Why Are Primary Docs Thinking About Leaving Medicine?

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.

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