What’s the news: Two in five physicians—40.3% of the 1,344 doctors surveyed—have told researchers that it was “likely” or “definite” that they would reduce clinical work hours in the next 12 months, according to research published in Mayo Clinic Proceedings.
That’s roughly double the share of doctors who felt that way in 2014, when 19.8% of physicians surveyed indicated that it was “likely” or “definite” that they would cut back on clinical work hours. Just 16.1% felt that way in 2011.
In the most recent survey, 25.6% physicians told researchers that it was “likely” or “definite” that they would leave their current practice in the next 24 months. That was similar to 2014 findings when 26.6% of those surveyed indicated that; 18.4% answered that way in 2011.
“There has not been a substantive change in the portion of physicians intending to leave their current position over the last 10 years, but a profound increase in the proportion intending to stay in their current position and reduce clinical work hours,” said Tait D. Shanafelt, MD, chief wellness officer of Stanford Medicine, lead author of the study and an AMA member.
Burnout was a factor in results from the most recent survey, conducted in the winter of 2021–2022. Physicians were more likely to intend to cut clinical work hours if they had had higher emotional exhaustion or depersonalization score. Each one-point increase in emotional exhaustion was associated with 19% increased odds of an intention to leave. Every one-point rise in professional fulfillment was linked to a 21% lower likelihood of having an intent to leave.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Why it’s important: The U.S. has been staring down a physician shortage for years and it will only be exacerbated if physicians follow through on their intent to leave the workforce or cut the number of hours they spend seeing patients.
Although intent-to-leave is a proxy measure, multiple studies have shown that it is a strong predictor of actual departures.
“Specifically, 25% to 35% of those indicating they intend to leave follow through on this intention compared with a 4% to 8% departure rate among those who do not intend to leave,” says the study, which was co-written by Christine Sinsky, MD, Michael Tutty, PhD, and Lindsey E. Carlasare of the AMA, as well as collaborators from Mayo Clinic (Colin West, MD), the University of Colorado (Lotte Dyrbye, MD), and Stanford University (Mickey Trockel, MD, Hanhan Wang).
Just over 3% of participating physicians indicated they intended to leave their current position in the next 24 months and also leave the practice of medicine altogether to pursue a different career. If 30% of the physicians who indicate a high likelihood of leaving medicine followed through on this intention, it would equate to a 1% decline in the U.S. physician workforce. If 30% of those intending to reduce clinical work hours cut clinic hours by 10%, it would mean another 1.2% decline in the American doctor workforce.
“A 2.2% reduction in the physician workforce would equate to a loss of 20,234 physicians, roughly equivalent to the graduating class of all medical schools in the U.S. in 2022,” says the study.
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Dr. Shanafelt said objective data is not yet available to know what percentage of people who said that they may leave or cut hours has followed through.
“But we do know from several sources that the weekly work hours for physicians have already been decreasing, including data form the Current Population Survey that the U.S. Bureau of the Census administers,” said Dr. Shanafelt, chief wellness officer at Stanford Medicine. He pointed to a JAMA Internal Medicine study and JAMA Network Open research that back up the trend.
If even a fraction of physicians follow through on these intentions, it will exacerbate the large shortage in physicians projected by the Health Resources and Services Administration.
Although more medical schools have opened in the U.S. over the last decade, Dr. Shanafelt noted that this increase was intended to meet the increasing societal need for care, including caring for an aging population, rather than replace erosion in the existing physician workforce.
“Health care organizations and leaders of the U.S. health care delivery system need to address the factors that contribute to this phenomena,” he said.
Learn more: The AMA is working to address current and future physician shortages, including legislative changes that would provide physicians an annual Medicare payment update to account for practice cost inflations and reduce administrative burdens such as prior authorization.
Visit AMA Advocacy in Action to find out what’s at stake in reducing physician burnout and other advocacy priorities the AMA is actively working on.
