• 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.

    @aaronecarroll

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    • Great post.

    • Aaron—

      I agree—docs do like to bellyache, and they do love to hate health care reform.

      I also don’t think that docs are going to flee medicine—I, for one, have no other marketable skills. I can see primary care physicians transitioning their practice to retainer based or maybe do more legal work—both of which would reduce provider supply.

      I have a difficult time believing that physicians seeing >150 patients a week aren’t majorly frazzled—no one I know is trying to get busier. I also don’t believe pushing doctors away from small practices (disclaimer: I have one partner) with ACOs is a good thing. This is just anecdotal, but I don’t believe the quality of my care would be better with an ACO and I’m unwilling to give up my role as small business owner.

      I’m frankly surpised that medical school applications remain strong. I love medicine, but return on investment is not very good. Young docs don’t want to go into primary care in general—again that is my regional perspective. Of the most recent graduating group of internists from Maryland and Hopkins, less that 10% aren’t training in a subspecialty.

      Most of us in the community believe that the ACA will result in an increased number of insured patients but that we will be reimbursed at a lower rate to see them creating a more work for less pay scenario. That might work for a large practice or health care system but not for the community based private practice internist. That is the true endangered species here.

      Regards

      Jon

    • Just did a story on residency match this week.

      In NC, the number of young docs going into primary care was strong, not as high as med school officials would like and they’re throwing internists into their stats even though most of internal med residents will probably end up in a specialty. For consistency, I listed all the folks going into internal medicine for all schools (still waiting granular stats from one school, not listed).

      But salient to this post was a comment made by the guy I interviewed at AAMC. He said that their data show that among med school faculty nationwide, primary care faculty (both didactic and clinical) have the highest job satisfaction rates. I didn’t get it into the story, but probably should have…