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

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.