TOPLINE:

A greater proportion of physicians left clinical practice in 2019 than in 2013, across regions and specialties, with higher risks for exit among female and rural physicians.

METHODOLOGY:

• Researchers analyzed two datasets to assess the proportion of US physicians who left clinical practice between 2013 and 2019 and the factors influencing their exit.
• They identified 712,395 physicians (70.8% male; 90.8% in urban settings) who billed at least 50 evaluation and management services to Medicare in a year.
• Physicians practiced across broad specialties: hospital-based (28.2%), primary care (27.8%), surgical (16.5%), obstetrics and gynecology (4.0%), and psychiatry (3.7%).
• The primary outcome was the time to attrition from clinical practice, defined as physicians leaving clinical practice without reentry for at least 3 years.

TAKEAWAY:

• While 3.5% of physicians left clinical practice in 2013, the proportion rose to 4.9% in 2019, with increases across specialties, regions, and among those aged 35 years or older.
• Female physicians had a higher risk of leaving clinical practice than male physicians (adjusted hazard ratio [aHR], 1.44; 95% CI, 1.43-1.46), as did those practicing in rural vs urban areas (aHR, 1.19; 95% CI, 1.17-1.21).
• Physicians practicing psychiatry, primary care, or obstetrics and gynecology had elevated risk for exit; after adjusting for physician and patient factors, hospital-based physicians had the highest risk of leaving practice.
• The risk for exit was significantly elevated in physicians caring for older or high-risk patients, or a greater percentage of patients eligible for both Medicare and Medicaid.

IN PRACTICE:

“This evidence can help facilitate clinical operations and policy efforts to maintain the physician workforce, and accordingly, patients’ access to physician care,” the study authors wrote.

SOURCE:

This study was led by Lisa S. Rotenstein, MD, MBA, MSc, of the University of California, San Francisco. It was published online on October 07, 2025, in Annals of Internal Medicine.

LIMITATIONS:

The results may not represent physicians who did not take Medicare. Physicians were classified by the specialty they billed most often. The outcome measured complete exit from practice rather than drops in time spent working.

DISCLOSURES:

This study received funding from the Physicians Foundation. One author reported receiving support from the funding agency.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.