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One-Third of Physicians Intend to Leave Academia

Jan 31, 2024 7:16 pm

A cross-sectional survey of academic physicians shows that approximately one-third intend to leave their institutions in the next two years. Burnout, lack of professional fulfillment, and other personal and organizational factors were associated with intention to leave.

A survey was adminstered to 37 511 attending-level medical specialists at 15 academic medical institutions between May 2022 to March 2023.

Of the nearly half (n=18 719) of academic physicians who responded, 6903 (37.9%) met criteria for burnout and 7301  (39.3%) for professional fulfillment; and 5177 (32.6%) reported moderate or greater intention to leave (ITL). Burnout, professional fulfillment, and ITL varied across specialties.

Burnout was associated with a 52% greater odds of leaving; as each 1-point increase (range 0-10) in burnout was associated with ITL (odds ratio 1.52 [95% CI, 1.49-1.55]). Depression (OR, 1.08) and and negative impact of work on personal relationships (OR, 1.09) were directly associated with ITL.

Factors weighing against intention to leave included supportive leadership behaviors (OR, 0.83), peer support (OR, 0.93),personal-organizational values alignment (OR, 0.81), perceived gratitude (OR, 0.95), COVID-19 organizational support (OR, 0.88), and electronic health record helpfulness (OR, 0.95).

Nearly one-third of academic physicians intend to leave academia within 2 years. Comprehensive measures are needed to overcome the contributors to this threat.

Join The Discussion

Eric Ruderman, MD

| Jan 31, 2024 8:51 pm

I have to say it’s somewhat frightening, but not terribly surprising, where rheumatologists land on professional fulfillment in Figure 2. i believe it speaks to the lack of respect we feel from our institutions.

Jack Cush, MD

| Jan 31, 2024 10:38 pm

I agree w/ Dr. Ruderman. If you look at Fig 1 in the paper, rheumatology is in the top quarter, with ~36% intending to leave academia. Moreover, Fig. 2 shows rheumatology with the lowest in professional fulfillment, while being in the top quartile of burnout scores! What drives these numbers? Is it a lack of respect? Based on the comparators, its not salary, nor cognitive specialty or patient care?

I've been surprised by people who stay in academia but have salaries circa 1998 up til this day. I have a feeling it is more about having respect, being appreciated, and being allowed to do what they love. I've also seen situations where the university does not have a base salary because they feel that you are being lent the name of the university is sufficient for you to stay, and expect physicians to generate money as if they were in private practice (but still the dept taxes, and clinic overhead still applies) - some stay because of other benefits (kids can go to college for free IF THEY GET IN, or some kind of loyalty towards the university). But of course, for the segment of people who really need the money, or feel that their division chiefs really don't appreciate what they do (lack emotional intelligence among other things), they eventually realize that they have to quit academia or move to another academic center with better salary structure and support.

Ann Chauffe

| Feb 01, 2024 9:03 am

As someone who just left academia, I think the biggest issue is that we’ve become hospital employed physicians with RVU goals higher than some of my private practice colleagues, but lacking a commiserate salary. Academic endeavors are minimally supported and essentially done on personal time given the clinical burden. This was not feasible with a family at home.

Kathryn H. Dao, M.D.

| Feb 01, 2024 9:03 am

It's getting harder to practice medicine. The cause of physician burnout is multifactorial: loss of autonomy, flexibility, and authority to manage their patients are huge factors and impacted by work and family demands. When physicians are asked if they want more money or time off, the majority would choose time off. While the authors did not show the analysis, I suspect there are gender disparities in the results as well.

Cummins Lue

| Feb 01, 2024 9:44 am

Keep in mind that some young academic physicians see their employment only as a temporary stepping stone to a permanent position in the private sector. The poor reimbursement in academic institution compared to non-academic positions in the same community adds to the sense of not being appreciated. Furthermore, academic physicians involved in basic science have the enormous burden of applying for outside funding which is often unsuccessful.

I agree with everything said. When in academia, there was also less support infrastructure to do the work than there is in the private sector, so I was prepping injections, checking in my own patients at times, typing all my consulting letters (when we did things on paper), all valuable time that could be put towards other endeavors. I also personally would say that I have achieved levels of ‘academic’ fulfillment in industry while still being able to contribute to my academic institution and trainees in my adjunct position. Lastly, teaching is not really remunerated and doesn’t satisfy the bean counters that have also invaded the academic space. Physicians in academia are always being asked to accomplish more and more with less and less. For rheumatologists too, the number of patients out there that need to be seen just once leads to packed clinic schedules and burnout. Those that are successful getting research funding increasingly leave the clinical duties behind such that the few left in the clinic are even more burdened. Lastly rheumatology has become an incredibly competitive specialty and yet we are not training enough rheumatologists.

Karina Torralba

| Feb 06, 2024 3:23 pm

I agree with everything that's been said. But even for academics that stayed for the long haul - just be aware you are just another (for profit or non profit) corporate employee & are subject to the whims of people in the C Suite, the higher ups in division/department, or the board of the faculty medical group. Don't get me wrong, I've had a very successful career in academia. But I lived by the mantra for the last 14-15. years that No One Is Indispensible - that goes for any career/job that you take. I made the most of my time in whatever role I established or was assigned to do be it fellowship PD, div chief, clinical trials head, etc. I was lucky to have a Dept chair who understood our needs & with evidence based negotiation gave me almost everything I wanted for my faculty including higher salaries c/w the rest of the country. Pay attention to who your direct bosses are - don't rely on titles. See/Ask how they work with & value people and if they advocate for their people - if they score low, don't waste any more time where you are at or applying for that job. Get mentors who are in tune with the times - you will need different mentors at different times of your career.

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The author has no conflicts of interest to disclose related to this subject