The number of physicians who have chosen early retirement or have left medicine because of the COVID-19 pandemic may be considerably lower than previously thought, results of a new study suggest.
The research letter in the Journal of the American Medical Association, based on Medicare claims data, stated that "practice interruption rates were similar before and during the COVID-19 pandemic, except for a spike in April 2020."
By contrast, in a Physicians Foundation Survey conducted in August 2020, 8% of physicians said they had closed their practices as a result of COVID, and 4% of the respondents said they planned to leave their practices within the next 12 months.
Similarly, a Jackson Physician Search survey in the fourth quarter of 2020 found that 54% of physicians surveyed had changed their employment plans. Of those doctors, 21% said they might hang up their white coat for early retirement. That works out to about 11% of the respondents.
The JAMA study's authors analyzed the Medicare claims data from January 1, 2019 to December 30, 2020 to see how many physicians with Medicare patients had stopped filing claims for a period during those 2 years.
If a doctor had ceased submitting claims and then resumed filing them within 6 months after the last billing month, the lapse in filing was defined as "interruption with return." If a physician stopped filing claims to Medicare and did not resume within 6 months, the gap in filing was called "interruption without return."
In April 2020, 6.9% of physicians billing Medicare had a practice interruption, compared to 1.4% in 2019. But only 1.1% of physicians stopped practice in April 2020 and did not return, compared with 0.33% in 2019.
Older physicians (55 or older) had higher rates of interruption both with and without return than younger doctors did. The change in interruption rates for older doctors was 7.2% vs. 3.9% for younger physicians. The change in older physicians' interruption-without-return rate was 1.3% vs. 0.34% for younger colleagues.
"Female physicians, specialists, physicians in smaller practices, those not in a health professional shortage area, and those practicing in a metropolitan area experienced greater increases in practice interruption rates in April 2020 vs April 2019," the study states. "But those groups typically had higher rates of return, so the overall changes in practice interruptions without return were similar across characteristics other than age."
Significance for Retirement Rate
Discussing these results, the authors stressed that practice interruptions without return can't necessarily be attributed to retirement, and that practice interruptions with return don't necessarily signify that doctors had been furloughed from their practices.
Also, they said, "this measure of practice interruption likely misses meaningful interruptions that lasted for less than a month or did not involve complete cessation in treating Medicare patients."
Nevertheless, "the study does capture a signal of some doctors probably retiring," Jonathan Weiner, DPH, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, told Medscape Medical News.
But he added, "Some of those people who interrupted their practices and didn't return may still come back. And there are probably a lot of other doctors who are leaving or changing practices that they didn't capture." For example, it's possible that some doctors who went to work for other healthcare organizations stopped billing under their own names.
In Weiner's view, the true percentage of physicians who have retired since the start of the pandemic is probably somewhere between the portion of doctors who interrupted their practice without return, according to the JAMA study, and the percentage of physicians who said they had closed their practices in the Physicians Foundation survey.
No Mass Exodus Seen
Michael Belkin, JD, divisional vice president of recruiting for Merritt Hawkins, a physician search firm, told Medscape Medical News that the real number may be closer to the interruption-without-return figure in the JAMA study.
While many physician practices were disrupted in spring of 2020, he said, "it really didn't result in a mass exodus [from healthcare]. We're not talking to a lot of candidates who retired or walked away from their practices. We are talking to candidates who slowed down last year and then realized that they wanted to get back into medicine. And now they're actively looking."
One change in job candidates' attitude, Belkin said, is that, because of COVID-related burnout, their quality of life is more important to them.
"They want to know, 'What's the culture of the employer like? What did they do last year during COVID? How did they handle it? Have they put together any protocols for the next pandemic?' "
Demand for Doctors Has Returned
In the summer of 2020, there was a major drop in physician recruitment by hospitals and health systems, partly because of fewer patient visits and procedures. But demand for doctors has bounced back over the past year, Belkin noted. One reason is the pent-up need for care among patients who avoided healthcare providers in 2020.
Another reason is that some employed doctors — particularly older physicians — have slowed down. Many doctors prefer to work remotely 1 or 2 days a week, providing telehealth visits to patients. That has led to a loss of productivity in many healthcare organizations and, consequently, a need to hire additional physicians.
Nevertheless, not many doctors are heading for the exit earlier than physicians did before COVID.
"They may work reduced hours," Belkin said. "But the sense from a physician's perspective is that this is all they know. For them to walk away from their life in medicine, from who they are, is problematic. So they're continuing to practice, but at a reduced capacity."