More physicians are regretting choosing to pursue medicine, according to a 2023 survey from the Physicians Foundation, and here are five reasons why physicians are turning away from the practice.
1. Loss of autonomy
Autonomy is on the top of mind for many physicians as the workforce migrates to employed models and physician practices continue to consolidate.
In 2012, hospitals and health systems employed 26% of physicians and owned 14% of physician practices. However, as of 2024, hospitals, health systems and other corporate entities employ nearly 80% of physicians and own nearly 60% of physician practices, according to research commissioned by the Physicians Advocacy Institute.
"The main reason the physicians are increasingly dissatisfied with their career in medicine is the feeling of lack of control over their work and ability to take care of their patients," Vladimir Sinkov, MD, founder and CEO of Las Vegas-based Sinkov Spine Center, told Becker's. "Due to declining reimbursements and increasing regulatory and non-clinical burdens, more and more physicians decide to become employees of large organizations (hospitals, insurance company affiliates like Optum or Kaiser or mega-groups controlled by venture capital firms). Once they become employees, a significant amount of clinical and career autonomy is lost. The initial increases in salary eventually become diluted by ever-increasing 'production' requirements, and physicians then feel trapped in a job they do not like but can no longer leave (don't forget the non-compete clause)."
Additionally, more physicians would take a pay cut for more autonomy in 2024, 75%, compared to 2023, 71%, according to Doximity's 2024 "Physician Compensation Report."
"This is based upon the recent trend of a total lack of autonomy as physicians become employed at an exponential rate," Kenneth Candido, MD, CEO and president of Chicago Anesthesia Associates, told Becker's. "In the past, physicians had the ability to select their optimal work environment and the parameters upon which they saw patients…. The corporation has its ultimate goal of maintaining control over all professional functions; the physician has lost decision making abilities."
2. Reimbursement declines
Physicians are also looking to leave medicine because of declining compensation. Between inflation, reimbursement declines and Medicare pay cuts, physician pay is struggling to keep up.
"These declining reimbursement rates in the face of increased operational cost and inflationary pressures are not sustainable," Christopher Yeung, MD, spine surgeon at Desert Institute for Phoenix-based Spine Care, told Becker's. "This financial stress is eroding the enjoyment of being a physician. It’s already stressful caring for your patient’s health and wellness. These additional financial worries make being a physician a less enjoyable profession."
According to Doximity's report, around 35% of physicians said they were not satisfied with their current compensation, and 62% said their current pay did not reflect their level of expertise and the amount of effort required in their roles. Additionally, some physicians are irritated by the disparity between pay to hospital physicians compared to private practice or physicians at ASCs.
"Changes need to be made to the Affordable Care Act to reign in the high reimbursements to hospitals, compared to the reimbursements of physicians in private practice," John Prunskis, MD, CEO and Medical Director of the Elgin-based Illinois Pain & Spine Institute, told Becker's. "This irrational difference in reimbursement between hospitals and ASCs and private practices is needed to increase physician satisfaction."
3. Increased consolidation
Physicians are also choosing to leave medicine because of the increase in healthcare consolidation that is further eroding physician autonomy and independence. Independent practices are struggling to keep pace with the capital requirements and skyrocketing practice costs. From 2019 to 2021, more than 108,700 physicians left private practice for employment opportunities, according to the report from Avalere.
"The corporation feeds itself from monopolizing the local markets," Dr. Candido added. "Even where superior outside consultants would better serve patients, the corporation prohibits it. The corporation does not care about patients besides what type of health insurance they may have. There is no attempt to maximize the best options for patients, rather the goal is to maintain exclusive control of the patient's entire health universe…. Physicians sit by and watch all this unfold and are helpless and impotent to address the fundamental flaws in this system, since in the end they have become fearful and have been forced into a dependent role."
4. Burnout
While physician burnout saw a slight decline in 2024, the industry is still experiencing high levels. About 49% of physicians report feeling burned out, according to Medscape's 2024 "Physician Burnout and Depression Report."
"In order to enjoy what you are doing as a physician; you must avoid burnout," Zeeshan Tayeb, MD, owner of Pain Specialists of Cincinnati (Ohio), told Becker's. "This is the most crucial item when considering why physicians do not recommend others to join the field. Building a talented and efficient staff is the key factor to avoid burnout. Surrounding yourself with those who have a shared interest in your success, will help alleviate your personal burden in day-to-day operations. This will also allow you time to diversify into other ventures outside of medicine, should you have hobbies or interests."
An excess of bureaucratic tasks at work, including charting and paperwork, is the leading cause of physician burnout, according to Medscape's 2024 "Physician Burnout and Depression Report." Other causes included too many hours at work and lack of respect.
5. Educational costs
Physicians are also facing rising education costs. Younger physicians in particular are facing higher debts and a more unstable workforce, pushing them towards employment. A total of 85% of physicians 40 and younger work for an employer, according to Medscape's 2023 "Young Physician Compensation Report."
"Multiple reforms are needed, including reduction in educational costs that leave most doctors with over $250,000 of debt," Sam Joseph, MD, orthopedic surgeon at Tampa, Fla.-based Joseph Spine Institute. "With the margins continuing to get smaller, the ability to pay off this debt becomes more taxing on their overall lifestyle."