As the story goes, physicians in the United States quit their jobs in droves during the COVID-19 pandemic, driven to flee the profession by burnout, depression, and defiant patients. But did they really?
While some surveys and news headlines have suggested an unprecedented wave of early retirements or career changes during the past 2+ years, some experts are casting doubt on that scenario. So was there a mass shuttering of medical practices during the pandemic or not?
"It's an excellent question, and one that I'm not satisfied on a statistical basis has actually happened," Gary Price, MD, the president of the Physicians Foundation, a nonprofit group that funds healthcare research and policy, told Medscape Medical News.
On the surface, the reports certainly look dire. Surveys and testimonies from doctors collected since the start of the COVID-19 crisis all forecast a looming surge in resignations. In December, for example, a study published by the Mayo Clinic of 20,665 healthcare workers at 124 institutions found that approximately one third of physicians said they intended to reduce their working hours in the next year. One in 5 doctors said they intended to leave their current practice within the next 2 years.
Those numbers are similar to an ongoing survey of primary care doctors by researchers at Virginia Commonwealth University. Data from the most recent survey found that 62% of primary care physicians know of other clinicians who have retired early or quit their practices during the pandemic.
Price, a 69-year-old plastic surgeon in New Haven, Connecticut, considered retiring at the start of the pandemic when elective surgeries were put on pause. He expects to retire within a year. And, like many doctors, Price knows of colleagues — including a former student — who quit medicine during the past two years of COVID.
But beyond such anecdotes, determining how many doctors called it quits during the pandemic is unclear. Physicians and scientists like to say that the plural of anecdote is not evidence — but anecdotes seem to be the main support for the pandemic retirement wave. Surveys capture doctors who say they plan on retiring in the near future, but several experts said in interviews with Medscape Medical News that no one is collecting hard numbers of physicians who have quit.
The data gap is particularly problematic for primary care, which represents the largest group of physicians in the US, numbering nearly 209,000. Rebecca Etz, PhD, a cultural anthropologist who co-directs Virginia Commonwealth's Green Center and leads the survey, says it is difficult to get reliable data on employment trends for primary care and medical specialties in general.
"We don't have any national database for primary care. It's a big, gaping hole for us," Etz said in a recent interview. "Most of what we know about primary care we know by proxy. We look at surrogates that tell us what is likely to be true and we look at broader datasets."
A survey conducted by Medscape this spring found that 18% of nearly 500 US physicians said they intended to retire within the next 12 months, whereas 24% said they planned to cut back on their work hours in the coming year.
Retirement from practice doesn't necessarily mean a departure from medicine itself. Indeed, 43% of those in the Medscape survey who said they planned to quit also said they wanted to stay involved in the field in some capacity.
Not surprisingly, most of the physicians who say they plan to leave their practices are older doctors. Nearly 45% of doctors across all specialties are older than age 55, data from a 2020 AAMC report found, leading researchers to conclude that more than 2 out of every 5 doctors who are actively practicing will be over 65 in the next 10 years.
Researchers at the University of Minnesota analyzed Medicare claims data before the pandemic began and in the months following the spread of COVID-19. Aside from a large spike in interruptions in claims during April 2020, rates of claims interruptions were pretty much the same during the pandemic as they were before COVID took hold. Physicians age 55 and up had the largest increases in stopping Medicare filings altogether, the researchers reported.
Ultimately, we don't really know if more doctors quit medicine during the pandemic than in earlier years. All we have are context clues — and those even paint a confusing picture.
What's Ailing Medicine?
For Etz and many other experts who study the pitfalls of the healthcare industry, doctors may be seeking retirement because of how the pandemic has chipped away at the patient–doctor relationship.
"What keeps [doctors] going is their connection with their patients. When that's destroyed or damaged, that's when they lose their resilience and they can't sustain their practice," Etz says.
For Price, the patient–doctor relationship was further injured by many patients' attitudes towards COVID, and the skepticism they brought into doctors' offices.
"The pandemic added a dimension we've never seen before as physicians and that was the dimension of patients refusing to help us make things better," Price said. "We found a big part of the population refusing to do something as simple as wear a mask or get vaccinated. And I think that was a feeling that physicians have never had before that they weren't working with the community to help everyone get better."
Much of the talk of early retirement may be a cry for help — or wishful thinking — from doctors who have spent years losing touch with patient care, says Denise Brown, MD, the chief strategy officer for Vituity , a national physician staffing firm.
According to Brown, doctors generally don't feel like their work is that rewarding anymore. The burdens of electronic health records, working as an employee, fighting with insurance companies, and other factors have weakened many doctors' emotional connection with patients and their profession. And then the pandemic hit.
When pondering their futures, "Some [doctors] just make it a knee-jerk reaction and say, ‘I'm going to retire,' " Brown added.
Ironically, Brown said, physicians may feel like victims but a sizable share of their problems today are of their own making.
"In the early 2000s especially, a lot of physicians relinquished their license to act. They threw up their hands and said, 'I guess I work for Blue Cross now.' Very few people were like, 'No, I'm not going to do that.' So some of what we're seeing today is the fruit of the poison tree," Brown explained. "Now is the time for physicians to take the reins back, to bring a little more sensibility to what we do."
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Cite this: Did COVID Really Send Doctors Fleeing Toward Retirement? - Medscape - Jun 17, 2022.