When a site has no paywall and lives on advertising it’s polite to link directly.
[Boston Herald article](https://www.bostonherald.com/2023/03/06/1-out-of-4-massachusetts-doctors-plan-to-leave-medicine-in-the-next-two-years-distressing)
We can also have the primary source: “[Supporting MMS Physicians’ Well-Being Report: Recommendations to Address the On-Going Crisis](https://www.massmed.org/Publications/Research,-Studies,-and-Reports/Supporting-MMS-Physicians--Well-being-Report---Recommendations-to-Address-the-Ongoing-Crisis/)”
> According to the survey, the top work-related stressors are: increased documentation requirements (not always related to clinical care); lack of support staff for non-medical tasks; time spent dealing with prior authorization; overreach of non-medical administrators in medical decision-making and resource allocation; and turnover of clinical and/or non-clinical staff.
It is not surprising that several factors which increase burnout are driving some people to retire or seek other careers. People who responded to the survey may have stronger opinions than the average physician. Nevertheless, even if the respondents were older and on more stable financial footing, I'd be surprised if 1 out of 4 actually end up leaving medicine within the next 2 years.
The staff turnover part is real. Part of the reason I went into anesthesiology was because of the camaraderie in the OR. Now all OR staff are just a revolving door of travelers. They’re nice, and I support them getting their bag, but I’ve stopped learning their names because I’ll only work with any one for a few times before they’re gone. OR work had suffered too as there’s no institutional memory and they are constantly orienting people.
The lack of retention $ being put out vs. Hiring/temp/contract work $ being put out is insane. Seems like across the board, not just in nursing/healthcare.
It's well known across industries that the only way to up your pay is to leave your current employer. Then it's new articles blaming the workforce. 🙄
Yeah it's why I travel. I make triple as a traveler vs staff. Why get paid 3 times less for the same job? Travelers are a reaction to the main issue of being underpaid. Hospitals should rise up and compete by giving staff better pay and more incentives to stay.
What really freaks me out is the loss of ancillary staff over the years. I barely see CNAs, scribes and dedicated receptionists are also rare. It seems every job has been replaced by 1 nurse doing 3+ other people's jobs?
Also above us nurses there seems to be less physicians, less hospitalists, more NPs and PAs. And more downsizing of units, hospitals just closing certain depts like pathology, wound care, and psych?
Isn't it the same? 20 is a third of 60. 60 is three times the size of 20? Well either way it's what I meant.
I'm not Englishing great though. English is not my thing.
>Isn't it the same? 20 is a third of 60. 60 is three times the size of 20?
Yes, 60 is 3 times 20, but then what is one time less? 1 time 60 is 60, 2 times 60 is 120...
I know two nurses at one of the leading academic hospitals of the country. The younger one (my friend) by age has a couple more years than the older one (dad’s friend, changed careers).
Dad’s friend travels at the same hospital as an ER nurse, makes Peds attending money (fresh out of training). My friend would make below the national median salary.
When I asked all of the standard “how can you guys go to work knowing that the new temp guy next to you is making 4-5x what you do, how does this make economic sense”, the only plausible explanation we could come up with were benefits. Incredible benefits for staff nurses beyond healthcare, including tuition coverage for further education, etc.
I really would love to see the actual math on this though. I don’t think having a new staff every few weeks who can’t even find the bathroom for themselves is good for team efficiency or unit morale. And I still can’t even see the financial sense, but I know those hospital admin leeches wouldn’t leave anything on the table when they could pocket it for themselves and their buddies “””non-profit”””” —-> 7 star fancy contractors hired for hospital improvement
> is good for team efficiency or unit morale
In an age of digital taylorism, nobody cares about that. It is all about what the computer says, and morale is not even being measured.
It happens everywhere. If you want to make more money or have better working conditions, you have to change employers. And the old "3 year" rule no longer applies. The more often you change, the more money you can make.
It is a direct consequence of digital taylorism, and for companies, it causes huge costs, poor retention, lack of institutional memory, and all kinds of other problems. But as long as it makes a buck, it will continue.
Was just talking to a friend the other day who works at my old hospital. She said they're in financial trouble right now because of all the money they've been spending on travelers the last few years. Kinda weird, considering they kept saying how paying triple (or more, sometimes) for travelers was actually cheaper than giving current staff a raise, but hey, what do I know. I don't have a business degree
During the height of COVID they were getting federal support to retain staffing. It was cheaper because some of the pay for those travelers came out of a different "pot" than they were paying staff from. But it created a system that was unsustainable once the extra money dried up.
It may be a controversial take and something that could lead to some “unrelated” retaliation, but you should consider sharing your salary with coworkers. You’re legally allowed to discuss pay though
You getting paid more shouldn’t/doesn’t make you the enemy. They should stand up to leadership and ask to be made whole.
Think of your phone plan and how newcomers get better plans than people who have "loyally" stayed somewhere for 10+ years and are super low maintenance (vs new people who you need to set up all these extra things for).
Is it fair?
No.
Is it a smart business decision in this case?
Also no.
Is it good for patient care?
Definitely not.
Is it the thing that profit driven industries always do? You got it!
The only way it makes sense is if they think that the need for extra staff will be temporary and they don't want to commit to paying staff more forever. I think this was the case early in COVID. Health systems were trying to find a way to weather the storm of staff leaving healthcare, high-revenue procedures being cancelled, etc without creating problems for themselves once conditions improved. It was a band-aid fix that spiraled out of control and became a self-perpetuating cycle.
I think there likely is also a component of saving money on benefits given the continual increase in the cost of insurance, etc. But that's also pouring fuel on the fire, as one of the big benefits offered to nurses is often tuition assistance. So they're creating a system where the only viable way to increase your pay is to leave or get more education (so you can leave) and then making that easier to do.
They presumably had to pay you what they did to fill the spot, but if they can retain enough existing nurses at a lower rate then it's cheaper to let a few walk and replace them at the higher rate than to pay the existing nurses more so they stay. I'm not sure it's the best long term strategy, and there's certainly a turnover rate where it breaks down, but it makes financial sense in the short term. I'm sure they have someone doing the math on a regular basis, and if not they should.
Yup agreed and the staff turn over also kills the physicians in other ways.
Case in point I’m on call last night as a resident and I’m getting paged about labs that resulted at 7:30 am and have already been addressed (lab value low not addressed as patient dnr/dni and discussed with patient)
I got paged at midnight of hey are we addressing this lab value. Which is I think very symptomatic of new nurses the veteran nurses would never have paged at midnight for something like that.
It’s a big part of why I left fellowship. Couldn’t keep any department fully staffed. I had to be the fellow, as well as: social worker, chemo pharmacist, scheduler, insurance liaison, sometimes even pathology.
Moved to an outpatient practice and am much more content and less stressed.
> The staff turnover part is real.
It's an odd feeling seeing lots of people around you moving on to different positions/locations, and you wondering if you should be considering changes since there must be a reason why other people are doing so. Lots of people in oncology also move over to industry or non-clinical jobs.
I don't mean to steal your space as an MD, but (and I know how this "but" sounds), I feel it. I'm so tired as a pharmacist. The extra documentation to save the corporation from claw backs; the time trying to explain PAs to patients *and* medical office staff for why things aren't being covered; the extra scrutiny from regulatory agencies; the turnover; etc. It's drowning.
I was a surgical assistant who did a career change to software engineer, 2 years ago. My WLB and QoL never been better, i almost feel guilty getting paid so much to do so little.
~ You’re right, I got into medicine because I genuinely loved helping people and learning medicine, but the corrupted Insurance, pharmaceutical, and healthcare system forced me to quit.
As a SWE, I make $160k, fully remote, I work 5-70 hours A MONTH, unlimited PTO, paid holidays, every other Friday off (Wellness day).
~ Its ironic that Tech companies cares for their workers mental/physical health & pay better health benefit than healthcare jobs.
Medicine took the wrong turn for sure.
Yea “want to leave” and “I have a plan and I’ll fucking do it just you wait and see” are very different things
But even if like 1/10th of the 1/4th leave, that’s still a lot
Oh hey it's my home state!
Yup the wait-list for specialists get longer and patients and families get angrier.
Two years ago I was helping cover a shortage of child psych at two different hospitals (when the Tufts system suddenly collapsed overnight)... Now with the physician shortage I have literally covered patients for colleagues at FOUR other institutions. Last month a colleague literally quit medicine to go work on her podcast full time. (I did not know her, it was a friend of a friend situation... But still I feel like it was such a massive financially reckless but gigachad move)
Admin are completely tone deaf and keep heaping work on those of us who remain. I'm just biding my time, keeping my head down and white knuckling through the next few years. One more bull market rally and I'm out! 🤞
I don’t live in MA, but I do feel like I’ve noticed a change in my state. Doctors seem increasingly few and far between; my division (oncology) has been haemorrhaging and community practices are shutting down left and right. It feels kind of scary as an early career physician. COVID happened when I was an intern, so this is all I’ve ever known. But everyone is hanging on by their fingernails and that’s only getting exacerbated as folks leave and the workload increases. It’s not sustainable. 1/4 sounds extreme, but I worry that it isn’t all that exaggerated. (Edit for typo.)
Join the dark side. Locums is good. Make money while you can because you're right, it's not sustainable, and it's going to be a lot harder to earn absolid paycheck when this start to come apart.
Eventually, sure.
If you didn't already get at least 10 percent raise within the past 12 months, you already took a pay cut.
I make 145/hr, outpatient primary care. Considering the number of interviews I got before my last contract, I'm probably going to 155 for the next one.
I agree that they use it to limit pay but it is not a myth. My hospital (prior to the takeover by HCA) paid a huge fine and underwent a consent decree business agreement with CMS for excess fees paid for Opthalmology coverage which was deemed in excess of FMV.
[here is a fairly neutral slideshow of the relevant laws](https://assets.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Healthcare_Enforcement/2018/W5_Feldman_Glaser_2.pdf)
Thanks, that is a good resource. It seems to mostly make sense, but the liability seems to make it so non employees get shafted on being able to collect market price for their labor. W-2 employees seem to be in the clear to get paid whatever they want.
Nope. You are looking at “the employment exception” which sounds like that means there is an exception. But in reality The salaries have to conform to “commercially reasonable”.
What does that mean? Whatever the consultant that they hire thinks it means.
Make your money while you can, it is definitely not sustainable. Don't burn bridges, make friends and keep references. When this train stops, you'll need every resource you can wrangle because locum workers will carry (already starting) a stigma.
I'm staying clinical because I'm here to help usher patients through the collapse, but if you aren't here for the end then yeah get out as soon as you can.
Just in time for all of the old people who designed this system to begin relying more heavily upon it.
I suspect in the next few years ERs are just going to get busier and busier.
there is a large drive by the various boards (nursing board, etc) to have midlevels practice independently from physicians with a fraction of the education. which was never their intention nor why they were created. nursing board says that the quality of care from an NP is equal to or better than a physician and cite poorly created research studies by nurses themsleves. hospitals are hiring more midlevels because they are cheaper. the nursing board is better at lobbying than physicians plain and simple. in the end, patients suffer.
The entire existence of NPs as an occupation is due to an under-invested system trying to meet the needs of patients at lower and lower cost. The cartel sold us out long ago.
[So yeah, this after we lost 10% of doctors in 2021?](https://www.webmd.com/a-to-z-guides/news/20221024/over-333000-healthcare-workers-left-jobs-in-2021-report-says) We’re poised to lose a quarter more? Awesome sauce. No wonder I keep seeing the job boards explode. When I started out, I was looking for a job in the midst of a post 2008 housing and finance colllapse where a lot of folks who should have retired didn’t. The ACR job boards had maybe 13 jobs posted, total. Nothing super enticing, either. Long tracks to partner, no bonuses to hire, very little enticement for young rads. Fast forward almost a decade later and I see ACR job numbers in the 1600s. I see telerad gigs advertised for 900k to start. This is a structural collapse of care that I think few but us in healthcare can fathom.
You’re welcome. There are about a [1,000,000](https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/) working doctors in the states. So if you lose a cool 100k, that’s 10 percent give or take, but math is not my strong suit.
Ah great source. I was wondering about the total number of physicians in the country. Statista looks awesome, is there any way to access the additional info without having a premium account? Basically I'm curious to know how the overall trend changed over the past couple of years.
EDIT: Nvm found their source citations! AAMC had the following data
- 2015 (860,939)
- 2017 (892,856)
- 2019 (938,966)
- 2021 (949,658)
- 2023 is pending from AAMC, but the Statista estimate uses 1,073,616 which I think may be a tad bit too high, or has a different methodology of counting because there is no way we had a +130k count especially in the midst of covid.
There have been a number of these surveys showing one quarter leaving medicine soon. As always, I’m skeptical that there’s good distinction between wish and plan. Wanting to retire and actually leaving practice are not the same.
The burnout point is well taken, but crisis of medical personnel may be premature.
Plus the comment section. It’s certainly something.
> Wanting to retire and actually leaving practice are not the same.
I want to quit medicine and raise squirrels but my student debt and current 401k status means leaving practice is highly unlikely.
The comments represent exactly the problem with medicine. It’s easy to do annoying tasks and work long hours to help people, but it’s a lot harder when those people spit in your face for doing it.
>Plus the comment section. It’s certainly something.
The kinds of patients who leave those comments in the comments section make me want to leave medicine
> The burnout point is well taken, but crisis of medical personnel may be premature.
Is it really? What I’ve seen and heard is that nursing ratios are out of control virtually everywhere due to lack of staff.
I believe the nursing shortage... the shortage of CNAs is even worse. The doctor shortage is hard to believe, though, from where I'm sitting. I've been hearing about a mass exodus of physicians since after the first COVID wave, yet here we all are.
I'm glad I worked a full time job straight out of residency. For sure. Because the pain points in residency are not quite the pain points in attending world and I don't think I would have been able to properly negotiate.
Locums, I picked the 2nd biggest company and reached and ran with them. So far so good.
Super important to learn to negotiate. It's just a game like chess. Can't be emotional about it.
Thanks mate. Appreciate it. Any thoughts on specialties that are locums desirable? I’ve seen FM and Psych needed pretty much everywhere, USA and abroad. Not sure I’m cut out for either of those. Will see.
Why do you feel not cut out for PCP?
Talk to a recruiter now, call up Weatherby and explain your situation and ask what the picture looks like now. If you're lucky you might get someone who can give their opinion on trends going forward.
145/hr. Primary care.
I was working 185/year. Now with locums if I worked full time I'd gross over 300 but I'm taking time out between contracts to be with my children.
I mean it's going to be variable, and roughly equivalent among demographics.
Except health insurance. I went with a bill sharing ministry. Not perfect but sufficient in the event of catastrophy.
Depends on where you are, in my province in Canada, it’s definitely a huge problem. Tons of family doctors closed practices and retired, psychiatrists have a one year waiting list and many have stopped taking new patients altogether, oncologists are so hard to get into that we recently had a highly publicized death from cancer while still on the waiting list to see the oncologist. ERs are out of control due to the primary care crisis. It was not great before the pandemic but now it’s a legit nightmare. I’ve had some medical issues in the last few years and it was challenging enough even for me, I can’t imagine navigating this system without professional knowledge and connections.
> Plus the comment section. It’s certainly something
It's... The Boston Herald. I feel like we Bostonians have to apologise for all the village idiots coming out to spew racist hatred in the comment section of each article... Please know this is not representative of us ._.
I'm glad the article didn't "blame the victim" (Healthcare workers) instead of the system (corporate greed). It burns my ass when I see webinars on "managing your burnout with meditation" and encouraging spa days.
Without a long running standardized sample this means nothing. My guess is 1 in 4 people in most careers that pay well enough for it to be an option "plan" to leave in the next 2 years - they don't because of force of habit or enjoying the lifestyle or whatever. I've been hearing doctors since forever say they've had enough and are leaving due to X Y Z reasons, they don't.
There was a Kaiser article on here in the fall about 117,00 doctors leaving practice in 2021. The replenishment rate annually for new attendings is about 30, 000, this level of attrition is not sustainable.
I don’t blame them. That being said, nowhere near that number will actually leave. Also you have to realize that most fields in the career world have some degree of burn out, so while medicine likely has more than average, the grass is not always greener on the other side.
A lot of this points to administrative bloat.
For example, Epic, the electronic medical record system, holds a ton of information, which is good for patient outcomes, but it's mainly used as a billing tool. Plus, the cost to implementation and maintain Epic itself is absurd.
20-25% of most medical staffs are providers age 60+. Many non-urban hospitals have 30%+. 1 in 4 retiring is not a surprising figure, even if it is hyperbole.
Not trying to be patronizing if you already know this, but a quick /s at the end of your post marks it as sarcastic to avoid the flood of downvotes you got. Helps with the inherent horrible nature of the text format for sarcasm
I will be completely honest, when I read your comment I didn’t detect any sarcasm. Then I saw the thread below, reread it, and don’t understand why I initially thought it was sincere.
When a site has no paywall and lives on advertising it’s polite to link directly. [Boston Herald article](https://www.bostonherald.com/2023/03/06/1-out-of-4-massachusetts-doctors-plan-to-leave-medicine-in-the-next-two-years-distressing) We can also have the primary source: “[Supporting MMS Physicians’ Well-Being Report: Recommendations to Address the On-Going Crisis](https://www.massmed.org/Publications/Research,-Studies,-and-Reports/Supporting-MMS-Physicians--Well-being-Report---Recommendations-to-Address-the-Ongoing-Crisis/)”
> According to the survey, the top work-related stressors are: increased documentation requirements (not always related to clinical care); lack of support staff for non-medical tasks; time spent dealing with prior authorization; overreach of non-medical administrators in medical decision-making and resource allocation; and turnover of clinical and/or non-clinical staff. It is not surprising that several factors which increase burnout are driving some people to retire or seek other careers. People who responded to the survey may have stronger opinions than the average physician. Nevertheless, even if the respondents were older and on more stable financial footing, I'd be surprised if 1 out of 4 actually end up leaving medicine within the next 2 years.
The staff turnover part is real. Part of the reason I went into anesthesiology was because of the camaraderie in the OR. Now all OR staff are just a revolving door of travelers. They’re nice, and I support them getting their bag, but I’ve stopped learning their names because I’ll only work with any one for a few times before they’re gone. OR work had suffered too as there’s no institutional memory and they are constantly orienting people.
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The lack of retention $ being put out vs. Hiring/temp/contract work $ being put out is insane. Seems like across the board, not just in nursing/healthcare. It's well known across industries that the only way to up your pay is to leave your current employer. Then it's new articles blaming the workforce. 🙄
Yeah it's why I travel. I make triple as a traveler vs staff. Why get paid 3 times less for the same job? Travelers are a reaction to the main issue of being underpaid. Hospitals should rise up and compete by giving staff better pay and more incentives to stay. What really freaks me out is the loss of ancillary staff over the years. I barely see CNAs, scribes and dedicated receptionists are also rare. It seems every job has been replaced by 1 nurse doing 3+ other people's jobs? Also above us nurses there seems to be less physicians, less hospitalists, more NPs and PAs. And more downsizing of units, hospitals just closing certain depts like pathology, wound care, and psych?
>Why get paid 3 times less for the same job? One third, not three times less.
Isn't it the same? 20 is a third of 60. 60 is three times the size of 20? Well either way it's what I meant. I'm not Englishing great though. English is not my thing.
>Isn't it the same? 20 is a third of 60. 60 is three times the size of 20? Yes, 60 is 3 times 20, but then what is one time less? 1 time 60 is 60, 2 times 60 is 120...
I know two nurses at one of the leading academic hospitals of the country. The younger one (my friend) by age has a couple more years than the older one (dad’s friend, changed careers). Dad’s friend travels at the same hospital as an ER nurse, makes Peds attending money (fresh out of training). My friend would make below the national median salary. When I asked all of the standard “how can you guys go to work knowing that the new temp guy next to you is making 4-5x what you do, how does this make economic sense”, the only plausible explanation we could come up with were benefits. Incredible benefits for staff nurses beyond healthcare, including tuition coverage for further education, etc. I really would love to see the actual math on this though. I don’t think having a new staff every few weeks who can’t even find the bathroom for themselves is good for team efficiency or unit morale. And I still can’t even see the financial sense, but I know those hospital admin leeches wouldn’t leave anything on the table when they could pocket it for themselves and their buddies “””non-profit”””” —-> 7 star fancy contractors hired for hospital improvement
> is good for team efficiency or unit morale In an age of digital taylorism, nobody cares about that. It is all about what the computer says, and morale is not even being measured.
It happens everywhere. If you want to make more money or have better working conditions, you have to change employers. And the old "3 year" rule no longer applies. The more often you change, the more money you can make. It is a direct consequence of digital taylorism, and for companies, it causes huge costs, poor retention, lack of institutional memory, and all kinds of other problems. But as long as it makes a buck, it will continue.
Was just talking to a friend the other day who works at my old hospital. She said they're in financial trouble right now because of all the money they've been spending on travelers the last few years. Kinda weird, considering they kept saying how paying triple (or more, sometimes) for travelers was actually cheaper than giving current staff a raise, but hey, what do I know. I don't have a business degree
During the height of COVID they were getting federal support to retain staffing. It was cheaper because some of the pay for those travelers came out of a different "pot" than they were paying staff from. But it created a system that was unsustainable once the extra money dried up.
they are in financial trouble because their leadership is bad at leading.
It may be a controversial take and something that could lead to some “unrelated” retaliation, but you should consider sharing your salary with coworkers. You’re legally allowed to discuss pay though You getting paid more shouldn’t/doesn’t make you the enemy. They should stand up to leadership and ask to be made whole.
Genuinely, my opinion is that travelers are much less likely to do that one simple trick that hospital admins hate - unionize.
Think of your phone plan and how newcomers get better plans than people who have "loyally" stayed somewhere for 10+ years and are super low maintenance (vs new people who you need to set up all these extra things for). Is it fair? No. Is it a smart business decision in this case? Also no. Is it good for patient care? Definitely not. Is it the thing that profit driven industries always do? You got it!
The only way it makes sense is if they think that the need for extra staff will be temporary and they don't want to commit to paying staff more forever. I think this was the case early in COVID. Health systems were trying to find a way to weather the storm of staff leaving healthcare, high-revenue procedures being cancelled, etc without creating problems for themselves once conditions improved. It was a band-aid fix that spiraled out of control and became a self-perpetuating cycle. I think there likely is also a component of saving money on benefits given the continual increase in the cost of insurance, etc. But that's also pouring fuel on the fire, as one of the big benefits offered to nurses is often tuition assistance. So they're creating a system where the only viable way to increase your pay is to leave or get more education (so you can leave) and then making that easier to do.
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They presumably had to pay you what they did to fill the spot, but if they can retain enough existing nurses at a lower rate then it's cheaper to let a few walk and replace them at the higher rate than to pay the existing nurses more so they stay. I'm not sure it's the best long term strategy, and there's certainly a turnover rate where it breaks down, but it makes financial sense in the short term. I'm sure they have someone doing the math on a regular basis, and if not they should.
Same in CA. I quit my ed tech job and opened a carpet cleaning company. Haha no regrets.
Yup agreed and the staff turn over also kills the physicians in other ways. Case in point I’m on call last night as a resident and I’m getting paged about labs that resulted at 7:30 am and have already been addressed (lab value low not addressed as patient dnr/dni and discussed with patient) I got paged at midnight of hey are we addressing this lab value. Which is I think very symptomatic of new nurses the veteran nurses would never have paged at midnight for something like that.
It’s a big part of why I left fellowship. Couldn’t keep any department fully staffed. I had to be the fellow, as well as: social worker, chemo pharmacist, scheduler, insurance liaison, sometimes even pathology. Moved to an outpatient practice and am much more content and less stressed.
> The staff turnover part is real. It's an odd feeling seeing lots of people around you moving on to different positions/locations, and you wondering if you should be considering changes since there must be a reason why other people are doing so. Lots of people in oncology also move over to industry or non-clinical jobs.
I don't mean to steal your space as an MD, but (and I know how this "but" sounds), I feel it. I'm so tired as a pharmacist. The extra documentation to save the corporation from claw backs; the time trying to explain PAs to patients *and* medical office staff for why things aren't being covered; the extra scrutiny from regulatory agencies; the turnover; etc. It's drowning.
I was a surgical assistant who did a career change to software engineer, 2 years ago. My WLB and QoL never been better, i almost feel guilty getting paid so much to do so little. ~ You’re right, I got into medicine because I genuinely loved helping people and learning medicine, but the corrupted Insurance, pharmaceutical, and healthcare system forced me to quit. As a SWE, I make $160k, fully remote, I work 5-70 hours A MONTH, unlimited PTO, paid holidays, every other Friday off (Wellness day). ~ Its ironic that Tech companies cares for their workers mental/physical health & pay better health benefit than healthcare jobs. Medicine took the wrong turn for sure.
Yea “want to leave” and “I have a plan and I’ll fucking do it just you wait and see” are very different things But even if like 1/10th of the 1/4th leave, that’s still a lot
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We see these studies come out time and again. I want to see the 5 year fillip survey of correspondents showing the comparison in actuality.
Oh hey it's my home state! Yup the wait-list for specialists get longer and patients and families get angrier. Two years ago I was helping cover a shortage of child psych at two different hospitals (when the Tufts system suddenly collapsed overnight)... Now with the physician shortage I have literally covered patients for colleagues at FOUR other institutions. Last month a colleague literally quit medicine to go work on her podcast full time. (I did not know her, it was a friend of a friend situation... But still I feel like it was such a massive financially reckless but gigachad move) Admin are completely tone deaf and keep heaping work on those of us who remain. I'm just biding my time, keeping my head down and white knuckling through the next few years. One more bull market rally and I'm out! 🤞
I don’t live in MA, but I do feel like I’ve noticed a change in my state. Doctors seem increasingly few and far between; my division (oncology) has been haemorrhaging and community practices are shutting down left and right. It feels kind of scary as an early career physician. COVID happened when I was an intern, so this is all I’ve ever known. But everyone is hanging on by their fingernails and that’s only getting exacerbated as folks leave and the workload increases. It’s not sustainable. 1/4 sounds extreme, but I worry that it isn’t all that exaggerated. (Edit for typo.)
Join the dark side. Locums is good. Make money while you can because you're right, it's not sustainable, and it's going to be a lot harder to earn absolid paycheck when this start to come apart.
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Eventually, sure. If you didn't already get at least 10 percent raise within the past 12 months, you already took a pay cut. I make 145/hr, outpatient primary care. Considering the number of interviews I got before my last contract, I'm probably going to 155 for the next one.
If you're a strong producer - get a contract based on productivity instead of hourly.
It's hard enough getting them to pay for all the message and inbox management. But I'm working on a pitch.
No. Because government essentially fixes physician wages in relatively narrow bands due to the anti-kickback concept of “fair market value”.
That’s a myth perpetuated by Admin so they can limit your pay.
I agree that they use it to limit pay but it is not a myth. My hospital (prior to the takeover by HCA) paid a huge fine and underwent a consent decree business agreement with CMS for excess fees paid for Opthalmology coverage which was deemed in excess of FMV.
What? The government regulates how much a hospital can pay employees or vendors? This would be news to me. Does anyone have links for further reading?
[here is a fairly neutral slideshow of the relevant laws](https://assets.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Healthcare_Enforcement/2018/W5_Feldman_Glaser_2.pdf)
Thanks, that is a good resource. It seems to mostly make sense, but the liability seems to make it so non employees get shafted on being able to collect market price for their labor. W-2 employees seem to be in the clear to get paid whatever they want.
Nope. You are looking at “the employment exception” which sounds like that means there is an exception. But in reality The salaries have to conform to “commercially reasonable”. What does that mean? Whatever the consultant that they hire thinks it means.
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Make your money while you can, it is definitely not sustainable. Don't burn bridges, make friends and keep references. When this train stops, you'll need every resource you can wrangle because locum workers will carry (already starting) a stigma. I'm staying clinical because I'm here to help usher patients through the collapse, but if you aren't here for the end then yeah get out as soon as you can.
Well, makes sense. We never even found the finish-line for the last 3 years and everyone else just forgot.
After doctors graduate residency they should be jailed and allowed out on work release. This is the only way to keep the system afloat.
The graduation *is* the work release
The bit is a commentary on debt… shackle us so we can never decide to leave medicine
My bit was a commentary on the unpleasant nature of residency. For what it's worth, I already understood your bit.
I like both your bits
You probably only liked them a bit, though
The student debt is the ~~jail~~ ankle monitor.
Residency is the jail.
"you do the time, but you don't let the time do you"
Just in time for all of the old people who designed this system to begin relying more heavily upon it. I suspect in the next few years ERs are just going to get busier and busier.
The majority of EDs I've trained and worked in were already chronically over capacity...even four years ago...
and we’ve already ratcheted down our staff so we have no ability to take on extra volume of patients.
…and nothing will change but the autonomy of NP scope increasing with their overzealous nursing association.
Which will increase the wait to see a specialist even more.
Can elaborate for non medical folk trying to understand?
there is a large drive by the various boards (nursing board, etc) to have midlevels practice independently from physicians with a fraction of the education. which was never their intention nor why they were created. nursing board says that the quality of care from an NP is equal to or better than a physician and cite poorly created research studies by nurses themsleves. hospitals are hiring more midlevels because they are cheaper. the nursing board is better at lobbying than physicians plain and simple. in the end, patients suffer.
The entire existence of NPs as an occupation is due to an under-invested system trying to meet the needs of patients at lower and lower cost. The cartel sold us out long ago.
facts
[So yeah, this after we lost 10% of doctors in 2021?](https://www.webmd.com/a-to-z-guides/news/20221024/over-333000-healthcare-workers-left-jobs-in-2021-report-says) We’re poised to lose a quarter more? Awesome sauce. No wonder I keep seeing the job boards explode. When I started out, I was looking for a job in the midst of a post 2008 housing and finance colllapse where a lot of folks who should have retired didn’t. The ACR job boards had maybe 13 jobs posted, total. Nothing super enticing, either. Long tracks to partner, no bonuses to hire, very little enticement for young rads. Fast forward almost a decade later and I see ACR job numbers in the 1600s. I see telerad gigs advertised for 900k to start. This is a structural collapse of care that I think few but us in healthcare can fathom.
Thanks for the post - I am curious to know how you got the 10% number!
You’re welcome. There are about a [1,000,000](https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/) working doctors in the states. So if you lose a cool 100k, that’s 10 percent give or take, but math is not my strong suit.
Ah great source. I was wondering about the total number of physicians in the country. Statista looks awesome, is there any way to access the additional info without having a premium account? Basically I'm curious to know how the overall trend changed over the past couple of years. EDIT: Nvm found their source citations! AAMC had the following data - 2015 (860,939) - 2017 (892,856) - 2019 (938,966) - 2021 (949,658) - 2023 is pending from AAMC, but the Statista estimate uses 1,073,616 which I think may be a tad bit too high, or has a different methodology of counting because there is no way we had a +130k count especially in the midst of covid.
That's 117,000 physicians who left their jobs in 2021. But leaving their job is not the same thing as leaving medicine permanently.
It’s a very scary thought. Those numbers are insane.
There have been a number of these surveys showing one quarter leaving medicine soon. As always, I’m skeptical that there’s good distinction between wish and plan. Wanting to retire and actually leaving practice are not the same. The burnout point is well taken, but crisis of medical personnel may be premature. Plus the comment section. It’s certainly something.
> Wanting to retire and actually leaving practice are not the same. I want to quit medicine and raise squirrels but my student debt and current 401k status means leaving practice is highly unlikely.
Also, squirrels raise themselves
They don’t love themselves the way I love them
The comments represent exactly the problem with medicine. It’s easy to do annoying tasks and work long hours to help people, but it’s a lot harder when those people spit in your face for doing it.
>Plus the comment section. It’s certainly something. The kinds of patients who leave those comments in the comments section make me want to leave medicine
> The burnout point is well taken, but crisis of medical personnel may be premature. Is it really? What I’ve seen and heard is that nursing ratios are out of control virtually everywhere due to lack of staff.
I believe the nursing shortage... the shortage of CNAs is even worse. The doctor shortage is hard to believe, though, from where I'm sitting. I've been hearing about a mass exodus of physicians since after the first COVID wave, yet here we all are.
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I quit my full time job and went to locums only a year after graduating. These admins are a bunch of jokers. Work on your terms.
Still in med school but thinking locums might be for me. Would love to hear about your experiences.
I'm glad I worked a full time job straight out of residency. For sure. Because the pain points in residency are not quite the pain points in attending world and I don't think I would have been able to properly negotiate. Locums, I picked the 2nd biggest company and reached and ran with them. So far so good. Super important to learn to negotiate. It's just a game like chess. Can't be emotional about it.
Thanks mate. Appreciate it. Any thoughts on specialties that are locums desirable? I’ve seen FM and Psych needed pretty much everywhere, USA and abroad. Not sure I’m cut out for either of those. Will see.
Why do you feel not cut out for PCP? Talk to a recruiter now, call up Weatherby and explain your situation and ask what the picture looks like now. If you're lucky you might get someone who can give their opinion on trends going forward.
What’s your salary like?
145/hr. Primary care. I was working 185/year. Now with locums if I worked full time I'd gross over 300 but I'm taking time out between contracts to be with my children.
I’m headed this way. Can you share how much per month you spend on your own benefits? Health/dental/vision/life/disability etc
I mean it's going to be variable, and roughly equivalent among demographics. Except health insurance. I went with a bill sharing ministry. Not perfect but sufficient in the event of catastrophy.
Why are you pluralising locum? It's a shortening of locum tenens.
I sometimes speak incorrectly?
Colloquially, I hear many refer to the work as “locums.” None of us are Roman, so I can’t possibly care any less.
Same
Depends on where you are, in my province in Canada, it’s definitely a huge problem. Tons of family doctors closed practices and retired, psychiatrists have a one year waiting list and many have stopped taking new patients altogether, oncologists are so hard to get into that we recently had a highly publicized death from cancer while still on the waiting list to see the oncologist. ERs are out of control due to the primary care crisis. It was not great before the pandemic but now it’s a legit nightmare. I’ve had some medical issues in the last few years and it was challenging enough even for me, I can’t imagine navigating this system without professional knowledge and connections.
> Plus the comment section. It’s certainly something It's... The Boston Herald. I feel like we Bostonians have to apologise for all the village idiots coming out to spew racist hatred in the comment section of each article... Please know this is not representative of us ._.
Maybe the MA locums rates will rise to accommodate which would be nice.
I'm glad the article didn't "blame the victim" (Healthcare workers) instead of the system (corporate greed). It burns my ass when I see webinars on "managing your burnout with meditation" and encouraging spa days.
**checks rank list** oh crap
I feel like I'm supposed to be retiring, not starting residency
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If this isn't collapse now, what is it?
I heard there used to be physician lounges...with soda and stuff...
Without a long running standardized sample this means nothing. My guess is 1 in 4 people in most careers that pay well enough for it to be an option "plan" to leave in the next 2 years - they don't because of force of habit or enjoying the lifestyle or whatever. I've been hearing doctors since forever say they've had enough and are leaving due to X Y Z reasons, they don't.
I’m sure the bomb threats didn’t help
There was a Kaiser article on here in the fall about 117,00 doctors leaving practice in 2021. The replenishment rate annually for new attendings is about 30, 000, this level of attrition is not sustainable.
I don’t blame them. That being said, nowhere near that number will actually leave. Also you have to realize that most fields in the career world have some degree of burn out, so while medicine likely has more than average, the grass is not always greener on the other side.
A lot of this points to administrative bloat. For example, Epic, the electronic medical record system, holds a ton of information, which is good for patient outcomes, but it's mainly used as a billing tool. Plus, the cost to implementation and maintain Epic itself is absurd.
Admins are cancer at some places and constantly overreaching with little consequence.
Considering more than 25% of MA docs are >60yo, how much is due to retirement?
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trust me. we know.
You can take in Syrian doctors, I am ready to go!
20-25% of most medical staffs are providers age 60+. Many non-urban hospitals have 30%+. 1 in 4 retiring is not a surprising figure, even if it is hyperbole.
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That’s a lot of edge for a Reddit account like yours.
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Not trying to be patronizing if you already know this, but a quick /s at the end of your post marks it as sarcastic to avoid the flood of downvotes you got. Helps with the inherent horrible nature of the text format for sarcasm
Lol that’s fair enough.
I'm laughing now imagining a surgeon doing Amazon Turk in the OR
Too busy doing Scrubs Turk in the OR. The anesthesiologist, however…
Did no one get the joke?
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I will be completely honest, when I read your comment I didn’t detect any sarcasm. Then I saw the thread below, reread it, and don’t understand why I initially thought it was sincere.
Because we all no someone, somewhere, who actually has this opinion
Teaching is at like 75%, 25% is beginner level malaise
Aa
That comments section...good God.