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The double whammy of pandemic burnout and the aging of baby boomer physicians has, indeed, the makings of some scary headlines. A recent survey by Elsevier Health predicts that up to 75% of healthcare workers will leave the profession by 2025. And a 2020 study conducted by the Association of American Medical Colleges (AAMC) projected a shortfall of up to 139,000 physicians by 2033.
“We’ve paid a lot of attention to physician retirement,” says Michael Dill, AAMC’s director of workforce studies. “It’s a significant concern in terms of whether we have an adequate supply of physicians in the US to meet our nation’s medical care needs. Anyone who thinks otherwise is incorrect.”
To Dill, it’s the number of older physicians — in all specialties — ready to retire that should be the biggest concern for hospitals all across the country.
“The physician workforce as a whole is aging,” he says. “Close to a quarter of the physicians in the US are 65 and over. So, you don’t need any extraordinary events driving retirement in order for retirement to be a real phenomenon of which we should all be concerned.”
And, although Dill says there aren’t any data to suggest that doctors in rural or urban areas are retiring faster than in the suburbs, that doesn’t mean retirement will have the same impact depending on where patients live.
“If you live in a rural area with one small practice in town and that physician retires, there goes the entirety of the physician supply,” he says. “In a major metro area, that’s not as big a deal.”
Why Younger Doctors Are Fast-Tracking Retirement
Fernando Mendoza, MD, 54, a pediatric emergency department physician in Miami, worries that physicians are getting so bogged down by paperwork that this may lead to even more doctors, at younger ages, leaving the profession.
“I love taking care of kids, but there’s going to be a cost to doing your work when you’re spending as much time as we need to spend on charts, pharmacy requests, and making sure all of the Medicare and Medicaid compliance issues are worked out.”
These stressors may compel some younger doctors to consider carving out a second career or fast-track younger physicians toward retirement.
“A medical degree carries a lot of weight, which helps when pivoting,” says Mendoza, who launched Scrivas, a Miami-based medical scribe agency, to help reduce the paperwork workload for physicians. “It might be that a doctor wants to get involved in the acquisition of medical equipment, or maybe they can focus on their investments. Either way, by leaving medicine, they’re not dealing with the hassle and churn-and-burn of seeing patients.”
What This Means for Patients
The time is now to stem the upcoming tide of retirement, says Dill. But the challenges remain daunting. For starters, the country needs more physicians trained now — but it will take years to replace those baby boomer doctors ready to hang up their white coats.
The medical profession also needs to find ways to support physicians who spend their days juggling an endless array of responsibilities, he says.
The AAMC study found that patients already feel the physician shortfall. Their public opinion research in 2019 said 35% of patients had trouble finding a physician over the past two or three years, up 10 percentage points since they asked the question in 2015.
Moreover, according to the report, the over-65 population is expected to grow by 45.1%, leaving a specialty care gap because older people generally have more complicated health cases that require specialists. In addition, physician burnout may lead more physicians under 65 to retire much earlier than expected.
Changes in how medicine is practiced, telemedicine care, and medical education — such as disruption of classes or clinical rotations, regulatory changes, and a lack of interest in certain specialties — could also be affected by a mass physician retirement.
What Can We Do About Mass Retirement?
The AAMC reports in “The Complexities of Physician Supply and Demand: Projections From 2019 to 2034” that federally funded GME support is in the works to train 15,000 physicians per year, with 3000 new residency slots added per year over 5 years. The proposed model will add 3750 new physicians each year beginning in 2026.
Other efforts include increasing use of APRNs and PAs, whose population is estimated to more than double by 2034, improve population health through preventive care, increase equity in health outcomes, and improve access and affordable care.
Removing licensing barriers for immigrant doctors can also help alleviate the shortage.
“We need to find better ways to leverage the entirety of the healthcare team so that not as much falls on physicians,” Dill says. “It’s also imperative that we focus on ways to support physician wellness and allow physicians to remain active in the field, but at a reduced rate.”
That’s precisely what Marie Brown, MD, director of practice redesign at the American Medical Association, is seeing nationwide. Cutting back their hours is not only trending, but it’s also helping doctors cope with burnout.
“We’re seeing physicians take a 20% or more cut in salary in order to decrease their burden,” she says. “They’ll spend 4 days on clinical time with patients so that on that fifth ‘day off,’ they’re doing the paperwork and documentation they need to do so they don’t compromise care on the other 4 days of the week.”
And this may only be a Band-Aid solution, she fears.
“If a physician is spending 3 hours a day doing unnecessary work that could be done by another team member, that’s contributing to burnout,” Brown says. “It’s no surprise that they’ll want to escape and retire if they’re in a financial situation to do so.”
“I advocate negotiating within your organization so you’re doing more of what you like, such as mentoring or running a residency, and less of what you don’t, while cutting back from full-time to something less than full-time while maintaining benefits,” says Joel Greenwald, MD, a certified financial planner in Minneapolis, who specializes in helping physicians manage their financial affairs.
Greenwald says that falling into the “like less” bucket are usually things like working weekends and being on call.
“This benefits everyone on a large scale because those doctors who find things they enjoy are generally working to a later age but working less hard,” he says. “Remaining comfortably and happily gainfully employed for a longer period, even if you’re not working full-time, has a very powerful effect on your financial planning, and you’ll avoid the risk of running out of money.”