An absurd data gap in healthcare

There are no national estimates of physician turnover, which makes one new assessment of the rate at which physicians left their practices over a decade noteworthy. 

"Physician Turnover in the United States," published July 11 in the Annals of Internal Medicine, estimates physician turnover from 2010 through the first three quarters of 2020 with a new method using Medicare Data on Provider Practice and Specialty. 

Study authors from Weill Cornell Medicine in New York used Medicare billing patterns to identify whether an individual physician moved or left a practice, using this information to develop national estimates of turnover and to identify physician, practice and patient characteristics associated with turnover. The study authors required a physician to stop billing for at least 2 years to be defined as "leaving" practice.

Previous efforts to measure physician turnover at a national level have relied on surveys that drew low response rates or only reflected a physician's intention to move or leave, according to study authors. 

The findings warrant further investigation, according to the researchers. Five key takeaways: 

  • Between 2010 and 2018, the annual rate of turnover, based on physicians moving or not practicing anymore, increased from 5.3 to 7.6 percent, a change of 43 percent.
  • Most of the turnover occurred between 2010 and 2014, when the annual turnover rate increased from 5.3 to 7.2 percent, and resulted from physicians who stopped practicing. Why turnover increased during those years remains unknown.
  • The turnover rate was stable through 2017 and increased modestly in 2018 to 7.6 percent. 
  • In the second and third quarters of 2020, turnover was slightly lower than in the corresponding quarters of 2019. While a great deal of turnover did not seem to be occurring early in the COVID-19 pandemic, analysis of 2021 and 2022 data is needed to better identify pandemic trends. 
  • The final sample of physicians analyzed represented 82 percent of all physicians or 92 percent of Medicare physician billing between 2010 and 2020. Some physicians were excluded from the study, including those who infrequently bill Medicare (pediatricians, psychiatrists, Kaiser Permanente physicians and physicians who saw fewer than 4 Medicare enrollees in each billing year) and those younger than 33, given their likely moves from residency or fellowship into practice. 

The authors do note study limitations, including situations in which a physician stopped billing Medicare but continued to practice and accept non-Medicare patients — as built, such a physician would erroneously be counted as leaving practice. Another limitation is that the authors were unable to account for burnout, either measuring it or correlating it to turnover. 

Nonetheless, the authors are bullish that their claims-based method be replicated and used for future research studies and be of practical interest to medical groups, medical specialty associations, health systems, health insurers, and federal and local policymakers.

"The new method provides a consistent estimate of national rates of physician turnover — a metric that has never been rigorously and systematically captured," the authors noted in their study conclusion. "Furthermore, the method enables comprehensive analysis of physician turnover — both movers and leavers — at the physician level, allowing researchers to observe annual and even monthly rates of turnover at the national, regional, local, and medical group levels, and stratified by physician, practice, and patient panel characteristics." 


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