Healthcare organizations are grappling with the increasingly difficult—and urgent—task of attracting and retaining physician talent to meet increasing patient demand for care. By the end of this year, the United States is expected to have a shortage of up to 64,000 physicians.1 The COVID-19 pandemic exacerbated the already substantial burnout among physicians and contributed to an unprecedented departure of physicians from the clinical workforce.2 Looking ahead, physicians’ desires to step back from clinical care show no signs of abating, with current projections indicating the physician deficit could grow to up to 86,000 by 2036.3
One reason for the expected shortage is that some 20 percent of clinical physicians are aged 65 years or older, putting organizations in the position to soon lose a substantial number of physicians to retirement.4 The expanding gap in the physician workforce is particularly consequential given the projected growth in patient demand: the number of people aged 65 and up—an inherently higher-need patient group—is expected to rise to 23 percent of the population, from 17 percent, by 2050.5
To deploy effective strategies to address the physician shortfall and ensure continued delivery of quality patient care, healthcare organizations are searching for the root causes of physicians leaving the workforce. With this in mind, we focused our seventh physician survey on unearthing the mindsets that are pushing doctors in the United States out of the workforce (see sidebar, “Research methodology”). Our findings, based on a survey of 631 physicians, underscore the need to take urgent action.
Physician turnover
Approximately 35 percent of physician respondents indicate they are likely to leave their current roles in the next five years, of which roughly 60 percent say they are likely to leave clinical practice entirely. This upcoming shift is not just restricted to physicians nearing the traditional retirement age. Of those surveyed who say they are likely to leave, 59 percent of those aged 54 to 64 note that early retirement or leaving the care delivery workforce is their most likely next step, and 13 percent share that they would prefer to move to an administrative role within the care delivery workforce. For respondents aged under 54 who are likely to leave, 37 percent prefer early retirement or exiting the clinical workforce, and 14 percent prefer an administrative role. The high proportion of physicians considering a departure from clinical care represents not only a numerical shortfall but also a potential erosion of clinical knowledge and apprenticeship.
Retention challenges
Turnover is likely to continue increasing as physician respondents’ interest in leaving their current positions continues to rise. In our survey, 58 percent state their desire to change jobs has grown over the past year. In our prior survey, 43 percent reported the same. Although not all of those physicians act on that desire—median turnover of employed physicians is less than 10 percent per year1—physicians are also acutely aware that they have other job opportunities: 72 percent of respondents report they are approached about alternative job offers at least monthly, and 50 percent report being approached at least weekly.
Why physicians leave
When asked about factors that influence their decision to leave, physicians’ family needs are just as critical as compensation. In our survey, 69 percent of respondents flagged a desire for higher remuneration, and the same proportion selected family needs and competing life demands. Other well-being factors, such as the demanding nature, emotional toll, and physical toll of work (66 percent, 65 percent, and 61 percent, respectively), are also key determinants. Besides compensation and well-being, the other key influencers on physicians’ decisions to leave, according to our survey, include whether they are involved in decision making and whether they have sufficient staffing support (discussed in further detail below).
Workload and well-being
While long hours can lead to burnout, a lack of control over their schedules affects physician well-being even more than the absolute time spent on the job, according to the survey. Fifty-two percent of respondents who say they work more than 60 hours per week report experiencing burnout, but 66 percent of those dissatisfied with their schedules say the same. Similarly, more respondents who are unhappy about their schedules say they are likely to leave in the next year (32 percent) versus those working more than 60 hours (23 percent).
Defining flexibility
Work flexibility is a key driver of well-being, as evidenced by the correlation between schedule satisfaction and burnout.1 But it can mean different things to different people, so in our survey, we asked physicians about the importance of various aspects of flexibility. A larger share of physician respondents say that flexibility over the specific days and times during the day that they work is important, compared with flexibility of work location. The majority of surveyed physicians report that the ability to take time off (87 percent) is important, while finding coverage when needed (77 percent) and the ability to work specific hours of the day (69 percent ) are next in line. On the other hand, 38 percent of physician respondents share that the ability to work remotely is important.
Inclusion in decision making
Involvement in decision making is a key consideration for physicians in determining whether to leave their position, with more than 60 percent of physician respondents saying they expect to at least be consulted or have a vote on major decisions. This was consistent across various types of decisions, such as patient care quality, culture, and strategic priorities, as well as across respondents employed by health systems and large physician groups. Among those surveyed, expectations of involvement are highest for patient care quality and lowest for strategic priorities.
Delegation of tasks
To understand how best to provide appropriate support to physicians—the lack of which is a key influencer for leaving a job—we analyzed how physicians spend their time. Survey respondents say nearly 20 percent of their clinical time is spent on tasks that could be handed over to nonphysician staff or technology. Respondents indicate that the biggest proportion of delegable time could be entrusted to advanced practice professionals, with hospital-based physician respondents reporting the highest percentage of possible delegation to this group (42 percent).
These findings—combined with our experience with the healthcare workforce—suggest four elements organizations can prioritize to bridge the growing gap between healthcare demand and physician supply:
- compensation and incentive structures
- lifestyle needs
- involvement in decision making
- staffing and support systems
For our insights on these levers and peer examples that organizations can use to differentiate themselves in these four areas, read “How to attract and retain physicians in a challenging labor market.” Organizations that direct resources toward these areas are likely to stand out in attracting top talent, boosting job satisfaction, and ultimately advancing their strategic goals, all while delivering exceptional patient care.