Author is an advisor to Clinician Nexus
Are physicians satisfied in their jobs? Recent studies suggest the answer for many is likely ‘no’ as around 53% of physicians reported experiencing burnout in 2023. This represents a sharp increase from the 41% seen at the start of the COVID-19 pandemic. Furthermore, in 2022, nearly 1 in 5 physicians reported that they intended to leave their practices within a few years. These sobering statistics have led people to call this the ‘Great Clinical Resignation’, and it has left many health care organizations wondering how they can better retain physicians.
Improving retention starts with understanding physician burnout
If nearly half of physicians are reporting burnout and many are planning to leave medicine, we must identify the causes of the problem in order to implement effective retention strategies.
There are several reasons cited for physician burnout, including staffing issues, financial burdens, feeling undervalued, and more:
- Many physicians feel that patients have developed unrealistic demands. Issues may arise when a patient wants something – such as an MRI, pain medications, etc. – but their doctor does not recommend it. Patients can leave poor reviews, complain to the practice administrator, or post about their experience on social media – all of which may result in undue stress on the physician. This leaves many feeling emotionally and physically drained when they feel they can no longer meet patient expectations.
- Lack of work-life balance. Physicians have always worked longer hours than most professionals due in part to a demanding training schedule and call responsibilities. While most physicians understand these expectations when they enter into this field, many do not anticipate the ever-increasing administrative burden that takes time away from their families and personal lives. In 2023, physicians reported spending an average of 14.1 hours on indirect patient care (e.g., EMR messages, patient phone calls) and 7.9 hours on administrative tasks per week. This time is not billable and is spent during nights and weekends.
- Reimbursement continues to decline for physicians – particularly with Medicare. Physician practices cannot simply hire more staff to help offset the amount of time spent on the indirect patient care and administrative tasks mentioned earlier. On top of this, costs continue to increase and physicians are faced with a dilemma. They must see more patients to keep up with the overhead, but then worry about whether the quality of care will decline as a result. As a doctor myself, I know this goes against our training and the Hippocratic Oath we all took upon graduation from medical school. For many, this ethical dilemma is reason enough to leave their practices.
- Physicians are being consolidated as a commodity. As private equity intervenes with the hopes of making practices more efficient, this often results in physicians being told to see more patients. More than 108,700 physicians reported moving away from private practice to employed physician opportunities between 2019 to 2021. Would most physicians choose to remain autonomous if there were not the added financial pressures? Personally, as a physician who retired from my practice a decade early, I became burned out and no longer enjoyed practicing medicine as the financial burden of practice grew too large.
- The increasing cost of medical school is outpacing salaries. The class of 2021 had an average medical school debt of $194,280 among students attending public schools and $218,746 among students attending private institutions. Additionally, 14% of students at public schools and 27% of students at private institutions said they had a combined premedical and medical school debt of more than $300,000. These loans are deferred until after post-graduate training is completed, but the average stipend for a resident the first year after medical school is only $57,863.
What can employers do to reduce burnout and improve physician retention?
Strategies to help physicians practice more efficiently while also reducing their administrative workload should be prioritized:
- Employers should consider a care team approach. Pairing a physician with a nurse practitioner (NP) or a physician assistant (PA) to help with patient care coordination and pre-op and post-op visits can alleviate some of this burden. These visits are not billable for the physician and are predictable enough to be easily managed by other clinicians. A pre-operative visit runs fairly standard across the board with tried-and-true talking points. The first post-operative visit is similar. This allows the NP or PA to take on some of the more routine patient care tasks and frees up the physician to focus on building stronger relationships with patients while guiding them through important decisions regarding their health and future care.
- Look to artificial intelligence (AI) and machine learning. This can also help to reveal ways to improve efficiency and reduce workload – especially with mundane administrative tasks. For instance, virtual AI can transcribe clinic visits and leave less for the physician to document. Utilizing AI to fill out FMLA, Return to Work, and Disability forms or to assist with prior authorizations for prescriptions, procedures, and surgeries could also be helpful. Further, physicians could experiment with AI scheduling tools to make day-to-day operations more efficient or have chatbots assist with answering commonly asked questions. All of these things can help reduce overhead for physicians.
- Focus on physician wellness and work-life balance. As physician preferences and work expectation shifts, it is important for employers to be flexible. Considering an alternative work schedule may help. For instance, a schedule of 4.5 days per week with one Saturday per month allows one afternoon off weekly to attend to personal or family obligations. A standard work week of four days per week (with a commensurate decrease in salary) may also be attractive to physicians looking for part-time options.
- Value a physician’s time off and away from the office. This requires placing the end-of-day or after-hours calls with the on-call physician and respecting the time of physicians who are not on call. Receiving messages at night or on the weekends – even with simple questions – is disruptive to personal and family time and creates the expectation to always be working. This concept of working hard while you are on call and covering other physicians’ patients is not new, but it should be enforced in order for physicians to truly have time off to rest, relax, and reset.
- Assist with student loan repayment. While employers cannot fix the ongoing decreases in Medicare reimbursement, they can help in other ways. Debt from student loans is always looming and can feel insurmountable. Employment contracts could include loan assistance, starting in the second or third year, where a portion of the loans could be paid monthly until the loan is paid off. This should include stipulations, however. For example, if a physician chooses to leave the organization before a certain number of years, all student loan assistance must be paid back to the employer.
Considering some of these strategies can help support physician retention, and it can certainly help elevate each physician’s work-life balance, financial stability, and overall level of happiness.