Rescuing Retention in an Era of Provider Shortages, Burnout, and Turnover

In the newly published AMN Healthcare report, 2024 Survey of Locum Tenens Physicians and Advanced Practice Professionals, we examined the results of a survey of physicians and APPs who have worked on a locum tenens basis sometime in the last 18 months, highlighting a variety of factors impacting the career choices of physicians and APPs. 

The report was conducted during a time of high volatility in the healthcare workforce. Both healthcare provider shortages and high levels of provider burnout and turnover present challenges to hospitals, medical groups, and other healthcare employers seeking to maintain or grow their staffs.

Physician Shortages Have Become a Multi-Faceted Challenge

The shortage of physicians has been well documented and is a result of a number of factors that AMN Healthcare terms the “Seven Ps.”

The “Seven Ps”

1. Population Growth: The U.S. population is projected to grow from 332 million people today to 423 million by 2050.*
2. Population Aging: By 2034, there will be more seniors 65 and over in the U.S. than children 17 or younger, the first time this has occurred. Older people visit a physician at three times the rate of younger people.*
3. Provider Aging: 30% of physicians in active patient care are 60 or older, creating a looming “retirement cliff” in the physician workforce.***
4. Provider Burnout: Burnout among physicians was labeled a public health crisis by the Harvard H.T. Chan School of Public Health prior to COVID-19. Physician burnout and turnover were further driven by the pandemic.
5. Pervasive Ill-Health: 6 in 10 U.S. adults have a chronic medical condition such as diabetes or lung disease, while 4 in 10 have two or more.**
6. Pipeline Problems: Federal funding for physician training was capped in 1997 and has been limited since, restricting the number of new physicians.
7. Practice Styles: Many physicians are embracing practice styles such as part-time, employment, non-clinical roles, and locum tenens that may reduce overall full-time-equivalents (FTEs).

As a result of these and other factors, the Association of American Medical Colleges (AAMC) projects a shortage of up to 124,000 physicians by 2034.

Physician Burnout: A Public Health Crisis

One of the factors driving the physician shortage is not directly related to demographics, public health metrics, or training capacity, but is centered on how physicians feel about their profession. Professional burnout among physicians has been endemic for years and continues to be pervasive. 

A 2022 study published by the Mayo Clinic showed that mean emotional exhaustion scores among physicians increased by 38.6% year-over-year. Overall, 62.8% of physicians had at least one manifestation of burnout in 2021, compared with 38.6% in 2020. 

The study concludes: A dramatic increase in burnout and decrease in satisfaction with work-life integration occurred in U.S. physicians between 2020 and 2021. Differences in mean depression scores were modest, suggesting that the increase in physician distress was overwhelmingly work related. Given the association of physician burnout with quality of care, turnover, and reductions in work effort, these findings have profound implications for the U.S. health care system.

The COVID-19 pandemic was partly responsible for the increased incidence of burnout among physicians found in the study. However, the Harvard H.T. Chan School of Public Health identified physician burnout as a public health crisis in 2019, prior the pandemic.

Physician Turnover on the Rise

One result of pervasive physician burnout is rising rates of physician turnover. Physician attrition rates rose 43% between 2010 and 2018, up from 5.3% to 7.6%, according to a study published in October of 2023 by the Journal of the American Board of Family Physicians. The study, which interviewed physicians who left their ambulatory care practices, found that physicians were motivated to leave their practices primarily to:

1. Increase Time Off
2. Have More Flexibility
3. Achieve Higher Earnings

Physicians included in the study also were driven to leave their current practices by other factors, including isolation, the corporatization of medicine, the pandemic, inbox burden, difficult patients, volume and intensity of work, and advancement opportunities. (Physician turnover more complex than just burnout, study finds. Susanna Vogel, Healthcare Dive, Oct. 20, 2023).

The Road Ahead: Regaining Retention

While many physicians and APPs are embracing alternative practice models such as locum tenens as a result of burnout and other career frustrations, there is a path to reversing this trend of physician turnover moving forward. Asked if they would return to permanent practice if the schedule, compensation, and other aspects of the practice were favorable, 45% of those said that they would. 

The fact that close to half of locum tenens physicians and APPs would return to permanent practice given favorable working conditions underscores the dissatisfaction many of them feel with traditional practice models. 

However, the door is still open for hospitals, medical groups, and other employers to enhance their physician and APP retention rates by addressing the factors that cause providers to turn to locum tenens, change jobs, or retire. These factors include inflexible schedules, inordinate paperwork duties, and convoluted reimbursement formulas.

About AMN Healthcare Physician Solutions

AMN Healthcare Physician Solutions was originally established in 1987 as Merritt Hawkins. AMN Healthcare provides permanent physician, locum tenens, advanced practitioner, plus, leadership, language services, nursing, and allied staffing and search services to hospitals, medical groups, community health centers, telehealth providers, and many other types of entities nationwide.

As a thought leader in our industry, AMN Healthcare produces a series of surveys, white papers, books, and webinar presentations internally and produces research and thought leadership for third parties.