The medical care workforce pipeline is leaking

The medical care people pipeline stretches back to high school. Students' intent on a career in medicine or other health professions and their parents understand applicants face stiff competition, so building their CVs, career experiences, credentials and resumes begins, unfortunately, early in life at the expense, sometimes, of just spending time being a kid.

Because of high costs, some high school graduates have opted to delay, drop out of or forgo attending college altogether to avoid student debt that could hang over them for decades.

But that is just the beginning. At the end of medical school, graduates are making some important choices that have immediate impact on the patients they will treat: What should I practice? Where should I practice? How should I practice?

After completing specialty training, the "how ' question comes down to three basic models: Independent, private practice v academic practice v non-academic employed practice. A recent survey indicates that independents are pessimistic but willing to pay the price. In the meantime, more graduates are electing to be non-academic employed physicians.

Patients should pay attention to how this will evolve, since access, quality and cost of care depends, in part, on the mix of physician practice business models. For example, independent physicians need to be more entrepreneurial to thrive and can offer innovative, less costly care. Some argue that the rise in employed doctors is another reason costs are going up, not down, because of market consolidation and negotiating power with payers. In addition, part-time doctors, job sharing and other subsegmentation in the continuity of care affects patients directly.

The doctor pipeline is leaking as medical students drop out or choose not to do a residency, clinical careers don't last as long as they used to and doctors are choosing non-clinical roles that replace or supplement their clinical activities. There is a crisis of commitment to the "calling". For many doctors, it has become just a job with little job security.

If you’re unhappy at work, you already know that feeling can grow rapidly for a variety of reasons. In the current economic climate where job stability feels uncertain, professionals who had previously been disengaged from work may be rethinking their short-term objectives. If you want to keep your job or stay on track until you can take the next step on your own terms, here’s how to shift your approach and intentions to embrace the role you currently have.

Why US boys are failing at school.

The vanishing American man.

Women are changing the face of medicine

The growth in the total physician workforce — from 730,654 in 2004 to 989,320 in 2022 — reflects the increasing presence of women physicians.

• From 2004 to 2022, the number of women in the active physician workforce increased 97%, while the number of men increased 13%.
• Women accounted for 38% of active physicians in 2022 (a total of 371,851), an increase from 26% (a total of 188,926) in 2004.
• Men accounted for 62% of active physicians in 2022 (a total of 613,974), a decrease from 74% (a total of 541,285) in 2004.

If over half of US medical students are women, why are only slightly over a third of US active clinicians women. Why the quit rate?

Several factors contribute to why female doctors tend to leave medical practice at higher rates than men, and these factors are often a combination of personal, social, and systemic issues. Here are some of the most prominent reasons:

1. Work-Life Balance and Family Responsibilities

• Caregiving roles: Female doctors often bear a disproportionate share of family responsibilities, including child-rearing and elder care. This can make the long and unpredictable hours associated with medical practice more difficult to manage.
• Part-time work preferences: Some female doctors opt for part-time positions or less demanding specialties to balance family responsibilities, which may lead to a perception that they are less committed to their careers, sometimes resulting in less career support or advancement.

2. Burnout and Job Satisfaction

• Burnout: Studies show that women in medicine report higher rates of burnout, driven by the emotional strain of balancing professional demands with personal obligations, workplace discrimination, or feeling undervalued.
• Job satisfaction: Female physicians may experience lower job satisfaction due to workplace culture, lack of autonomy, or fewer leadership opportunities compared to their male counterparts.

3. Gender Discrimination and Bias

• Workplace culture: Women in medicine often face implicit bias and systemic gender discrimination, which can make their work environment less supportive. This includes fewer opportunities for promotion, mentorship, or leadership roles, as well as disparities in salary.
• Microaggressions and harassment: Many women in medicine report facing gender-based harassment or microaggressions, contributing to an unwelcoming work environment that pushes them to leave.

4. Specialty Selection

• Specialty preference: Female doctors are more likely to enter primary care or less procedural specialties (e.g., pediatrics, family medicine) that tend to offer more predictable hours, which can sometimes lead to lower financial compensation and less institutional support, compared to male doctors who more often enter higher-paying procedural specialties (e.g., surgery, cardiology).
• Workload intensity: Some specialties require long, grueling hours, and women in these fields may find it difficult to cope with the demands, especially if they have caregiving responsibilities.

5. Lack of Support Systems

• Mentorship: Female doctors often report a lack of mentorship and role models in leadership positions, which can make it harder for them to advance in their careers or feel supported in navigating professional challenges.
• Supportive policies: Lack of institutional support, such as inadequate parental leave, childcare options, or flexible work arrangements, can contribute to female doctors leaving practice or reducing their hours.

6. Financial and Career Considerations

• Pay disparities: Female doctors are often paid less than their male colleagues, even after accounting for specialty, hours worked, and experience. This wage gap can contribute to job dissatisfaction.
• Slower career progression: Due to bias, family leave, or part-time work, many women find that their career advancement is slower than that of their male counterparts. This lack of progression may prompt some to leave medicine or seek alternative career paths.

7. Personal Health and Well-Being

• Health concerns: The physical and emotional demands of medical practice, particularly in high-stress environments, may take a toll on female physicians’ mental and physical health, leading to early retirement or career changes.

All of these factors can intersect and compound, resulting in higher attrition rates among female physicians. Addressing these challenges requires systemic changes, such as better support for work-life balance, addressing gender discrimination, and fostering a more inclusive, supportive workplace environment.

How can we plug the leaks?

1. Prevention: It's been demonstrated that burnout prevention interventions work best when there are personal and organizational tools brought to bear. However, the outcomes fatigue so it takes ongoing vigilance and monitoring. Changing the warrior mentality of medical workers would also help but that means changing the culture of medical education and training. Researchers have identified three types of burnout:?overload, under-challenged, and neglect — and provides readers with signs to watch out for, and tips on how to overcome each type.

We also need to give medical students and residents an adequate job preview and the KSAs and the hidden curriculum they will not learn during their formal training to insure Physician Information about career Success and Satisfaction.

2. Innovative ways to detect and treat burnout. Some have hired in-house corporate chaplains or counselors , use behavioral health apps or telepsychiatry. A new AI tool from Washington University in St. Louis researchers aims to help identify burnout among physicians and could potentially prevent it in the future.

3. Surveillance. Self-reporting does not work. Snitching does not work either. We need better ways to keep track of who is in trouble or likely to be and a way to measure the burnout impact factor of organizations.

4. Stewardship. Stop piling on administrivia, rules, regulations, red tape and bad bosses who simply get between the patient and their doctors and add little or no value to patients.

5. Better job previews

6. Exit ramps

7. Premedical student-medical student-graduate medical education mentoring

8. Medical education and training curriculum reform

9. Reducing the corporatized and technology burnout impact factors

10. Cut the real and opportunity costs of becoming a doctor

Sick care affects every American citizen in one way or another. While the focus has been on who pays for expanded access via Obamacare, the sideshow few are paying attention to is how doctors are choosing how to practice. Their decisions will determine whether you can get access to quality care at an affordable price when you need or want it.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack