Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. In this retrospective Medicare data review, the rate of standard physician turnover increased from 5.3% to 7.2% between 2010 and 2014.

2. There was no significant increase in physician turnover during the coronavirus disease 2019 (COVID-19) pandemic captured within this study.

Evidence Rating Level: 2 (Good)

Study Rundown:

Over the past decade, rates of physician turnover rates in the United States have been a salient point of discussion within healthcare policy, particularly in the context of the COVID-19 pandemic. Although there are many reasons for physicians to retire or change the location of their practice, a consistently rising rate of physician turnover may be a proxy of systemic concerns such as a growing sense of dissatisfaction or an increasing sense of burnout within the profession. This study utilized a novel study design of collating data from Medicare billing patterns to capture the pattern of physician turnover in the United States over the past decade and identify whether there are any statistically significant associations between characteristics of groups that may have higher rates of turnover. Results of the study found that although there was an increase in the rate of annual turnover between 2010 and 2014. This rate stabilized through 2017 and has remained relatively constant since, with only very minor increases. A strength of this study is serving as “proof of concept” for this novel method of systemic turnover surveillance. However, Medicare billing cannot comprehensively capture all physician activities, particularly those specialties or practices which do not rely heavily on traditional Medicare billing structures. A key limitation of this study is the ascertainment measure of outcome through Medicare and generalizability to excluded groups.

In-Depth [retrospective study]:

This study was a retrospective review of Medicare Data on Provider Practice and Specialty (MD-PPAS) over 11 years to evaluate whether the rate of physician turnover has changed between 2009 and 2022 within the United States. The primary outcome was the ascertainment of physician turnover rates with a comparison of the rates throughout the study time period. Additional outcomes of interest included reasons for turnover where data was available, and differences in physician turnover rate when stratified by sex, location of practice, specialty, and characteristics of the patient population that they care for. Physicians who were known to not typically bill traditional Medicare based on the specialty of practice, those who billed a significant portion of their practice to service lines not easily represented by MD-PPAS data, and early-career physicians were excluded. After the application of the inclusion and exclusion criteria, the standardized annual turnover rate of physicians from 2010 to 2020 was determined. Primary results of the analysis found that the annual physician turnover rate rose from 5.3% to 7.2% between 2010 and 2014, plateauing through to 2017, and then rising slightly to 7.6% in 2018. The majority of the increase in turnover rate from 2010 and 2014 could be accounted for by physicians who retired from practice, as well as those who changed geographical locations of practice. Physician turnover rate differed significantly between sex, location of practice, specialty, and characteristics of the patient population that they care for. Overall, this study provided an overview of physician turnover over the past decade, demonstrating that rates fluctuate through periods of rapid turnover and periods of stability.

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