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Tuesday, July 11, 2023

Physician Turnover in the United States

Medical groups, health systems, and professional associations are concerned about potential increases in physician turnover, which may affect patient access and quality of care. 

To address this concern, they are working together to develop innovative strategies to retain physicians. These include providing financial incentives, such as loan repayment programs and signing bonuses; offering flexible work schedules; increasing administrative support staff; creating career development opportunities for physicians; and improving the overall work environment. Additionally, physician organizations are exploring how technology can be leveraged to help retain doctors, such as through telemedicine and remote patient monitoring. 

The hope is that these measures will enable physicians to better manage their workloads, allowing them to spend more time providing quality care and less time dealing with administrative tasks. A strong emphasis on physician retention could help ensure the continued availability of reliable medical care for patients across the country.

A study from the Annals of Internal Medicine by Amelia M. Bond, PhD, Lawrence P. Casalino, MD, PhD, Ming Tai-Seale, PhD indicates there was little change in physician turnover.  The study, however, was based upon billing practices for Medicare patients. 

To examine whether turnover has changed over time and whether it is higher for certain types of physicians or practice settings.

Design:

The authors developed a novel method using 100% of traditional Medicare billing to create national estimates of turnover. Standardized turnover rates were compared by physician, practice, and patient characteristics.

Setting:  Traditional Medicare, 2010 to 2020.

Participants: Physicians billing traditional Medicare.

Measurements:  Indicators of physician turnover—physicians who stopped practicing and those who moved from one practice to another—and their sum.

Results:

The annual rate of turnover increased from 5.3% to 7.2% between 2010 and 2014, was stable through 2017, and increased modestly in 2018 to 7.6%. Most of the increase from 2010 to 2014 came from physicians who stopped practicing increasing from 1.6% to 3.1%; physicians moving increased modestly from 3.7% to 4.2%. Modest but statistically significant (P < 0.001) differences existed across rurality, physician sex, specialty, and patient characteristics. In the second and third quarters of 2020, quarterly turnover was slightly lower than in the corresponding quarters of 2019.

Implications:

The data suggest that physician turnover is an ongoing challenge for healthcare organizations, particularly in rural areas. It also suggests that healthcare organizations may be more successful in recruiting and retaining physicians if they can identify the factors associated with increased turnover, anticipate changes in the local or larger healthcare market, and design strategies to retain existing staff. The findings from this study add

Conclusion:

Over the past decade, physician turnover rates have had periods of increase and stability. These early data, covering the first 3 quarters of 2020, give no indication yet of the COVID-19 pandemic increasing turnover, although continued tracking of turnover is warranted. This novel method will enable future monitoring and further investigations into turnover. It also indicates that healthcare organizations should remain engaged in identifying the factors associated with increased turnover and developing strategies to retain existing staff. With this information, healthcare organizations can create better working environments and more efficient health service delivery for their patients. ~~~~~~~~~END~~~~~~~~~~~

This study flies in the face of frequent statements and beliefs about physician burnout, depression, suicide, and career change.

There are no national estimates of physician turnover, so it is not known whether turnover has increased, as is sometimes assumed (2). If changes in turnover over time exist, they could be driven by the large shift in the composition of physicians and their practices as the number of female physicians and the size of practices have grown in recent years. Even if turnover rates have not changed, they may vary by physician and practice characteristics, geographic location, or the composition of a practice’s patient population. The degree to which turnover merits additional or targeted organizational and policy intervention and investment requires information on these questions.1. Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Intern Med. 2017;177:1826-1832. [PMID: 28973070] doi:10.1001/jamainternmed.2017.4340

Measuring Physician Turnover

We defined 2 types of physician turnover, physicians who moved from one practice to another and those who stopped practicing (that is, left practice), henceforth “movers” and “leavers.”

When identifying movers, our goal was to determine whether a physician who was working with one practice ended the relationship and joined a second practice. In billing data, it is possible to identify the month a physician begins billing a new practice or TIN. However, billing a new practice does not necessarily indicate movement; it could, for example, indicate that a medical group is using more than 1 TIN, that a medical group was acquired by another practice, or that a physician worked part-time in 2 practices. We developed 3 preconditions to determine whether the billing of a new practice constituted a physician moving: A physician had to have a relationship with both the first and new practices through sufficient months of billing—we used 4 months as the primary specification, with 3 and 6 months in sensitivity analyses; the relationships with the first and second practices had to be temporally independent (that is, a physician must bill at least 4 months with their old practice and new practice in different months); and the potential move should not represent a medical group reorganizing its financial structure. Specifically, the old practice had to continue to exist after a physician moved, and a physician could not continue to bill with many of their former peers. Section II of the Supplement provides full details on methods and sample flow charts

The goal in identifying physician leavers was to identify physicians who fully retired from practice or stopped practicing for an extended period. This method considered an extended period to be 2 years and identified physician leavers as those who stopped billing for 2 years (Section II of the Supplement). In sensitivity analyses, we applied periods of 3 months, 1 year, and 3 years.

Primary measures of moving and leaving were reported on a July-to-June basis because measurement of moving required up to 6 months of billing data before and after a potential month of moving. Rates of moving were reported for years 2010 to 2020. Rates of leaving were reported for years 2010 to 2018 because measurement of leaving required 2 years of billing data after a potential month of leaving.

In a supplementary analysis examining turnover during the beginning of the COVID-19 pandemic, we used modified quarterly measures that could be constructed through the third quarter of 2020. Moving required a physician to have a 3-month rather than a 4-month relationship with both the first and new practices. Leaving required a physician to stop billing for 3 months rather than 2 years.


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