Becoming a physician requires an enormous amount of time, education, and sacrifice.1-2 Most physicians train for at least 7 years in medical school and residency before practicing independently. Such a commitment makes it difficult for physicians to entertain the possibility that becoming a physician may have been the wrong career decision. That said, it is important for physicians to honestly assess their career choices and to make a change, if needed.
Physicians who question their career choice should know that they are not alone. Since the start of the COVID-19 pandemic, rates of burnout and physician job dissatisfaction have risen significantly.3 Even prior to the pandemic, US physicians were more likely than other US workers to experience work-related stress and burnout.4
According to a survey supported by the American Medical Association (AMA) and published in 2022, 1 in 5 physicians said they were likely to leave their current practice within 2 years.5 This article will explore the factors contributing to this statistic, including the pandemic, that have influenced the decision by physicians to leave medical practice, what occupations they could pursue next, and what can be done to retain the physician workforce.
The Reality of Being a Physician
Although many medical students are motivated by altruism and the desire to help people when they pursue a career in medicine, reality quickly sets in as they progress through training. The reality of practicing medicine presents many challenges beyond the extraordinary responsibility of caring for patients.6
Starting in medical school, physicians take on a burdensome workload. They work grueling hours with on-call responsibilities, have unrealistic time constraints, and are regularly expected to put work responsibilities ahead of their personal needs.6-7 In the United States, insurance company policies and procedures add additional stress by limiting physician autonomy and interfering with the therapeutic physician-patient relationship.8
Coping with this reality is difficult for many physicians. Authors of a large 2017 study in which US physicians were surveyed found a strong relationship between burnout and physician task load.9 Authors of a study published in 2018 found that increased workload was associated with increased distress, sleep issues, and lower workability in more than 2000 surveyed physicians over a 9-year follow-up period.7
The COVID-19 pandemic has exacerbated these issues. In a survey of 2440 US physicians, the overall prevalence of burnout increased from 38.2% in 2020 to 62.8% in 2021.3 The physicians surveyed also reported significantly lower work-life balance satisfaction and professional fulfillment and high levels of emotional exhaustion.
Although the initial stresses of the pandemic have subsided — including the risk of severe infection, lack of vaccines, and inadequate protective equipment — physicians continue to deal with its long-term effects.3,10 These effects include decreased staffing, antiscience beliefs of patients, distrust in the medical system, and worsening social justice issues that affect the health of the country as a whole.
Navigating Career Uncertainty
With the huge burden placed on modern physicians, it should not be surprising that many are experiencing career uncertainty. That said, deciding to leave clinical practice requires careful consideration. Looking for guidance from other physicians who have transitioned out of clinical practice can be helpful.
Dr Kristen Fuller, a family physician who changed careers during the pandemic, shares useful questions to ask oneself before considering a career change11:
- What is motivating the idea to leave medicine? Is your current work environment informing your decision?
- Will you feel that something is missing if you are not able to care for patients?
- Are you dealing with burnout; if so, have you seen a mental health professional to address your mental wellness?
- Have you talked about this decision with family, friends, or mentors?
- Can you afford to leave medicine?
- Do you have a plan for your next career? Is there another role that seems intriguing? Will you feel happier?
If someone’s specific workplace is contributing to their discontent, it may be worth changing employers before quitting. Some options to consider prior to abandoning clinical practice include locum tenens work, changing specialties, or transitioning between inpatient and outpatient work.11
Physicians should also prioritize healing from burnout and other mental or physical illnesses before making a major career change like leaving clinical practice. Addressing these uncertainties and complicating factors first will best prepare physicians to determine the next steps in their careers.
Deciding What to Do Next
After dedicating many years to preparing for clinical practice, physicians who decide to leave may feel like failures. However, changing careers is a brave move and reflects prioritizing your values and needs first. There are also many options for physicians to apply their medical knowledge in nonclinical jobs.12 These include:
- Medical writing
- Medical consulting
- Medical education
- Healthcare administration
- The pharmaceutical and biomedical device industry
- Health IT
- Public health
- Career coaching
Importantly, the jobs listed here vary in compensation and experience required. For example, physicians who leave clinical practice before completing residency may not be qualified to work in certain healthcare administration or medical consulting jobs without a license or board certification.13 That said, many of the jobs listed here can still be explored by physicians who leave practice during residency.
Retaining the Physician Workforce
While physicians who ultimately leave clinical practice should be fully supported in their decision, the medical field must also prioritize retaining physicians, as the consequences of a dwindling physician workforce are dire.14,15
Without adequate physicians and nursing staff, healthcare systems collapse, as they lack the support needed to care for patients safely.5 Research shows that changes at the organizational level are necessary and effective for creating an environment in which both clinicians and patients may thrive.3 Some of the most important interventions for organizations to consider are reviewed in the Table.
Table. Systems-Level Interventions to Improve Physician Retention
|Reduce administrative burden||Years of research have identified administrative burden as a stressor for physicians that can lead to burnout and job dissatisfaction.7,9,16 In response, the ACP developed “Patients Before Paperwork,” a framework for mitigating tasks not directly related to patient care.15 Other organizations may use this framework to make changes to processes within their institution.|
|Create a diverse and inclusive work environment||A diverse workforce in which physicians from different backgrounds feel included promotes faculty retention and better patient care.17,18 Experts emphasize the importance of senior leadership in shaping the culture of their institution and prioritizing diversity.19|
|Improve EHR platforms||In 2019, 5000 surveyed physicians graded current US EHR platforms an F for usability.20 Low usability was also strongly and positively related to physician burnout. Organizations engaged in changing the EHR are prioritizing plan-oriented systems.21 A plan-oriented EHR not only documents health information but also supports physicians in managing patient plans more effectively.|
|Provide professional development and career advancement opportunities||Lack of professional development opportunities is a predictor of physician burnout.22 Physicians are more likely to experience burnout when less than 20% of their time working is spent engaged in meaningful professional activity.23 Conversely, purpose and passion are protective against burnout and promote retention.|
|Support mentorship||Faculty mentorship can reduce alienation and career anxiety experienced by training or junior physicians.24 Mentorship benefits not only the mentee but also the mentor and the institution. Supporting mentees can give mentors a sense of purpose and relieve burnout. Organizations are more likely to retain physician workers when they invest in robust mentorship programs.|
|Improve working conditions||Poor working conditions — including inadequate time and staff, toxic organizational culture, and chaotic work environment — are associated with physician burnout, stress, and a desire to leave clinical practice.25,26 A supportive team environment can protect against these effects.7 Working conditions also have a significant effect on both the quality of care provided by physicians and patient outcomes, which also affect physician job satisfaction and retention.|
|Engage in transparent communication||Physicians who feel aligned with their employer’s values and goals are more likely to be engaged with their work.22 Organizations should communicate their values and goals clearly to facilitate this alignment.|
|Prioritize physician well-being and allow for work flexibility||Physicians are less likely than other US workers to feel content with their work-life balance, thereby increasing burnout risk.22 Wellness programs have historically addressed individual factors, but evidence supports the need for institutional changes to support physician well-being.17 Changes to consider include developing an institutional definition of well-being, transparent decision-making that engages learners, exposure to the arts, and supporting learners to understand what promotes their personal wellness.|
ACP = American College of Physicians; HER = electronic health record.
Prioritizing Your Health
Exacerbated by the COVID-19 pandemic, the physician burnout epidemic has been a global crisis for decades. In 2023, organizations are in a position to make significant changes to address this epidemic and preserve the physician workforce.
Although individual physicians should be involved in these efforts, they must also prioritize their own health and well-being. If clinical work is making them mentally or physically sick or dissatisfied, it is acceptable to consider a career change. Those physicians who decide to leave clinical practice have numerous options available to them, and engaging with family, friends, and mentors for support will help to ensure a smooth career transition.
- Thompson AE. A physician’s education. JAMA. 2014;312(22):2456. doi:10.1001/jama.2014.16394
- Koshy M. Being a doctor: time for a reality check. Quant Imaging Med Surg. 2016;6(2):238-239. doi:10.21037/qims.2016.03.09
- Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002
- Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199
- Henry TA. Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years. American Medical Association. Published January 18, 2022. Accessed July 26, 2023. https://www.ama-assn.org/practice-management/physician-health/medicine-s-great-resignation-1-5-doctors-plan-exit-2-years
- Abid R, Salzman G. Evaluating physician burnout and the need for organizational support. Mo Med. 2021;118(3):185-190.
- Aalto A-M, Heponiemi T, Josefsson K, Arffman M, Elovainio M. Social relationships in physicians’ work moderate relationship between workload and wellbeing—9-year follow-up study. Eur J Public Health. 2018;28(5):798-804. doi:10.1093/eurpub/ckx232
- Brock DW, Buchanan A. Ethical issues in for-profit health care. In: Gray BH, ed. For-Profit Enterprise in Health Care. National Academies Press; 1986.
- Harry E, Sinsky C, Dyrbye LN, et al. Physician task load and the risk of burnout among US physicians in a national survey. Jt Comm J Qual Patient Saf. 2021;47(2):76-85. doi:10.1016/j.jcjq.2020.09.011
- Berg S. Pandemic pushes U.S. doctor burnout to all-time high of 63%. American Medical Association. Published September 15, 2022. Accessed July 26, 2023. https://www.ama-assn.org/practice-management/physician-health/pandemic-pushes-us-doctor-burnout-all-time-high-63
- Fuller K. So you want to quit medicine. MDLinx. Published June 13, 2022. Accessed July 27, 2023. https://www.mdlinx.com/article/so-you-want-to-quit-medicine/n73emH1LdjSurcQD4l1pF
- Darves B. Outside the fold: exploring nonclinical work opportunities for physicians. NEJM Career Center. Published July 1, 2019. Accessed July 27, 2023. https://resources.nejmcareercenter.org/article/outside-the-fold-exploring-nonclinical-work-opportunities-for-physicians/
- Transition toolkit: the instruction manual for doctors considering career change. Non Clinical Doctors. Published July 1, 2022. Accessed July 27, 2023. http://www.nonclinicaldoctors.com/transition-toolkit/read-this-before-you-drop-out-of-medical-residency
- AMA recovery plan for America’s physicians. American Medical Association. Accessed July 27, 2023. https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians
- Patients before paperwork: reducing administrative burdens. American College of Physicians. Published June 2, 2023. Accessed July 30, 2023. https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork-reducing-administrative-burdens?gad=1&gclid=CjwKCAjw8ZKmBhArEiwAspcJ7jNNY6UGKamlkDM0yOmgKbEPNiKm2__op-zJ1whyUMcK_UqjBpNItRoCXqYQAvD_BwE&gclsrc=aw.ds
- Rao SK, Kimball AB, Lehrhoff SR, et al. The impact of administrative burden on academic physicians: results of a hospital-wide physician survey. Acad Med. 2017;92(2):237-243. doi:10.1097/ACM.0000000000001461
- Terregino CA, Byerley J, Henderson DD, et al. Cultivating the physician workforce: recruiting, training, and retaining physicians to meet the needs of the population. Med Teach. 2021;43(sup2):S39-S48. doi:10.1080/0142159x.2021.1935832
- Crites K, Johnson J, Scott N, Shanks A. Increasing diversity in residency training programs. Cureus. 2022;14(6):e25962. doi:10.7759/cureus.25962
- Capers Q. Diversifying the physician workforce — from rhetoric to positive action. N Eng J Med. 2023;388(10):865-867. doi:10.1056/NEJMp2211874
- Melnick ER, Dyrbye LN, Sinsky CA, et al. The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clin Proc. 2020;95(3):476-487. doi:10.1016/j.mayocp.2019.09.024
- Glaser J. It’s time for a new kind of electronic health record. Harvard Business Review. Published June 12, 2020. Accessed July 27, 2023. https://hbr.org/2020/06/its-time-for-a-new-kind-of-electronic-health-record
- Berg S. Magnificent 7: these are the keys to boosting physician well-being. American Medical Association. Published January 28, 2020. Accessed July 30, 2023. https://www.ama-assn.org/practice-management/physician-health/magnificent-7-these-are-keys-boosting-physician-well-being
- Shanafelt TD, West CP, Sinsky C, et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94(9)1681-1694. doi:10.1016/j.mayocp.2018.10.023
- Fishman JA. Mentorship in academic medicine: competitive advantage while reducing burnout? Health Sci Rev. 2021;1:100004. doi:10.1016/j.hsr.2021.100004
- Linzer M. Improving working conditions reduces physician burnout. Agency for Healthcare Research and Quality. Published 2017. Accessed July 27, 2023. https://www.ahrq.gov/funding/grantee-profiles/grtprofile-linzer.html
- Greco J. Improving working conditions for better patient care. Cornell Chronicle. Published December 10, 2021. Accessed July 27, 2023. https://news.cornell.edu/stories/2021/12/improving-working-conditions-better-patient-care-0