There has been an influx of headlines reaching my desk that appear to link burnout with doctors quitting medicine and, subsequently, an exacerbation of the looming doctor shortage in the US.
There are three issues going on here:
- Physician burnout. There are a number of recent studies and reports on this topic. The results of a Medical Economics survey published in August 2019 are a good example. This survey found that 68% of physicians currently feel burned out.
- Doctors quitting medicine. Yes, some physicians leave medicine. In fact, every physician eventually leaves medicine. But this, I feel, is less of an issue than the recent medical hype leads us to believe. Keep reading, as I’ll go into detail about my rationale.
- A looming doctor shortage. The AAMC projects a shortage of 42,600 to 121,3000 physicians by the year 2030.
Most likely, there’s some amount of interconnectedness between these three issues. However, I feel that they’re being lumped together in a misleading way that’s not actually backed by data.
(Granted, I run this blog that’s all about career fulfillment for medical professionals. I have a cognitive bias toward any news and articles on the topics of burnout and healthcare careers. But, with this caveat in mind, I’ve made an effort to approach this topic with a minimal amount of bias.)
How many doctors are actually quitting medicine? It may be fewer than you think.
Recent media buzz leads readers and listeners to believe that burnout, clunky EHRs, administrative burden, over-scheduling, and stressful work environments are causing doctors to quit medicine in droves, leaving our country without enough doctors to care for our population.
As it turns out, the data indicating that physicians are actually leaving the profession is quite limited.
It’s more anecdotal.
For example, the NBC article The doctor is out? Why physicians are leaving their practices to pursue other careers mentions a few physicians who lost passion for their work as clinicians. That’s it.
Moreover, a Bloomberg article titled Med School Grads Go to Work for Hedge Funds that discusses a third-year Harvard Medical Student who has already secured a job with the management consulting firm McKinsey. The article quotes the student clearly indicating that he hopes his career involves a period of dedicated time taking care of patients. But it then goes on to say, “Like [this student], more people are coming out of medical school and choosing not to practice medicine.”
Most of the actual data on this topic is about physicians who are thinking of quitting medicine.
A lot of doctors think about leaving medicine…
A 2018 survey by the Aimed Alliance polled 600 US-practicing specialists in family medicine, internal medicine, pediatrics, and OB/Gyn. The survey was specifically about their experiences and opinions related to health insurers’ restrictive cost-containment strategies. They asked physicians to respond to the statement:
The barriers that insurance companies create for my practice have caused me to consider leaving the medical profession.
The results were as follows:
Data from Aimed Alliance.
There’s a lot of agreement there. Almost half agreed strongly or somewhat. But the respondents are only agreeing that they’ve considered leaving medicine.
In another study, Locumstory.com surveyed nearly 1,000 physicians across multiple practice types and specialties, finding that 55% had considered quitting or leaving the medical field in the past few years.
Again, a high percentage. But a high percentage who’ve just considered quitting medicine.
The 2012 Medical Practice & Attitude Report by Jackson Healthcare reported on the results of a survey of over 2,000 physicians. This study found that 16% of physicians planned to or were considering leaving medicine, retiring, or transitioning to part-time work within the next year.
Notably, the percent planning to retire or leave medicine (1%) was significantly lower than the percent considering retirement or leaving medicine (7%).
A 2016 survey of more than 17,000 physicians by the Physicians Foundation and healthcare recruiting firm Merritt Hawkins reported that 13.5% said they planned to seek a nonclinical job within three years. Again, they were planning.
But who knows how many of those surveyed actually transitioned to nonclinical work within the next year? Nobody knows.
People (even doctors) frequently think about things without ever acting
I can’t think of a single job I’ve had or training program I’ve been part of in which I didn’t, at some point, think about quitting. Practicing medicine is difficult. Medical training is tough. And it’s completely natural to think about how much easier and better things could be if we were doing something else.
This is so common, actually, that we have common sayings and idioms to describe it:
The grass is greener on the other side.
The streets of London are paved with gold.
Personally, when I’m stressed out at work, I daydream about how much better other jobs and professions would be. This librarian/retail associate/park ranger/nanny has it so easy. Why don’t I do that instead?
Had I taken part in any of the surveys mentioned above, I most likely work have indicated that I’d considered leaving medicine. And then, years later, I’d be where I am right now… still practicing medicine (albeit not full-time).
People think and talk about plans and ideas frequently without following through. I’m not criticizing anyone, it’s just the way we are as humans.
So, given the available data, the main question that comes to mind is this:
Are doctors truly quitting medicine?
I’m not convinced that the “thinking of quitting” data is really helpful or an accurate reflection of what actually takes place.
The data I’ve mentioned also spark another question.
Are physicians any different from other professions when it comes to quitting?
In a cursory search for similar survey data of other professions, it seems that medicine is not the only field in which professionals are bogged down by these thoughts. Several professions have some data on actual rates of quitting and transitions:
Teachers considering leaving the classroom
A 2019 poll by PDK International – a professional association for educators – found that 50% of the 556 teachers surveyed have seriously considered leaving the teaching profession in recent years.
Nurses considering leaving the bedside
A recent survey by RNnetwork found that 49% of registered nurses have considered leaving the profession at some point over the past two years.
Pharmacists leaving the pharmacy
A study published in the Journal of the American Pharmacists Association found that over 50% of community pharmacists want to quit their jobs.
Lawyers leaving law firms
The National Association of Women Lawyers conducted a survey of female lawyers and found that over 70% of them had left the profession by the 7th year.
Academics leaving academia
A study of authorship of scientific papers found that 60% of scientists who’ve supported principal investigators and other lead authors have never progressed to lead a paper of their own.
Management consultants leaving consulting firms
Business consulting is well known to be a high-stress line of work. Most (77%) Boston Consulting Group employees have worked at the company for 5 years or less. Only 11% have spent more than 10 years at the firm and only 2% have spent more than 20.
Fundraisers leaving their nonprofits
Survey results published last year in The Chronicle of Philanthropy indicated that 51% of fundraisers plan to leave their jobs by 2021.
Engineers quitting engineering
It’s been estimated that nearly 40% of women with engineering degrees either leave the profession or never even work in the engineering field after earning their degrees.
The issue of “doctors quitting medicine” is misinformed and misdirected
That said, we don’t have much data to support that doctors are quitting medicine, and we certainly haven’t proven that the ones who quit are doing it because of burnout.
In fact, the Jackson Healthcare Medical Practice & Attitude Report (mentioned above) provided the reasons that survey respondents give for considering retirement or leaving medicine. The reasons are all over the map, as shown in the chart below, which is taken from their report:
Source: 2012 Medical Practice & Attitude Report by Jackson Healthcare
Burnout is one reason, but not even the most common or the second most common.
Peoples’ motivations for changing careers are wide-ranging. They might be:
- Seeking a higher level of satisfaction
- Wanting more flexibility
- Experiencing a change in personal or professional goals
- Itching for a new challenge
- Desiring to focus on new things
This last one is especially true for physicians. We’re lifelong learners. Many medical fields have become subspecialized, leaving some physicians doing the same procedures and treating the same diseases over and over.
As mentioned at the beginning of this post, a substantial physician shortage is projected. However, the AAMC indicates in their report that a major reason is the growing, aging population. There are more patients in need of medical care and more doctors reaching retirement age.
The driver of the looming doctor shortage is not preventable burnout.
A nonclinical career isn’t quitting medicine
Physicians who transition from clinical work to a nonclinical job might do so as a result of burnout or because of any of the reasons listed above. Regardless of the rationale, taking a nonclinical job shouldn’t automatically be considered quitting medicine.
Most nonclinical careers require a physician’s medical knowledge and experience. Many nonclinical jobs – such as utilization management – usually require board certification. Some even require an active medical license, such as certain jobs in healthcare administration.
Because most nonclinical jobs rely on a strong medical background, the physician’s expertise comes through in the products of their work. The result is a product or service that makes people healthier or more effectively treats a disease.
Burnout, rather than leading to doctors quitting medicine, prompt some physicians to help individuals and populations in a different way than they do at the bedside.