As you can imagine, I spend a lot of time with physicians. As a group, they sure do like to complain. Yet, medical school applications are strong, and residency spots are still competitive. So I take cries of “they’re all going to quit” with a grain of salt.
That said, I also like data. So it’s worth checking in every once in a while to see what physicians, as a group, are thinking. There’s a study in the Journal of Primary Care and Community Health that does just that:
The status of the primary care workforce is a major health policy concern. It is affected not only by the specialty choices of young physicians but also by decisions of physicians to leave their practices. This study examines factors that may contribute to such decisions. We analyzed data from a 2009 Commonwealth Fund mail survey of American physicians in internal medicine, family or general practice, or pediatrics to examine characteristics associated with their plans to retire or leave their practice for other reasons in the next 5 years.
What did they find? More than half of physicians age 50 and over had plans to leave their practice in the next 5 years, or weren’t sure about staying in practice. No physicians age 35-49 had plans to retire, but 20% weren’t sure they’d stay in practice. I take such numbers with a grain of salt, though. That’s partly because, as I said above, doctors like to complain. That’s also because saying what you are going to do in the future is not the same as what you will actually do. In case people hadn’t noticed, the job market isn’t too awesome out there. I think many physicians are delusional if they think they can just quit practicing medicine and find another lucrative job.
But I think that the reasons that primary care docs say they might quit are illuminating. Those reasons are likely the things that make them unhappy about practicing, and we can definitely learn from that.
Among the younger physicians, internists were more likely to talk about leaving than were pediatricians or family physicians. Having a lot of uninsured patients was associated with plans to leave, but having a high percentage of Medicare or Medicaid patients was not. Working long hours was associated with plans to leave, but seeing a high number of patients a week (>150) was not. And, surprising me not at all, the use of information technology had no impact on whether a younger physician might think about leaving the practice of medicine.
Older physicians were more likely to think about retiring. They are also more likely to think about leaving the practice of medicine if they had high numbers of uninsured, Medicare, or Medicaid patients. Those in solo or two-doc practices were more likely to think about leaving than those in larger practices.
Here’s the irony. For all the anecdotal stories of docs planning to quit because of outrage over the ACA, a number of provisions contained within it may make primary care docs, especially younger ones, less likely to jump ship. The ACA will reduce the number of uninsured, high numbers of which were associated with younger docs thinking about leaving. The formation of ACOs should also lead to fewer solo or small practices, which was associated with older docs thinking about leaving. Docs also like to see more patients, and no one thinks the ACA is going to lead to fewer patients in the health care system.
It’s entirely possible that the ACA might lead to fewer primary care physicians leaving medicine, not more. We will have to see. But the next time you read an op-ed by an doctor outraged by the ACA, threatening to quit, it’s worth remembering that he or she might not be representative of all of them.
Aaron E. Carroll, MD, MS is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine, as well as the director of the Center for Health Policy and Professionalism Research. Carroll’s work has been featured in The New York Times, USA Today, The Los Angeles Times, Newsweek, and many other national publications. He blogs at The Incidental Economist, where this post was originally published.
Filed Under: Physicians, THCB
Tagged: Affordable Care Act, Physician Shortage, primary care Mar 22, 2012
You gotta like a post about any group that starts with “I love working with x — they always love to complain” and then goes on to complain about that the group in question ….
I was shocked to learn the author is in fact a physician, but then when you realize he is insulated in the academic world of theory and prose, what do you expect when academics tell those at the front lines how to think and act.
But, when will we as the full time providers find out what academic colleagues really do and not just have to endure all their words!?
It’s the sad truth but the reality about medical physicians. In every career there are setbacks which come along with it and in the case of these physicians its not about the increasing numbers of patients but the fact that most of these patients are not insured.
It is however surprising that the young physicians and interns are the ones who plan to leave mostly. This clearly shows why most family doctors are older people.
One of the biggest mistakes my younger colleagues made in dumbing down the profession of medicine was pushing for limited call hours during residency. Just played into the hands of the anti physician crowd who saw it as both weakness and exploitable for paraprofessionals to claim more physician responsibilities.
The issue had legitimacy to correct, but too many lazy and entitled students forced the issue beyond what was fair and standard of care. Being a doctor is NOT a 9 to 5 job!!!
My friend is a Primary Care doc and she wants OUT! I guess working for the Veterans Administration your work hours are advertised as 8am to 4:30pm. What a joke and lie that is. She never gets home to spend quality time with family, much less have any type of quality or balance to her life. The money is far from worth it as far as she is concerned.
There may be some hope though with MDVIP Corp., now owned by Proctor and Gamble.
Time will tell, wish I knew how she could use her education and experience to find another job. She would work for $50K less a year if she could work 3 days a week so quality and balance in life would be manageable.
Oh good grief. I actually gave this guy some credit until I realized he’s not even a (real doctor) clinician. Maybe those of us in practice will leave and go into academic medicine. Sounds like they’re a pretty satisfied bunch.