Rising physician departures from Medicare fuel access issues
Age-adjusted exit rates in 2023 were lowest among physicians in solo practice.
The rate of physician departures — especially primary care physicians — from Medicare has increased from pre-pandemic years, fueling access issues, according to new research.
The share of physicians exiting traditional Medicare annually increased between 2010 and 2023 from a low of 1.8% to as high as 3.6%, according to research recently published in in JAMA Health Forum.
Physician departures generally increased until they spiked in the main COVID-19 pandemic years of 2020 and 2021 before resettling at a higher rate in 2023 than they were pre-pandemic, according to the findings based on a sample of 791,025 physicians.
“This result is consistent with earlier findings, but exits remained high even after the pandemic, which likely accelerated some physicians’ exit,” wrote the authors, who included Michael Chernew, PhD, a professor in the Department of Health Care Policy at Harvard Medical School.
The departure rates in 2023 varied between physician types including:
- 4.4% of primary care physicians
- 3.5% of hospital-based specialists
- 2.9% of surgical specialists
- 2.5% of medical specialists
While age-adjusted exit rates in 2023 were lowest among physicians in solo practice, the annual increase in exits among solo practitioners exceeded that of physicians in medium and large group practices, according to research.
The authors said the factors fueling exits among all physician types may include:
- Greater burden of new communication methods
- Increased demands for clinical documentation
- Decreased payments
The research runs somewhat counter to reports from the Medicare Payment Advisory Committee (MedPAC). It’s latest annual report said its surveys found “the share of clinicians accepting Medicare is comparable with the share accepting private insurance, despite private health insurers paying higher rates.” However, it also found “a slow decline in the number of primary care physicians” billing Medicare.
Health system view
Intermountain Health has seen major reductions in primary care physicians recently.
“We realized maybe about 18 months ago, if we just used the inertia of the current system, we ‘d probably be ok. But we would leave a lot of people in our community behind,” Dan Liljenquist, chief strategy officer at Intermountain, said in June at the HFMA Annual Conference.
The system is increasingly hearing from patients whose primary care physicians have retired, which has recently happened to one million patients in Utah, where Intermountain is based, Liljenquist said.
The system is trying to develop new primary care approaches in response to the physician shortage.
“We are going to need to sever the one-on-one traditional doctor-patient relationship — that expectation — because there aren’t enough people to provide that level of care,” he said.
That may involve less frequent in-person visits and use of AI to help coach patients on self-care.
“That’s the biggest challenge because systems never change until there is a crisis moment and we are at that crisis moment,” Liljenquist said.
Healthcare providers will need to develop new approaches nationwide.
“It’s going to take the folks actually delivering healthcare to say, ‘Here’s what healthcare looks like going forward, and it’s safe and effective and it’s going to be a lot less expensive,’” Liljenquist said. “It may be a lot less one-to-one doctor-patient [interactions] but frankly the capabilities we have are far ahead of where we were just a couple years ago. We’re going to have to lean into that or a lot of people are going to get hurt.”
Overall trend
A 2024 report from the Association of American Medical Colleges (AAMC) found 20% of clinical physicians are 65 or older and another 22% are between age 55 and 64.
“As a result, a significant number of physicians will reach retirement age within the next decade — if they have not already,” said the report. “The AAMC projects that this will significantly decrease the physician supply in the coming years.”
AAMC projects a shortage of up to 86,000 physicians by 2036.
Congress may try to mitigate the shortage through recently introduced legislation to increase the number of Medicare-supported doctor training slots available for medical students.
“There is an urgent, demonstrated need to strengthen our health care system by combating the alarming shortage of providers, particularly in rural areas,” Sen. John Boozman (R-Ark.), the bill’s sponsor, said in a press release. “Lifting the outdated cap on residency positions supported by Medicare can expand the supply of physicians while helping ensure access to quality care and treatment in more communities nationwide.
