Intention to Leave Emergency Medicine: Mid-career Women are at Increased Risk

Mid-Career Women Are at Increased Risk

Michelle D. Lall, MD, MHS; Sarah M. Perman, MD; Nidhi Garg, MD; Nina Kohn, MBA, MA; Kristy Whyte, MD; Alexa Gips, MD; Tracy Madsen, MD; Jill M. Baren, MD; Judith Linden, MD


Western J Emerg Med. 2020;21(5):1131-1139. 

In This Article

Abstract and Introduction


Introduction: Burnout is prevalent among emergency physicians and may cause physicians to consider leaving the practice of emergency medicine (EM). This study sought to determine whether there is a gender difference in reporting burnout and seriously considering leaving the specialty of EM, and secondarily to explore the factors reported as contributing to burnout.

Methods: This was a secondary analysis of the 2014 American Board of Emergency Medicine Longitudinal Survey of Emergency Physicians. We used multiple logistic regression to determine which factors were associated with reporting serious consideration of leaving EM, when stratified by years in practice and adjusting for individual, departmental, and institutional factors.

Results: The response rate was 82%, (n = 868); 22.6% (194) were female and 77.4% (664) were males; and 83.9% (733) White. The mean age of men responding was significantly higher than women (52.7±11.9 vs. 44.9±10.4, p<0.001). Overall, there were no significant gender differences in reporting having had serious thoughts of leaving EM in either unmatched or age-matched analyses. More women reported that burnout was a significant problem, while men more often were equivocal as to whether it was a problem. When stratified by years in practice, mid-career women had a seven-fold increase in the odds ratio (OR) of seriously considered leaving EM, compared to men of similar years in practice (OR 7.07, 95% confidence interval, 2.45–20.39). Autonomy at work, control over working conditions, fair compensation, personal reward, and a sense of ownership were factors associated with a lower rate of reporting considering leaving EM.

Conclusion: Our findings suggest that the intention to leave EM is not more prevalent in women. However, mid-career women more often reported seriously considering leaving the specialty than mid-career men. Further research on the factors behind this finding in mid-career women in EM is needed.


Burnout, defined as "a state of emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment," is prevalent among physicians.[1] In the medical literature, burnout is often measured using the Maslach Burnout Inventory (MBI),[1] Oldenburg Inventory,[2] or single-item measures of emotional exhaustion and depersonalization.[3] However, prior work on emergency physicians (EP) demonstrated that self-reported burnout (as assessed by "have you thought you are experiencing burnout") accurately predicted burnout as defined by MBI scores 72% of the time.[4] Burnout in physicians is associated with many negative effects including decreased job satisfaction,[5] an increase in intention to leave a job,[6,7] decreased job productivity,[8] increased medical errors and decreased patient safety,[9,10] and substance use disorders.[11] The prevalence of burnout in attending physicians across medical specialties is more than twice that observed in the general adult working population, with EPs reporting one of the highest burnout rates – between 48–70%.[12–14]

Prior studies reveal gender differences in reported burnout, with women reporting burnout at higher rates than men, yet little is known about gender differences in burnout among EPs specifically.[15–21] In one study of internal medicine residency program directors, women had higher rates of emotional exhaustion and depersonalization.[18] A study of American surgeons revealed that women suffered from higher rates of burnout than men and also had higher rates of emotional exhaustion, a factor that has been shown to be associated with a desire to leave clinical practice.[20] Data on gender differences in burnout in emergency medicine (EM) is lacking.

Previous studies have shown that older age may be protective against burnout.[22–24] Older age has also been shown to be a positive factor in EP job satisfaction.[25] Since women in EM are often of a younger age and may also have more non-clinical and family responsibilities,[26,27] these factors may contribute to higher burnout rates among mid-career women. Mid-career seems to be a particularly vulnerable time for female physicians.[17,28–30] Additionally, the notable decline in women who rise to higher ranks of leadership and seniority in EM[28,31] could be either a contributor to, or a result of, potentially higher burnout rates for women.

Physicians suffering from burnout are significantly more likely to leave healthcare,[6,7,32–34] and those who report an intent to leave is a strong predictor of actual departure.[33] Prior to leaving healthcare, physicians often reduce their work hours and change their clinical work environment in an attempt to ameliorate burnout.[13] Burnout and the attrition of physicians from healthcare is quite costly.[34–37] Our primary objective was to determine whether there is a gender difference in reported serious consideration of leaving the field of EM. As a secondary objective, we sought to determine whether previously identified domains contributing to burnout are associated with burnout among EPs.