The increase in physician turnover was greatest from 2010 to 2014, rising from 5.3% to 7.2%.
The annual physician turnover rate increased significantly between 2010 and 2018, according to a recently published journal article.
Physician turnover was defined as physicians moving to a new practice or leaving the practice of medicine. Physician turnover has several negative consequences, including the cost of replacing physicians who leave a practice, interruption of continuity of care, and reducing access to care such as for rural patients.
The recent journal article, which was published by Annals of Internal Medicine, is based on a new method of gauging physician turnover through Medicare billing records. The analysis compared turnover rates by physician, practice, and patient characteristics.
The journal article features several key data points.
- The annual physician turnover rate rose from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and rose to 7.6% in 2018
- From 2010 to 2014, most of the increased turnover rate was due to physicians who stopped practicing, with an increase from 1.6% to 3.1%
- Younger physicians were more likely to move to a new practice, with 5.6% of physicians between 35 years old and 44 years old moving in a given year, and 2.6% of physicians 65 years old or older moving in a given year
- Older physicians were significantly more likely to leave practice, with 9.8% of physicians 65 years old or older leaving practice compared to 1.4% of physicians 35 to 44 years old leaving practice
- Physicians in rural areas were more likely to move than physicians in urban areas (5.1% vs. 3.9%) and more likely to leave practice (3.3% vs. 2.7%)
- Female physicians were more likely to move and leave practice than male physicians
- Compared to physicians in larger practices, physicians in solo or 2-physician practices were less likely to move or leave practice
- Physicians seeing a higher proportion of dual-eligible (Medicare and Medicaid) patients were more likely to move (top vs. bottom quartile: 4.2% vs. 3.9%) and more likely to leave practice (top vs. bottom quartile: 3.5% vs. 2.9%)
- Among specialties, hospitalists had the highest annual moving rate (5.4%), followed by surgical specialists (4.5%) and primary care physicians (4.0%)
- Among specialties, obstetrician-gynecologists had the lowest annual moving rate (3.5%)
- Among specialties, hospitalists had the highest annual rate of leaving practice (3.6%), followed by primary care physicians, obstetrics-gynecology, and hospital-based physicians (ranging from 3.1% to 3.2%)
- Among specialties, medical specialists (2.0%) and surgical specialists (2.4%) had the lowest annual rates of leaving practice
The increase in turnover rates between 2010 and 2018 is significant, and it poses challenges for healthcare providers and patients, study co-author Lawrence Casalino, MD, PhD, emeritus professor of public health, Department of Population Health Studies, Weill Cornell Medical College, told HealthLeaders.
"You have to look at the percentage change and the absolute numbers. The change in the absolute numbers—5.3% to 7.6%—does not seem that large, but it is still one out of 13 physicians leaving medicine or moving to another practice. That is fairly high, and it is close to the other studies that have looked at physician turnover. It is expensive for a practice or a health system if a physician leaves. When they have to look for a new physician, there are several costs involved. It is also bad for patient care, particularly for patients who have had a physician for a long time," he said.
Interpreting the data
The finding that physician turnover is higher in rural areas than urban areas is concerning, Casalino said. "Rural areas are already short on physicians in primary care and specialties. In addition, people in rural areas are usually poorer and sicker than people in urban areas."
The finding the physicians with higher proportions of dual-eligible patients have relatively high turnover rates is also concerning, he said. "To the extent that dual-eligible and poorer patients are sicker, they need their doctors even more."
Financial and clinical pressures likely contribute to the physician turnover rates of physicians with higher proportions of dual-eligible patients, Casalino said. "It's common knowledge that practices that have high percentages of dual-eligible or otherwise poor patients have lower revenue than other practices. So, they take in less money, but to provide good care for poorer and sicker patients, it takes more time and money for physicians to provide that care. There is more financial and clinical pressure on physicians in practices that have a high poor patient mix."
Multiple factors likely explain why physician turnover is higher for women than men, he said. "On average, female physicians are younger than male physicians, and younger physicians are more likely to move to another practice. Women also are involved in more care of children and elderly parents, and they may not be as tied to a particular practice as men. They may have to leave because they cannot make their schedule of caring for other people work with their practice, and they have to go somewhere else that has the schedule they need."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Younger physicians were more likely to move to a new practice, with 5.6% of physicians between 35 years old and 44 years old moving in a given year, and 2.6% of physicians 65 years old or older moving in a given year.
Older physicians were significantly more likely to leave practice, with 9.8% of physicians 65 years old or older leaving practice compared to 1.4% of physicians 35 to 44 years old leaving practice.
Physicians in rural areas were more likely to move than physicians in urban areas (5.1% vs. 3.9%) and more likely to leave practice (3.3% vs. 2.7%).