Ten Miles Square


March 21, 2012 11:34 AM Why Are Primary Doctors Thinking about Leaving Medicine?

By Aaron Carroll

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 Obama’s Affordable Care Act, 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.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.


  • POed Lib on March 21, 2012 8:11 PM:

    If they leave medicine, what will they do? I suppose they could work at insurance companies or other consulting work, but you do get paid pretty well as an MD. I work with physicians as a statistician and consultant. While there are downsides to the physician career, you do get a lot of money, and pay a lot of money too.

  • Anonymous on March 21, 2012 9:24 PM:

    I am a family physician in the L.A. Area. I started my solo practice in 2007, right before the financial crash of 2008. I work 50 hours per week. After I pay my two assistants, my rent, my malpractice, health insurance for my employees, and the rest of my overhead (which averages $15,000 per month) I literally have no paycheck for myself. I have not taken any salary in the past five years. I keep working the treadmill to keep from dragging my family down financially, until my office lease commitment is done. Thankfully my husband has a good job. Another reason I keep going is that I worry my patients will not be able to find a new primary care physician if I close my doors. As it is, we get 8-10 calls a day from new patients who are looking fo establish care, but are having trouble finding a practice that is accepting new patients.
    There are some extremely lucrative specialties in medicine, but primary care is not one of them. I will either have to go cash-pay (like the guy who cuts my hair, except his overhead is minimal) or close shop and become a cog in a "high volume" industrial clinic that feels more like being on an assembly line than being a physician. I know people don't have much sympathy for "rich" doctors, but are just the canary in the coal mine. We are an endangered species that are necessary for the overall healthcare system in this country to function. The idea of a govt bureaucracy getting involved in medical decision making scares me, but I think the only solution is Single Payer health care, with incentives for medical students to go into primary care specialties. The business of medicine is totally dysfunctional. I would love to be able to just focus on caring for my patients, not have to worry about dealing with insurance companies or going broke, and get paid a decent middle class income

  • Anonymous on May 25, 2013 1:57 PM:

    I agree with "Anonymous". I can't help but wonder if Dr. Carroll has ever been self-employed. I think it would be good if all physicians were self-employed for at least 5 - 7 years. I have been in Family Practice for 27 years - still go to the hospitals in town, work 60 - 100 hours a week, and still can't keep up with the paperwork, etc. I believe the cost of EMR has put some doctors out of business. Medicine has been controlled by "Big Business" or - as a friend of mine has said - the "Iron Triangle of Healthcare" - for much of my career - that, of course, being the insurance industry, the pharmaceutical industry, and the hospitals/?specialists. Doctors are "small business" people. Then, of course, there are always the threat of lawsuits. I have not been sued, but know it's always a possibility. A friend of mine - who is an Internal Medicine physician - told me a couple of years ago that he was living off of his wife's salary. He was trying to do everything right. Possibly the most respected physician in my town told me 10 -15 years ago that they were "trying to run people like you out of business". He was in his 70s or 80s and still practicing and he was talking about Family Practitioners. He had come to town to do general surgery but had done stress tests, treated broken bone, delivered babies, etc. because of the physician shortage. He had been one of the owners of the hospital and understood business. Do you ever look at the salaries of the people who work in the hospital administrations?

  • Anonymous on May 25, 2013 2:15 PM:

    I am the last "Anonymous" writer. Why did they take Darvocet off the market and leave me with Lorcet, Percocet, etc? I kind of feel like they took a rifle away and left me with a machine gun. I have e-mailed the President about the possibility of more of a universal EMR, etc and my concerns that teachers should run schools and physicians be in charge of hospitals - but not paid as CEOs - but I only get responses asking for donations or telling me to listen to his weekly address.