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Many physicians have surely had it rough lately.
Between getting the squeeze from insurance companies, private equity buyouts of practices, and (oh yeah) a raging global pandemic, there has been a lot of pressure placed on physicians and medical staff across the world.
Do you feel a little on the “fried” side? Has some of the joy, the raison d’être you had for practicing medicine diminished somewhat?
As The Darwinian Doctor points out in this guest post, you are surely not alone.
Today, I explore why it seems like all doctors are quitting medicine. Is it just perception, or is our nation’s healthcare on the brink?
You may have noticed something strange if you’re friends with any doctors on social media these days. It seems like a startling number of doctors are quitting medicine to pursue other career paths or retire early. Some might be leaving to become life coaches, while others might be leaving to become investors or business owners.
Has the Great Resignation finally come for health care providers, or is this just a continuation of historical trends pushing medical professionals towards non-clinical careers? As a practicing surgeon who straddles the worlds of clinical practice, education, and investing, I’d like to add my perspective.
A couple of questions seem pertinent: What the heck is going on? Is our healthcare system in trouble?
What the heck is going on?
If you’re nodding your head in agreement, perhaps you’ve noticed firsthand that some of your colleagues at work are making changes to their medical careers. Some might simply be switching health care organizations.
Job hopping is fairly common, especially in the first couple of years of practice, so this isn’t revolutionary. What’s more interesting are those that are leaving to start their own practice or doctors who are quitting medicine altogether for nonclinical careers.
It’s not just your imagination. Over the past year, I’ve personally noted dozens of physicians choosing early retirement or a new career entirely. These are high-functioning doctors in the prime of their careers, giving up literally decades of education, hard work, and well-established medical careers.
There is clearly something larger going on, both acutely over the last couple of years, and chronically for the past decade or two.
To begin this discussion, let’s address the elephant in the room.
The Covid-19 Pandemic
The Covid pandemic has clearly caused unprecedented challenges for the medical community. The sheer crush of morbidity and mortality over the past two years is like nothing the medical community has ever seen.
The number of deaths from Covid is now more than the deaths we saw from World War II, Korea, and Vietnam combined.
Depending on your specialty, you’ve had varying levels of exposure to the “front line.” If you’re an emergency physician, you’ve seen the triage areas full of gasping Covid patients. You’ve likely experienced the fear of treating a Covid patient with minimal protective equipment. If you’re a pulmonologist, you’ve likely had to make unbearable decisions about withdrawing ventilator support for the unrecoverable patients in the intensive care unit.
This level of death and emotional trauma takes a toll. It heightens feelings of depersonalization and moral injury, AKA burnout. There’s only so much emotional reserve you can have when so many of your patients lose the ability to breathe and die under your care.
For the rest of us further from the front line, the impact of the pandemic has come in many forms. At the beginning of the pandemic, many of us experienced:
- Anxiety about job stability
- Clinic and OR shutdown
- Redeployment to Covid patient care
- Redeployment to vaccination drives
Then as the surges ebbed and medical care opened up again, the pendulum swung back to:
- Staffing shortages
- Unhappy and frustrated patients
- Long surgical backlogs and operative days
- High patient volume and overbooked clinics
When you overlay all of this onto the background of vaccine controversy, it’s been an incredibly tough couple of years to have a medical degree. It’s safe to say that this applies in general to healthcare workers in both private practice and employed medicine.
More doctors are retiring
Data from late 2021 shows that it is in fact true that more doctors are retiring from medicine. In fact, 25% of physicians are thinking about early retirement. This shows that it’s not just a feeling. More doctors are in fact quitting medicine, and many more are considering it.
Dissatisfaction with the status quo
Another factor in this overall trend towards career upheaval has been the recognition that the traditional work paradigm perhaps isn’t so great. And it’s not just physicians that are unhappy.
Working a 9-5 job with a commute has never seemed so unsatisfactory for our nation at large. In 2021, somewhere between 25% to 40% of workers planned to leave their jobs. Most are planning to move to a better job, but many people (especially women), may have left the workforce for good.
Even well into our economic recovery in early 2022, job openings are high and workers continue to quit their jobs.
The experience of healthcare workers
Another driving force in career unrest for healthcare workers is the increased corporatization of medicine over the last few decades. Medical practices are increasingly being bought by private equity groups and hospital systems. In fact, 2020 marked the first year more physicians were employed, rather than in private practice (according to the AMA).
While this trend brings advantages such as standardization of care and electronic health records (EHRs), experience has shown that these swords are double-edged. Physicians now spend more time with electronic medical records systems than with actual patients. As health professionals know, EHRs are great for storing past medical data, but they’re incredibly time-consuming to satisfy in regards to visit complexity levels and billing codes.
Most physicians would agree that they spent four years of medical school and 3-7 years of residency so that they could care for patients, not to satisfy finicky EHR systems riddled with hard stops and requirements.
Don’t even get me started on the frustrating world of prior authorization, insurance companies, and pharmaceutical medication coverage. For a purportedly modern society, it still takes so much paperwork to navigate our nation’s healthcare system.
These dual trends of corporatization and increased documentation requirements have warped the practice of medicine. They lead to a decreased sense of autonomy, which is a potent predictor of burnout/moral injury.
Many physicians are also bad with money
Adding fuel to the fire is the fact that physicians are not great with money. A recent report showed that about 25% of physicians are worth under $1 million by the time they hit their 60s. For one of the highest-paid job categories out there, I find this pretty startling. I’ve written before about the phenomenon of golden handcuffs amongst high-income professionals, and it’s another big problem.
Physicians who are trapped in their jobs by financial pressures can’t make unbiased decisions about their careers or the medical care they provide. This is why I focus so much on personal finance literacy in my writing.
Is our healthcare system in trouble?
I do believe our health care system is in trouble. We can’t take the loss of more unhappy and burnt-out physicians and healthcare workers.
The field of medicine is facing a severe doctor shortage within the decade. We’ve had an epidemic of physician burnout for quite some time, and it’s only gotten worse since the pandemic began. Therefore, it’s high time for us to reverse these troubling trends.
As a physician leader within my own organization, I know that rallying physicians behind a common cause is like herding cats. But the general population in our country deserves our attention to this matter.
Administrators take note: Helping healthcare workers prioritize mental health and reasonable work hours takes more than just resilience training and appreciation lunches. It will take a fundamental revamp of our nation’s approach to public health. Physician leadership will be essential in this process.
I additionally believe that physicians who are financially free will have the best shot at influencing our system for the better. It’s difficult to enact change from a position of financial instability. Therefore, I also support inserting personal finance and business education into the curricula of our medical students and residents to better prepare them for the realities of practice on the other side of their training.
Conclusion
The good news is that recent months have given the United States a glimmer of a post-pandemic future. Mask mandates are dropping, as are Covid infections and deaths. While a new variant can upend our worlds once again, there’s reason for optimism now.
In regards to our healthcare system, I’m worried that we’re at a tipping point. More doctors are quitting medicine early, with many more considering it. Perhaps some are quitting the workforce for good, or perhaps they’re exploring other career opportunities. Regardless, they’re facing a difficult decision about life balance and professional satisfaction.
As for me, I’m hedging my bets. I continue to operate, serve my patients and my hospital, and work on financial freedom via real estate investing and business. This is my own insurance policy in case our nation’s healthcare continues this troublesome descent into corporate moral injury. Prove me wrong, please, I beg you.
Do you know of doctors who’ve quit medicine?
9 thoughts on “Why It Seems Like All Doctors Are Quitting Medicine”
Thank you for writing this article. Though many factors for the exodus from medicine are correctly identified, I agree with Andrew Wilner that loss of autonomy plays a primordial role. Physicians train to make difficult decisions on their own in treating patients. They can, on their own decision, request opinions from other physicians expert in other specialties, or with more experience in their own fields. This is a well-accepted fact of practicing “good medicine”. In the end, the patient outcome depends on the physician’s choice and will affect his personal professional liability.
In the current US system, physicians have to submit to the system’s managers criteria to implement treatment and even labs and imaging to care for patients. If something goes wrong and you end up in a deposition, none of these managers share the responsibility of the sad event. I was told once that it is how healthcare and justice work in the US… I am Canadian born and trained physician.
Medicine transformed into a vile business many decades ago, when it is an art, not an exact science. By the time I finished medical school, it was already insidiously prevalent both in Canada and America. In Canada, the manager is the government within a socialized system, which is unmovable: Personal taxes rates are at their maximum, so the only option is to cut services.
Another of my frustration is being called a” provider ” when I spent a third of my life on school benches and killing myself by sleep deprivation on long night shifts in the ER. I feel, we, physicians are treated mostly like automatons with “protocols, algorithms, etc”. There is little room for compassion or the art of taking care of someone asking for relief, a little attention and reassurance.
No wonder patients are angry and demanding their due now that the Internet allows them to learn what should happen and they realize what they get, fall short of what a professional, us, should offer.
Where is the patient in all that mess if the physician does not take a firm stance to care for his patient??? I tell you: the patient is over tested and irradiated to satisfy algorithms, over or under-treated to satisfy health and liability insurance companies, and completely lost and anxious about the outcome of all that he or she has to bear with. I claim this as a personal experience I will always remember. And I had been practicing medicine for 25 years.
The other sad fact is that physicians are so individualistic that discussions about the future of healthcare have been going in all directions, while our managers are inventing more protocols, standard of care, coding rules, burying us in unbelievable paperwork and rigid bureaucracy that have nothing to do with caring for people.
I rarely post about our dying profession. But this one just had to be answered. I retired from medicine at the start of COVID because the hospital managers canceled all my locums contracts. After a year, the pandemic in full swing, thanks to our ineffective government managers, I just took a leap of faith and went back to school in a totally different field. I now am more serene than I have ever been, unless a locums recruiter contacts me. I will have nightmares a few nights and reassess my finances, but in the end I just cannot return to that hell.
Dr Linda.
Could you share what other field you went back to school to do? I’m just curious and related to your reply and always looking for inspiration!
I like that I can pull in meds and just edit a change. I like copying and pasting labs or results into my note. I like being able to read other specialty notes about my patients in real time.
I like EMR! And I’m 64!
The idea that physicians weren’t involved in formatting the software is absurd. They have experienced MDs on staff at these billion dollars companies for just that reason.
Finally employed physicians are on an RVU schedule and can work as much or little as they desire within reason. They aren’t overworked! You may disagree with the RVU amount, but I can tell you as a hospital board member that it is almost always less than we collect. We make it up on other places. Like everything in economics, the insurers pay what the market will bear, although fewer big companies does create the problem of price fixing for our services.
Medicine is going to do fine. Fewer physicians just means more clout for the remaining ones and higher incomes. Capitalism isn’t perfect but the long arc of history shows it works.
Thank you for outlining these important observations about the current state of medical practice and the many pressures encouraging physicians to exit.
Personally, I think the greatest threat to physician happiness and the development of burnout is loss of autonomy. Physicians don’t shy away from hard work and long hours but they bristle when they are told what to do by those with less understanding of medicine (i.e., administrators) or systems that they didn’t design (i.e. EMRs).
The growth of locum tenens with its flexible schedules and increased autonomy is testimony to the number of physicians unhappy with the traditional practice model.
As for solutions, that’s a long discussion with many possibilities including physician unions, socialized medicine, concierge medicine, greater regulation of third-party payers, and I’m sure many others.
I agree with educating physicians including medical students and residents about the “health care system” is essential and applaud your efforts!
I think this was the most vapidly written articles that acknowledges a problem and fails to have any useful take.
“As a physician leader within my own organization, I know that rallying physicians behind a common cause is like herding cats. But the general population in our country deserves our attention to this matter.”
Also this is a condescending statement.
So the critiques is that the author didn’t provide a solution to a problem. I must admit that I thought the premise was to identify the various aspects of the problem that need to be exposed, which is the preamble to anyone providing a solution.
It sounds like this particular comment is meant to open the doors to some form of solution, so I look forward to those points rather than continued condescension. The simlest example I’m aware of is the possible “contractor hybrid” model where phyisicians take more of the responsibility but also more of the reward for their own practice, instead of the full employee model that so many of use have endured for so long.
The usefulness of your comment is very suited to your take on the article.
As someone in her mid-60s, it is scary to think the U.S. medical system is in trouble. We had better take good care of our health!
Perhaps you need a new group of doctor friends. It’s not all that bad!