent to 7.6 percent.

However, the study also showed no indication yet of an effect of the COVID-19 pandemic on increasing physician turnover rates. In fact, researchers reported slightly lower turnover rates in the second and third quarters of 2020 compared to the same quarters in 2019.

The healthcare industry is currently facing significant workforce challenges, including widespread labor shortages, record levels of clinician burnout, and high labor costs.

“Observed changes in physician turnover could be cyclical—related to the overall economy—yet specific to the [healthcare] industry,” researchers speculated in the study.

Researchers pointed out that the study’s period coincides with the Great Recession from 2007 to 2009 in which worker retirement declined modestly across the US. However, more physicians left their practices—whether moving to a new one or leaving altogether—during that time.

The beginning of the study’s period, in which physician turnover started to trend up, also marked the start of the meaningful use program that incentivized the use of EHR systems. Healthcare providers notoriously complained about program requirements. Studies have also linked EHR use to physician burnout, which can lead to turnover.

“Whether or to what extent turnover is linked to burnout is unknown at this time,” researchers stated.

However, industry leaders will want to understand why physician turnover rates are generally increasing and whether events like the COVID-19 pandemic will worsen matters, especially for vulnerable populations.

The study notably found that rural physicians are more likely to stop practicing, with a rate of 3.8 percent compared to 3.0 percent of non-rural physicians.

“Although this difference is relatively small, over time it would compound existing workforce and equity concerns because rural patients, who are generally poorer and older with more chronic conditions, already have less access to health care providers than their urban counterparts,” researchers explained.

Physicians who see more dual-eligible patients are also more likely to leave and move practice, raising similar concerns about care access and continuity for these clinically and socially complex patients.

Additionally, the study showed that female physicians are more likely to move practice. Retaining female physicians will become a priority for organizations since women currently make up more than half of recent medical school graduates. Females tend to care for children and elderly parents versus males, even when they belong to dual-income households.

Further research is warranted, considering the substantial impact the pandemic has had on the healthcare industry. Researchers hope the new method of measuring physician turnover to become the gold standard.

To identify whether an individual physician moves or leaves a practice, researchers used Medicare billing patterns versus surveys. Physician surveys tend to have low response rates and measure turnover based on physician intentions. Researchers acknowledged that Medicare claims data is more reliable, although it cannot discern if physicians stop seeing traditional Medicare patients and cannot measure burnout.

Researchers also acknowledged the data does not include nurse practitioners or physician assistants, whose workforces have increased substantially in the past decade to help alleviate workforce concerns, especially in rural areas.

“Once we know the reasons behind doctor turnover, individual practices or hospitals can better develop programs to retain their providers,” Lawrence P. Casalino, MD, PhD, professor emeritus of population health sciences at Weill Cornell Medicine, told the Cornell Chronicle. “That’s why we’re making our algorithm public for other researchers to use.”