American Primary Care Physicians’ Decisions to Leave Their Practice: Evidence from the 2009 Commonwealth Fund Survey of Primary Care Doctors

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The Issue

Fewer than 40 percent of U.S. physicians are primary care doctors, and the limited number of new doctors choosing primary care as their specialty is a serious policy concern. In this Commonwealth Fund–supported study, researchers examined results from a 2009 survey to identify some of the nonpsychological factors that might contribute to the decision of primary care physicians to discontinue their practices.


What the Study Found

The survey was completed by 479 primary care physicians between the ages of 35 and 49 and 525 who were age 50 or older. Among the younger physicians, 30 percent were planning to leave their practices within five years. Among the older group, 27 percent of doctors were planning to retire and 25 percent were planning to leave their practices for other reasons within five years.

Analysis showed that the amount of time spent coordinating patient care was strongly associated with primary care physicians’ plans to discontinue practice. Furthermore, among younger physicians, treating large numbers of uninsured patients was linked to having plans to leave practice; among older physicians, treating large numbers of Medicare patients was associated with plans to retire. Surprisingly, seeing more than 150 patients per week—considered an unusually high caseload—was not linked to plans to discontinue practice in either age group.


Conclusions

Although the survey did not ask about physicians’ income, “it contains hints that income may be affecting plans to retire or leave practice for other reasons,” write the authors, who point to the association between having a large share of privately insured patients with lower rates of plans to leave. The Affordable Care Act may help in this regard, as insurance coverage expansions should reduce the number of uninsured patients faced by primary care physicians. Moreover, evidence that high patient caseloads do not factor into decisions to abandon practice may bode well for the ability of the nation’s primary care workforce to meet the expected increase in demand for health services once health reform is fully implemented.