Access to Care

Physicians who are dissatisfied with their profession are two to three times more likely to leave medicine than satisfied doctors

Amidst decreasing reimbursement and rising practice costs, physicians are under growing pressure to see more patients and keep up with an ever-expanding list of recommended treatments. Career satisfaction remains a source of ongoing concern in the physician community. A new study, supported in part by the Agency for Healthcare Research and Quality (HS10803), shows that very dissatisfied physicians are over twice as likely to retire and over 3 times more likely to cut back on their hours than satisfied physicians. Very dissatisfied physicians retired 2 years earlier than very satisfied physicians. Physicians' ratings of their professional autonomy, which other studies have judged to be important to their satisfaction, and their ability to obtain needed inpatient and outpatient services, were minimally related to subsequent retirement or reduced work hours.

The researchers analyzed data from the 1996 and 1998 rounds of the Community Tracking Study Physician Survey, a series of nationally representative telephone surveys of physicians. Of 16,681 physicians interviewed in 1996 or 1998, 2.8 percent had retired 2 years later and 3 percent had reduced time spent in patient care to less than 20 hours per week.

Full- or part-time owners of practices were both less likely to retire and to cut back on hours. Internal medicine specialists and psychiatrists were less likely to retire, whereas surgical specialists were more likely to retire. These findings have implications for physician manpower projections and quality of care. Replacing physicians who leave practice is costly, leads to discontinuity of care, and requires additional investments of time by new physicians and patients to become acquainted.

More details are in "Leaving medicine: The consequences of physician dissatisfaction," by Bruce E. Landon, M.D., M.B.A., James D. Reschovsky, Ph.D., Hoangmai H. Pham, M.D., M.P.H., and David Blumenthal, M.D., M.P.P., in the March 2006 Medical Care 44(3), pp. 234-242.

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