No Exit: An Evaluation of Measures of Physician Attrition

Abstract

Objective. To validate physicians' self‐reported intentions to leave clinical practice and the American Medical Association (AMA) Masterfile practice status variable as measures of physician attrition, and to determine predictors of intention to leave, and actual departure from, clinical practice. Data Sources. Survey of specialist physicians in urban California (1998); the AMA Physician Masterfile (2001); and direct ascertainment of physician practice status (2001). Study Design. Physicians' intention to leave clinical practice by 2001 (self‐reported in 1998) was tested as a measure of each physician's actual practice status in 2001 (directly ascertained). Physician practice status according to the 2001 AMA Masterfile was also tested as a measure of physicians' actual practice status in 2001. Multivariate regression was used to predict both physicians' intentions to leave clinical practice and their actual departure. Data Collection/Extraction Methods. AMA Masterfile data on 2001 practice status were obtained for 967 of 968 physician respondents to the 1998 survey. Actual practice status for 2001 was directly ascertained for 957. Principal Findings. The sensitivity of Masterfile practice status as a measure of actual departure from clinical practice was 9.0 percent, and the positive predictive value was 52.9 percent. Allowing for a two‐year reporting lag did not change this substantially. Self‐reported intention to leave clinical practice had a sensitivity of 73.3 percent and a positive predictive value of 35.4 percent as a measure of actual departure from practice. The strongest predictor of both intention to leave clinical practice and actual departure from practice was older age. Physician dissatisfaction had a strong association (OR=5.6) with intention to leave clinical practice, but was not associated with actual departure from practice. Conclusions. Our findings call into question the accuracy of both AMA Masterfile data and physicians' self‐reported intentions to leave as measures of physician attrition from clinical practice. Research using these measures should be interpreted with caution. Self‐reported intention to leave practice may be more of a proxy for dissatisfaction than an accurate predictor of actual behavior.

Patterns of physician retirement and pre-retirement activity: a populationbased cohort study

“…Where such evidence exists, it suggests that self reporting projects a substantially higher rate of retirement (and at an earlier age) than has been observed using licensure data. 10,11 However, where selfreporting may overestimate retire ments, licensure data may underestimate them, either because of a lag in obtaining uptodate information 12 or because phys icians may maintain active licences without delivering any sub stantial quantity of clinical care. 10,11 Understanding what physicians are doing in the years leading up to retirement is also important, and literature in this area is similarly limited.…”

How Respected Family Physicians Manage Difficult Patient Encounters

“…7,34 Although we did not directly ask our participants whether experiencing difficult patient encounters led to burnout, or consideration of leaving clinical practice or early retirement, other research would suggest that dissatisfaction with practice, which is closely tied to physicians' ability to manage their day-to-day patient interactions 40 may lead to such outcomes. [45][46][47] Advice for physicians' self-care includes ideas suggested by our participants, such as Balint or support groups, retreats, and finding a colleague confidante to help alleviate the frustration and conflict. 45,48,49 Ultimately, physician management strategies may not succeed and the physician-patient relationship may be terminated.…”

Geographic Maldistribution of Primary Care for Children

“…The upper age limit was chosen to reflect the strong tendency for physicians Ͼ65 years of age to limit their clinical efforts or to retire entirely and the inability of the Masterfile to pinpoint retirement accurately otherwise. 8 General pediatricians were identified on the basis of their specialty designation in the Masterfile when it was accompanied by no medical or surgical subspecialty designation (for instance, a general pediatrician with a secondary designation in pediatric cardiology would be excluded). Pediatricians with a subspecialty designation were excluded because of the focus of this study on primary care distribution for children and an inability to quantify the primary care role, if any, of individual subspecialists.…”