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?
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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 career. Some might simply be switching health care organizations.
Job hopping is fairly common, especially in the first couple 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. In the beginning of the pandemic, many of us experienced:
- Anxiety about job stability
- Clinic and OR shutdowns
- 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 health-care 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 a lot of 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 that 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 the electronic medical records systems than with the 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 to care for patients, not 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.
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, while at the same time working 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.
–The Darwinian Doctor
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I’m not seeing it, of the many doctors I know not a one has retired early, and in fact, most of the ones who have already retired did so in their 70’s. But this is the rural South, maybe it’s different here?
Yes I wonder if it’s regional. I know of a handful at my place of work. Two are taking early retirement and a few have switched employers / gone into private practice.
Many of my med school classmates are still practicing medicine and we are in our 70s. I am not. I was completely out of medicine just before I turned 70. At 66, I went from full-time to part time. I would like to say that real estate is not the only way for one to leave medicine early and it is not for everyone. Our real estate was for our retirement and yes, it is making money and helping our retirement. I started a business, mainly because of my real estate aspirations during Covid. My philosophy is and this also relates to medicine and real estate , if you do not like it, find a way out. Real estate, like medicine, is not everyone’s cup of tea. I flipped a property and I will never do it again!
Absolutely true. My wife and I spent our vacation week last week painting our vacation rental in Palm Springs… never again!
I am in Canada. So, different healthcare system. However, I have seen some changes here. I am also a physician leader in the ICU field. There were changes happening prior to the pandemic. The big shift that I have noticed is less willingness to put aside other aspects of life to focus on medicine. I think that is a natural shift due to a cultural shift. When physicians were revered and treated as a valuable-difficult-to-replace resource, that was accompanied by a reciprocal sense of duty to meet that need. As our governments (or healthcare corporations in the US) and the public we serve has shifted to consider us easily replaced commodities, that has faded. If we are easily-replaced employees, then it is a job and not a calling. We started seeing this via our government over about the last decade where I work. As someone who fields patient complaints, there has been an increased “Doctor A isn’t saying what I want to hear so replace them”. In my leadership position, I was literally told to “just do what I was told or I was easily replaced” about 5 years ago. I refused and engaged our physician group to find what was actually a better solution than the command I was given. However, that really caused me to disengage and fed my burnout. If anything, the pandemic caused unburnout because suddenly we were being valued, our expertise/opinion sought out and listened to, and we were not easily replaceable. There is a degree of burnout now from the work-hours and emotional trauma you mention. However, that will fade as people recharge. I hope that the valuing of physicians doesn’t fade as quickly.
I think you’re onto something with regards to the cultural shift of the perceived value of physicians. Very astute and I believe these forces are at play this side of the border as well.
Other than the pandemic, what you described is similar to what has happened in the world of IT. We have become what my coworkers jokingly called “disposable widgets” on a corporate chart. Upper management makes personnel cuts based on employee counts and department without regard to how essential those workers are, or how much income they earn for the company. Then the remaining employees have to do the work of two people or more. The best and least geographically tethered employees remaining then leave for a better employer. I had achieved FI so when offered an early retirement buyout, I took it. So glad to be free of the burnout feelings.
Very interesting that this phenomenon is widespread, but perhaps not surprising. I’m glad you were able to break free!
Everything you said is true.
However, it seems very generational. Many Millennial and late Gen Xers physicians don’t see being a physician as a calling or don’t see being a physician as a central part of their identity.
Subsequently, work-life balance is more important, being able to be, and time to be, your true self outside work is important.
All the factors you listed as reasons for burnout apply here.
The fix to this problem is something administration will never understand (the only solution they see is to hire more administrators, make the physicians do more paperwork for insurances and care networks, increase time working, or reduce pay by shifting to unreasonable incentive bonuses)
I’ve seen many and know many physicians who have or are planning to retire early throughout all regions of the country.
Many of them are keeping this close to the chest, there is a lot of negative stigma towards physicians retiring before they are 50 years old. Especially the older generation of physicians whose job defines them, I have seen them work the hardest to stamp out proposals for efficient workflow, part time status, equal partnerships, etc, all while either wanting the same or selling out to PE groups with their golden parachutes, ranting about how they had to hike to the hospital uphill both ways.
I, myself, am stuck where I’m at with golden handcuffs. Payments and income are dropping noticeably every year. If I left my practice, I’d have to go to a PE group that would require an increased workload every year to make up for decreased payments, all while making less than I currently do. I save 50% gross income and plan to either go 0.75 FTE at 42 yo with 5 more years of work, or suck it up and retire fully at 45.
You want to fix medicine, reduce administration, reduce midlevels, decrease hours for experts in their field, increase pay, support each other and don’t be judgy Boomer physicians.
Thank you for taking the time to write this. Your words resonate with me. I hope you can find a good solution for your work-life balance, sooner rather than later! Check back in with us soon!
Agree with all the issues identified in the post and comments. One additional factor is a consequence of the FIRE movement. Doctors who follow that path are well positioned to be financially ready to retire way before “standard retirement age” and are not locked into having to deal with work nonsense for the income. There’s increasingly more doctors set up with their FU money. Probably the first big wave is in their 40’s, corresponding to the beginning of more widespread knowledge of FIRE movement. So I do agree that there will be more and more early physician retirees in the coming years.
For me, while solidly FI, I will work til the kids are off to college in a few years and then reassess (around age 50). I do admit to FOMO reading blogs of physicians who have retired early. But I continue to enjoy practicing medicine and will do so until that is no longer the case.
If you enjoy it, I’d agree there’s no need to walk away prematurely. Medicine is still a good profession in so many ways, and such a societal need.
Social media (including my own blog), can present a bit of a warped presentation of reality. It’s often all the glitz and none of the grime.
I believe the great resignation because healthcare has become retail. Physicians are no longer respected for the hard earned years of sacrifice and training. Rather now, we have become lumped into a group with the disgusting term “provider”. The midlevel creep where now with an online course a physician is one and the same is insulting. Physicians have become nothing more than cogs in the corporate machine. On average each physician earns a company anywhere from 2-5 million dollars annually. With their forced supervision of midlevels who they aren’t given proper time to actually supervise this in turns increases billable amounts by hospital systems. Additionally physicians are crammed with 15 minute slots and expected to work on empathy -(which we do because that’s why most embarked on this treacherous journey)- working through lunches, after hours and never getting a 15 minute break.our training teaches us we sacrifice because it’s the expectation based on oath. We are expected to make and meet “customer satisfaction”…. Umm when did patients become customers exactly?! We aren’t celebrated but rather villainized on a continuum being labeled as money hungry when many of those high earning dollars are spent in paying exorbitant debts in addition to the opportunity costs and costs in life used for training. I can tell you personally, i love medicine and my patients but the corporatization, lack of appreciation and the exorbitant costs of being a physician is why i would never recommend it and why I’m out once my loans are paid off.
Thanks for lending your opinion to the conversation. I think a lot of physicians share your frustrations. Do you think a different employer or work environment would change your perspective? I’m hoping that once I’m financially independent, I’ll find a sustainable and enjoyable practice environment that allows me to continue medicine on my own terms.
I am retiring in about a month mostly due to an ongoing medical condition but I was about to retire/leave medicine anyway. Pretty much all the good aspects of the job are being eliminated. I am a surgical sub specialist as well and frankly I am tired of being treated as an RVU producing widget in a large company and not a human being. The quality of the consults we see has dropped significantly due to poorer quality (basically absent) primary care. I am not criticizing the primary care docs as I can only imagine what it is like for them based on my own experience in clinic. They probably get 5 mins or less with a patient?
Call has also become much more of a burden as nearly everyone who calls you is a shift worker and could care less what time it is and if the concern is truly urgent.
We have been FI for awhile and the impact of the above was clearly damaging my life so what is the point of working a job I could barely stand for money I would not likely ever use.
I may try to get back in part time in the future, but when I asked to go part time with my current employer their response was to hire a younger physician to replace me. The younger generation of physicians will need to band together to try change things as the way it is heading now is not sustainable.
There are a lot of similarities in our experience, I believe. In my practice, we are getting crushed by poor quality consults where basic measures or medical management options haven’t even been attempted. I also don’t blame the PCPs. I also think they’re getting crushed by a tidal wave of demand. Call is clearly the killer poison in my coffee these days. Even when I don’t get killed overnight, I hardly sleep and am tired for days.
Good luck on your retirement, and I do hope it becomes just a sabbatical, as I’m sure the field of medicine can use your skills in some capacity!