Burnout and other causes of physician attrition: A qualitative study of physicians leaving direct patient care.

Abstract

e21002 Background: The rising rate of physician turnover poses a crisis for both public health and individual patients, including over 18 million cancer survivors in the U.S. The American Medical Association (AMA) estimates 20% of physicians plan to scale down their clinical care or leave clinical medicine in the next two years, which will have a significant impact across the cancer care continuum. Despite the passion for patient care and the investment in medical education, burnout and moral injury are prevalent among physicians. This study qualitatively investigates these and other contributors to decisions to leave patient care across various specialties and explores potential solutions. Methods: Participants were eligible if they 1) had a degree that allows for clinical practice in the U.S. (MD, DO, MBBS); 2) had plans to leave direct patient care in the next two years or had left direct patient care within the last 2 years. Participants were recruited from July 1, 2023- August 1, 2024, using convenience and snowball sampling, and completed surveys on demographics and practice status. Eligible subjects were invited to participate in a semi-structured interview exploring their experiences with practicing medicine and reasons for leaving clinical practice. Those who agreed to the interview provided informed consent and audio recordings were transcribed verbatim. Consistent with the grounded theory, the research team coded the interviews until thematic saturation was reached. This study was conducted through the University of Rochester Medical Center and approved by its ethics review board. Results: A total of 114 eligible participants completed surveys; 35 were interviewed. Most of the interviewed participants (74 %) were between 41-60 years of age and 68.6% were female. Of those interviewed, 54% were from medical specialties, 31% from surgical specialties, and 29% from primary care. 51% worked in outpatient settings, 46% at academic institutions, and 32% had 10 years or less in practice. Themes on causes of attrition focused on burnout brought on by dysphoria, institutional/systemic demands often resulting in moral injury, and lack of support from administration and leadership. A theme centered on the influence of these insults on mental health and the decision to leave direct patient care also emerged. Solutions offered by participants focused on increasing autonomy and support. Conclusions: Burnout is central to physician attrition but reflects broader systemic challenges, and the causes of burnout and other contributors to physician attrition from the workforce is a complex experience, as conveyed by our participants in this important investigation of how physicians come to the momentous decision to leave direct patient care. These data underscore the importance of bringing systemic change to our healthcare system.