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LetterCorrespondence

Response: Re: Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network

Leah Colucci, Ryan O’Connel and Edward R. Melnick
The Journal of the American Board of Family Medicine May 2024, 37 (3) 515-516; DOI: https://doi.org/10.3122/jabfm.2024.240176R0
Leah Colucci
From the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (LC, ERM), Yale University, New Haven, CT (ROC), Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT (ERM)
MD
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Ryan O’Connel
From the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (LC, ERM), Yale University, New Haven, CT (ROC), Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT (ERM)
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Edward R. Melnick
From the Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (LC, ERM), Yale University, New Haven, CT (ROC), Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, CT (ERM)
MD, MHS
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To the Editor: We appreciate the letter1 from Muir and colleagues on our qualitative analysis2 of physician departure from a large, multispecialty ambulatory practice network.

A criticism raised was the lack of detail on possible interventions, suggesting that interventions seeking to mitigate physician attrition should try to increase a sense of belonging. Camargo3 has proposed that “retention efforts should always follow recruitment strategies” and specifically mentioned efforts like sponsorship and mentorship in the workplace. A survey study of 366 women health care professionals performed by Schaechter4 and colleagues found that greater workplace belonging was associated with lower likelihood of attrition (OR 0.68, CI 0.63 to 0.74; P < .0001). Survey respondents further expressed the importance of open communication and empowering professional thriving.

Muir1 et al emphasized the strength of our analysis only including physicians who had already left the practice, indicating that our findings reveal factors that actually contributed to attrition, not just factors related to physician dissatisfaction. In future studies, we plan to examine factors associated with physician attrition in specialties with significantly higher burnout rates, like emergency medicine.

Emergency medicine was found to have one of the highest female attrition rates at 8.6% in a study done by Gettel5 et al. These women on average left the specialty 12 years earlier than their male counterparts. Identifying factors that are contributing to attrition in this high risk population could have important implications to improve retention efforts more broadly. According to Schaechter4 and colleagues, women have reported their sense of belonging is impacted by slowed career progression and suboptimal family-friendly policies. Future research could examine local policies in hospitals or emergency departments with higher retention rates of their female physicians. These policies could then be disseminated and implemented more widely to increase the retention of a valuable and diverse portion of the physician workforce.

Overall, attrition and retention in medicine is an area that must continue to be studied and acted on to create a healthier generation of physicians. In a study done by Vogel6, an increase of 10 primary care doctors per 100,000 people in the US increased patients' life expectancy by almost 52 days. Increasing physician retention could, therefore, improve population health and life expectancy. Moreover, a retrospective observational study of 776,927 Medicare fee-for-service beneficiaries hospitalized during 2016 to 2019 performed by Miyawaki7 and colleagues found a lower mortality and readmission rate in patients treated by female physicians. This furthers the need to improve not just physician retention but increased focus on female physician retention.

We look forward to the opportunity to investigate such an important topic.

Notes

  • To see this article online, please go to: http://jabfm.org/content/37/3/515.full.

References

  1. 1.↵
    1. Muir R,
    2. Feld L,
    3. Verduzco-Gutierrez M
    . Letter to the Editor on “Why do physicians depart their practice? A qualitative study of attrition in a multispecialty ambulatory practice network”. J Am Board Fam Med 2024:37:514.
    OpenUrlFREE Full Text
  2. 2.↵
    1. O'Connell R,
    2. Hosain F,
    3. Colucci L,
    4. Nath B,
    5. Melnick ER
    . Why do physicians depart their practice? A qualitative study of attrition in a multispecialty ambulatory practice network. J Am Board Fam Med 2024;36:1050–7.
    OpenUrl
  3. 3.↵
    1. Camargo A
    . Developing strategies to improve the sense of belonging and mitigate tokenism. Clin Imaging 2023;103:109987. Epub 2023 Sep 21.
    OpenUrl
  4. 4.↵
    1. Schaechter JD,
    2. Goldstein R,
    3. Zafonte RD,
    4. Silver JK
    . Workplace belonging of women healthcare professionals relates to likelihood of leaving. J Healthc Leadersh 2023;15:273–84.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Gettel CJ,
    2. Courtney DM,
    3. Agrawal P,
    4. et al
    . Emergency medicine physician workforce attrition differences by age and gender. Acad Emerg Med 2023;30:1092–100.
    OpenUrl
  6. 6.↵
    1. Vogel L
    . Life expectancy grows with supply of primary care doctors. CMAJ 2019;191:E347.
    OpenUrlFREE Full Text
  7. 7.↵
    1. Atsushi MAB,
    2. Jena LS,
    3. Rotenstein ,
    4. et al
    . Comparison of hospital mortality and readmission rates by physician and patient sex. Ann Intern Med. [Epub 23 April 2024].
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The Journal of the American Board of Family   Medicine: 37 (3)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 3
May-June 2024
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Response: Re: Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network
Leah Colucci, Ryan O’Connel, Edward R. Melnick
The Journal of the American Board of Family Medicine May 2024, 37 (3) 515-516; DOI: 10.3122/jabfm.2024.240176R0

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Response: Re: Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network
Leah Colucci, Ryan O’Connel, Edward R. Melnick
The Journal of the American Board of Family Medicine May 2024, 37 (3) 515-516; DOI: 10.3122/jabfm.2024.240176R0
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