Doctor drain: Women physicians are bailing out of health care

Female physicians are significantly more likely to leave clinical practice at younger ages than their male counterparts, according to results of a new national study.

Researchers used Medicare administrative data from 2013 to 2023 to track more than 707,934 physicians across specialties and practice locations, according to “Sex Differences in Physician Attrition From Clinical Practice Across Specialties: A Nationwide, Longitudinal Analysis,” published in the Journal of General Internal Medicine.

Earlier research has established that female physicians may provide better clinical care while facing greater workplace demands but earning less money than male doctors. The new study aimed to identify the rates at which women and men physicians end up leaving the workforce as the nation deals with a physician shortage that will get worse before it gets better.

The conclusion: “U.S. female physicians are significantly more likely to leave clinical practice than male counterparts at every age, across specialties and practice locations. Among physicians who leave clinical practice, female physicians are younger when they do so,” the study authors wrote.

A workforce problem that could compound

In the study group, female physicians accounted for 30.7% of the study sample, or 217,013 of the 707,934 physicians tracked. After adjusting for specialty, location and years of postgraduate training, female physicians were 43% more likely to leave clinical practice than male physicians at any given age, according to the study's hazard ratio analysis.

Among those who left clinical practice during the study period, the median age of departure was 49 for women, compared with 64 for men. That difference held across both rural and urban settings and across every specialty category examined.

The implications are significant: A physician leaving at age 49 rather than 64 represents roughly 15 additional years of clinical contribution that the health care system does not receive. The researchers noted the United States is already projected to face a shortage of 36,500 physicians by 2036, driven in part by rising rates of physicians leaving practice. From 2010 to 2018, the share of physicians who stopped practicing nearly doubled, from 1.7% to 3.1%. A 2022 nationwide survey found that more than one in four physicians said they were likely or would definitely leave their practice within two years, up from roughly one in six in 2011.

Differences across specialties

The study examined six broad specialty categories: primary care, medical specialty, surgical specialty, obstetrics and gynecology, hospital-based specialty, and psychiatry. Female physicians had higher attrition hazards than male physicians across all categories, but the gaps varied considerably by specialty.

The greatest disparity was found in psychiatry, where female physicians were 72% more likely to leave clinical practice than their male counterparts. Primary care followed, with female physicians 55% more likely to leave than male primary care physicians.

By contrast, the smallest gap was observed in hospital-based specialties, where female physicians were 26% more likely to leave than male physicians; it was the narrowest of any category studied.

The authors noted that certain specialties, including dermatology, endocrinology and infectious diseases, showed more comparable attrition rates between the sexes, and suggested those fields may offer clues about what structural or cultural factors help retain female physicians.

Rural and urban differences

The higher likelihood of female physician departure held in both rural and urban settings. The interaction between sex and location was not statistically significant, indicating that geography did not meaningfully alter the size of the gender gap in attrition risk. Overall, rural physicians of both sexes left clinical practice at higher rates than their urban peers.

What drives it — and what might help

The authors point to a documented accumulation of workplace disadvantages facing female physicians: longer time spent on electronic health record documentation, more patient messages, lower earnings, a higher burden of burnout, and experiences of mistreatment and discrimination. Female physicians also report greater work-life conflict and less schedule control than their male colleagues.

Addressing these factors, the researchers argue, requires both cultural change within health systems and structural reforms to how physicians are paid. Payment models that reward time and thoroughness, rather than volume, could better reflect and incentivize the care patterns more common among female physicians, the authors suggest, and in turn improve patient outcomes that research has associated with female physician care.

Study limitations

The authors acknowledged several constraints on their findings. Because the study tracked physician activity through Medicare fee-for-service claims, it may not fully capture the complete practice activity of all physicians. The study did not include physicians who care primarily for non-Medicare patients, such as pediatricians. Similarly, a small number of physicians who accept only private payment or who transitioned to concierge medicine were be reflected in the data.

The study also required that physicians perform at least 50 evaluation and management services in a given year to be considered actively practicing. That threshold is consistent with prior workforce research, but the cutoff means some physicians who practice at lower volumes may have been counted as having left clinical practice earlier than they actually did.

As for the study's timeframe, the researchers required three consecutive years of data to confirm a permanent departure from practice. Physicians who left after 2017 could not be captured, so the study excluded the COVID-19 pandemic period from the attrition analysis. Other research has suggested that physician attrition accelerated meaningfully during and after the pandemic, so the study may have underestimated the disparities between male and female physicians.