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Mcsey
&company
HealthcarePractice
Thephysicianshortageisn’t
goinganywhere
Physiciansshedlightonthefactorsthatarepushingthemoutoftheworkforceandthechangesthat
couldmakethemstay.
ByLauraMedford-Davisand
RupalMalani
withChelseaSnipesandPieterDuPlessis
September2024
Healthcareorganizationsaregrapplingwiththeincreasinglydifficult—andurgent—taskofattractingandretainingphysiciantalenttomeet
increasingpatientdemandforcare.Bytheendofthisyear,theUnitedStatesisexpectedtohaveashortageofupto64,000physicians.1The
COVID-19pandemicexacerbatedthealreadysubstantialburnoutamong
physiciansandcontributedtoanunprecedenteddepartureofphysicians
fromtheclinicalworkforce
.2Lookingahead,physicians’desirestostepbackfromclinicalcareshownosignsofabating,withcurrentprojectionsindicatingthephysiciandeficitcouldgrowtoupto86,000by2036.3
Onereasonfortheexpectedshortageisthatsome20percentof
clinicalphysiciansareaged65yearsorolder,puttingorganizationsinthepositiontosoonloseasubstantialnumberofphysicians
toretirement.4Theexpandinggapinthephysicianworkforceisparticularlyconsequentialgiventheprojectedgrowthinpatient
demand:thenumberofpeopleaged65andup—aninherentlyhigher-needpatientgroup—isexpectedtoriseto23percentofthepopulation,from17percent,by2050.5
Todeployeffectivestrategiestoaddressthephysicianshortfall
andensurecontinueddeliveryofqualitypatientcare,healthcare
organizationsaresearchingfortherootcausesofphysiciansleavingtheworkforce.Withthisinmind,wefocusedourseventhphysician
surveyonunearthingthemindsetsthatarepushingdoctorsintheUnitedStatesoutoftheworkforce(seesidebar,“Researchmethodology”).
Ourfindings,basedonasurveyof631physicians,underscoretheneedtotakeurgentaction.
1GlobalData,Thecomplexitiesofphysiciansupplyanddemand:Projectionsfrom2021to2036,AAMC,March2024.
2EthanPopowitz,Addressingthehealthcarestaffingshortage,DefinitiveHealthcare,September2023.
3GlobalData,Thecomplexitiesofphysiciansupplyanddemand:Projectionsfrom2021to2036,AAMC,March2024.
4“NewAAMCreportshowscontinuingprojectedphysicianshortage,”AAMCpressrelease,March21,2024.
5MarkMatherandPaolaScommegna,“FactSheet:AgingintheUnitedStates,”PRB,January9,2024.
Bytheendofthisyear,theUnited
Statesisexpectedtohaveashortageofupto64,000physicians.
Researchmethodology
Tosupporthealthcareorganizationsinunderstandingchallengesandtrendsinphysicianwell-beingandemploymentintheUnitedStates,McKinseylaunchedaresearchefforttogatherphysician
insightsonmyriadelementsoftheirexperience—fromemploymenttochangesinclinicalpractice,value-basedcare,compensation,andburnout.
ThesesurveysarenotmeanttobeacomprehensiveordetailedviewofallUSphysicianspecialtiesortopredicttheiractionsinthefuture.Instead,theyaremeanttoprovideearlyinsightsintophysicians’statedperspectivestohelpinformhealthcareleadersinsupportinghealthcareprovidersatlarge.
Themostrecentsurveyincluded631physiciansandwasinthefieldfromJunetoJuly2023.
ThepriornationwidesurveyswerefieldedonlinetoUSphysiciansatavarietyofpracticetypesandsizeswitharangeofemploymenttypesduringthefollowingdates:April27toMay5(538respondents),July22to27(150respondents),andSeptember22to27,2020
(303respondents);March25toApril5,2021(379respondents);andFebruary25toMarch8,2022(718respondents).Forprioranalyses,seethearticles“
Patientslovetelehealth—physiciansare
notsosure
,”“
Increasedworkforceturnoverandpressuresstrainingprovideroperations
,”and“
Physicianemployment:ThepathforwardintheCOVID-19era
.”
Physiciansinthefollowingspecialtieswereincludedinthesurvey:anesthesia;cardiology;
dermatology,emergencymedicine;gastroenterology;generalpracticeandfamilypractice;hospitalmedicine;immunologyandrheumatology;nephrology;obstetricsandgynecology;oncology;
ophthalmology;orthopedics,sportsmedicine,andmusculoskeletalhealth;otorhinolaryngologyorENT;palliativeandhospicecare;pediatrics;physicalmedicineandrehabilitation;plasticsurgery;psychiatryandbehavioralhealth;pulmonologyandcriticalcare;radiology;andsurgery.
Thephysicianshortageisn’tgoinganywhere2
Physicianturnover
Approximately35percentofphysician
respondentsindicatetheyarelikelytoleave
theircurrentrolesinthenextfiveyears,ofwhichroughly60percentsaytheyarelikelytoleave
clinicalpracticeentirely.Thisupcomingshiftisnotjustrestrictedtophysiciansnearingthetraditionalretirementage.Ofthosesurveyedwhosaytheyarelikelytoleave,59percentofthoseaged54to64notethatearlyretirement
orleavingthecaredeliveryworkforceis
theirmostlikelynextstep,and13percentsharethattheywouldprefertomovetoanadministrativerolewithinthecaredelivery
workforce.Forrespondentsagedunder54whoarelikelytoleave,37percentpreferearly
retirementorexitingtheclinicalworkforce,and14percentpreferanadministrativerole.The
highproportionofphysiciansconsideringa
departurefromclinicalcarerepresentsnotonlyanumericalshortfallbutalsoapotentialerosionofclinicalknowledgeandapprenticeship.
54–64years(n=185)
Overathirdofphysicianrespondentssaytheyarelikelytoleavetheirjobsinthenextfiveyears,andthat’snotrestrictedtothosenearingretirement.
Mostlikelyplansiftheyweretoleavetheirposition,¹%ofUSrespondents’firstchoice
Likelihoodofleavingcurrentpositioninthenext5years,%ofUSrespondents
Transitiontoadminrole
Remainin
aclinicalrole
Retireorleavetheworkforce
Will
leave
Somewhat
likelytoleave
All(n=631)
Verylikelytoleave
6
10
18
37
14
47
<54years(n=118)
<54years(n=387)
59
13
27
54–64years(n=75)
3
10
18
9
14
18
100
Note:Figuresmaynotsumto100%,becauseofrounding.
¹Questionposedtorespondentswhosaytheyareatleastsomewhatlikelytoleave:Pleaserankfromhighesttolowest,uptotop5,whatwouldbeyourmostlikelyplansifyouweretoleaveyourcurrentposition?
Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere3
Retentionchallenges
Turnoverislikelytocontinueincreasingas
physicianrespondents’interestinleaving
theircurrentpositionscontinuestorise.Inour
survey,58percentstatetheirdesiretochangejobshasgrownoverthepastyear.Inourprior
survey,43percentreportedthesame.Althoughnotallofthosephysiciansactonthatdesire—
medianturnoverofemployedphysiciansis
lessthan10percentperyear6—physiciansarealsoacutelyawarethattheyhaveotherjob
opportunities:72percentofrespondentsreporttheyareapproachedaboutalternativejob
offersatleastmonthly,and50percentreportbeingapproachedatleastweekly.
6BasedonMedicalGroupManagementAssociationdata.
Physicianrespondents’interestinchangingjobscontinuestogrow,andtheyareoftenbeingapproachedwithotheroptions.
FrequencythatUSphysiciansareapproachedaboutotherjobopportunities,%ofrespondents(n=631)
43
100
58
USphysicianswhosedesiretochangejobsgrewoverthepastyear,%ofrespondents
Daily
Acouple
Weekly
oftimes
Halfof
aweek
respondentssaytheyareapproachedeveryweek
16
16
18
Monthly
Quarterly
Onceor
twiceper
year
Lessthanonceper
year
22
11
8
9
20222023
(n=718)(n=213)
Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere4
Whyphysiciansleave
Whenaskedaboutfactorsthatinfluence
theirdecisiontoleave,physicians’family
needsarejustascriticalascompensation.
Inoursurvey,69percentofrespondents
flaggedadesireforhigherremuneration,
andthesameproportionselectedfamily
needsandcompetinglifedemands.Other
well-beingfactors,suchasthedemanding
nature,emotionaltoll,andphysicaltollof
work(66percent,65percent,and61percent,respectively),arealsokeydeterminants.
Besidescompensationandwell-being,the
otherkeyinfluencersonphysicians’decisionstoleave,accordingtooursurvey,include
whethertheyareinvolvedindecisionmakingandwhethertheyhavesufficientstaffing
support(discussedinfurtherdetailbelow).
Lifestyleandwell-being
Familyneeds/competinglifedemands
Emotionaltollofthejob
Intensityoftheworkloadanditsdemandingnature
Physicaltollofthejob
37
36
27
PhysicianinvolvementNotfeelinglistened
intherightdecisionstoorsupported
26
Toomuchuncertaintyandlackofcontrol
31
Balancingfamilyneedsandwell-beingisjustasimportantashigherpayininluencingphysicianrespondents’decisionstoleave.
38
31
28
30
34
33
32
Sta代ngandsupportsystems
Insu代cientlevelofsupportstaf
Insu代cientqualityofsupportstaf
2928
2827
Topfactors,excludingretirement,forUSphysiciansleavingcurrentrole,%ofrespondents(n=631)
Compensationandincentivestructures
Seekingahigherpaidposition
VerymuchafactorModeratelyafactor
3929
100
Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere5
Workloadandwell-being
Whilelonghourscanleadtoburnout,alackofcontrolovertheirschedulesaffectsphysicianwell-beingevenmorethantheabsolutetime
spentonthejob,accordingtothesurvey.
Fifty-twopercentofrespondentswhosay
theyworkmorethan60hoursperweekreportexperiencingburnout,but66percentofthosedissatisfiedwiththeirschedulessaythesame.Similarly,morerespondentswhoareunhappyabouttheirschedulessaytheyarelikelyto
leaveinthenextyear(32percent)versusthoseworkingmorethan60hours(23percent).
Scheduledissatisfactionafectsphysicianrespondents’well-beingevenmorethantheabsolutetimespentonthejob.
USphysicianworkhoursandscheduleasafactorinburnoutandlikelihoodtoleavecurrentrole,%ofrespondents(n=631)
52
40
Experiencingatleastonesymptomofburnout
32
23
Likelytoleaveinthenextyear
17
66
Allphysicians
Physiciansworkinga≥60hourweek
Physiciansdissatisfiedwiththeirschedule
Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere6
Definingflexibility
Workflexibilityisakeydriverofwell-being,
asevidencedbythecorrelationbetween
schedulesatisfactionandburnout.7Butitcan
meandifferentthingstodifferentpeople,so
inoursurvey,weaskedphysiciansaboutthe
importanceofvariousaspectsofflexibility.A
largershareofphysicianrespondentssaythat
flexibilityoverthespecificdaysandtimesduringthedaythattheyworkisimportant,compared
withflexibilityofworklocation.Themajorityofsurveyedphysiciansreportthattheabilityto
taketimeoff(87percent)isimportant,while
findingcoveragewhenneeded(77percent)
andtheabilitytoworkspecifichoursoftheday(69percent)arenextinline.Ontheotherhand,38percentofphysicianrespondentssharethatthe
abilitytoworkremotely
isimportant.
7PvalueforZtest(Z=4.52)is<0.00001.
Physicianrespondentsreporttheabilitytotaketimeofandfindcoveragearethemostimportantfactorsforimprovingworklexibility.
Importanceofvariousfactorsofworking
hours/schedulelexibilityto
USphysicians,
%ofrespondents(n=617)
Veryimportantfactor
Importantfactor
Abilitytofindcoveragewhenneeded
Abilitytoworkspecifichoursoftheday
Abilitytoworkspecificdaysoftheweek
42
35
Abilitytohaveafour-dayworkweek
39
Abilitytoworkpart-time
37
Abilitytoworkovertime/paidcall
34
Abilitytoworkacrossmultipleacuitylevels
32
Abilitytoworkremotely
28
Abilitytoworkinareasoutsidepatientcare
Abilitytoworkacrossmultiplesettings
29
12
23
27
10
27
29
28
27
23
20
15
10
Abilitytotaketimeof
33
55
Total
8777696561554842383737
Note:Figuresmaynotsumtototals,becauseofrounding.
Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere7
Inclusionindecisionmaking
Involvementindecisionmakingisakey
considerationforphysiciansindetermining
whethertoleavetheirposition,withmorethan60percentofphysicianrespondentssaying
theyexpecttoatleastbeconsultedorhaveavoteonmajordecisions.Thiswasconsistentacrossvarioustypesofdecisions,suchas
patientcarequality,culture,andstrategicpriorities,aswellasacrossrespondents
employedbyhealthsystemsandlarge
physiciangroups.Amongthosesurveyed,expectationsofinvolvementarehighestforpatientcarequalityandlowestfor
strategicpriorities.
Amajorityofphysicianrespondentsexpecttobeconsultedorhaveavoteondecisionsafectingtheirorganizations.
USphysicianexpectationofinvolvement,bytopicofdiscussion,¹%ofrespondents(n=337)
18
74
8
Tobeinformed
Tobeconsultedorhaveavote
Soledecision-makingauthority
Patientcarequality
29
68
27
69
3
4
CultureAllocation
ofresources
34
61
5
Strategicpriorities
¹Questionposedtophysicianswhoareemployedbyhospitals,healthsystems,andmedicalgroups.Source:McKinseyUSPhysicianSurvey,July14,2023
McKinsey&Company
Thephysicianshortageisn’tgoinganywhere8
Delegationoftasks
Tounderstandhowbesttoprovideappropriatesupporttophysicians—thelackofwhich
isakeyinfluencerforleavingajob—we
analyzedhowphysiciansspendtheirtime.
Surveyrespondentssaynearly20percent
oftheirclinicaltimeisspentontasksthat
couldbehandedovertononphysicianstaff
ortechnology.Respondentsindicatethatthebiggestproportionofdelegabletimecouldbeentrustedtoadvancedpracticeprofessionals,withhospital-basedphysicianrespondents
reportingthehighestpercentageofpossibledelegationtothisgroup(42percent).
Physicians’clinicaltimeisnotoptimizedforpatientcarethatonlytheycando,withnearly20percentidentifiedbyrespondentsasdelegabletasks.
6
15
26
18
31
6
7
14
16
14
42
7
15
24
20
30
4
5
OtherTechnology
Nonclinicalstaf
Othercliniciantype
Licensednurse
Advancedpracticeprofessional
ShareofdelegabletimethatcouldbecoveredbynonphysicianrolesaccordingtoUSphysicians,byspecialty,%ofrespondents(n=631)
7
8
16
20
21
28
Medicalspecialty(n=175)
Hospital
based
(n=121)
Proceduralspecialty(n=236)
Generalmedicine(n=99)
Note:Figuresmayn
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