麦肯锡-医生短缺不会消失 The physician shortage isnt going anywhere

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