The healthcare workforce is on the brink of experiencing high staff turnover rates, indicative of what is being deemed the "Great Resignation’, a new American Medical Association-led study suggests.
Among survey respondents, one in five physicians and two in five nurses said they intend to leave their current practice within two years, the study found. Additionally, about one-third of physicians and nurses reported their intention to reduce clinical work hours in the next 12 months.
Intention to leave an individual’s practice within two years was highest among nurses, advanced practice providers, other clinical staff and physicians. It was lowest among administrators.
“Because multiple studies have demonstrated that intent to leave among physicians correlates with actual departures, these findings are of concern,” the study stated. “Costs of replacing healthcare workers are also substantial. Replacing a nurse may cost up to 1.2 to 1.3 times their annual salary. Replacing physicians may cost $250,000 to more than $1 million per physician. The aggregate cost of physicians reducing or cutting back attributable to burnout alone is estimated at $4.6 billion annually in the United States.”
Who could blame them? Honestly, I think that if it weren’t for student loans and the limited non-clinical options for medical doctors, more would have left. As for nurses, most are still women, especially those who are older, often in a financial position of being the secondary income in the household. Plus there are a lot of non-clinical options for nurses, and many clinical options that are not “Covid-facing”. The younger ones who don’t have little children at home are either quitting to do travel nursing at thrice the pay, or considering it.
For those who are working in the Covid ICUs, I can only imagine the burnout, having spent the past 20 months or so helplessly watching their patients slowly suffocate to death - and for the past 9 months or so, most of those patients have been people who refused to get immunized. Their battle fatigue is unfathomable.
For the US, there is a bottomless well of foreign-trained nurses and doctors, but for nurses, they must pass the NCLEX exam/boards, and for doctors, they must do residency training in the US, which takes a minimum of three years, and pass the relevant boards. Fortunately, there’s an endless supply of homegrown nurses and doctors. There are still many more qualified applicants for nursing and medical school in the US than there are spots available.
The point is there isn’t an “endless supply” of homegrown doctors and nurses. It takes a minimum of 3-4 years to train a nurse. It takes 7+ years to train a physician. That training lag mean some staff positions are going to go unfilled. This means that more doctors and nurses are going to assigned non-voluntary, non-optional overtime (which, in turn, generate more burn-out and more stress). It’s already happening. D1 reports that at 3 of the 4 hospitals she works at that nurses and doctors (mostly nurses) are already being assigned additional mandatory overtime work shifts to cover staff shortages.
As for foreign-trained physicians–they still need a minimum of 3 years of US residency (6, if you want them to critical care boarded) and there are only a limited number of residency slots available–all of which are already filled with US MD and DO grads, US IMGs and FMGs in the training pipeline. You can’t just take create new residency slots out of thin air. (Not to mention that someone has to fund those slots and the US Congress hasn’t approved an increase in the number of residency slots funded since the early 1990s.)
I’m wondering how many of those leaving these professions are near enough to retirement age, or at retirement age…that they are just leaving a little earlier than they might otherwise have.
Does this study give age demographics for those leaving? I see that those practicing >20 years were more likely to leave. Is that surprising?
It’s pandemic frustration talk. Intentions and actions are not aligned. This too shall pass.
This is very similar to what we’re seeing in schools with all sorts of workers, from teachers to bus drivers or cafeteria staff.
Covid hits the older generations hard. Why risk it if you have other options?
Makes perfect sense to me TBH.
We hear constantly how medical school admission requires a near perfect GPA, shadowing experiences, etc. Maybe it’s time to let interested students who aren’t picture perfect but who have the smarts to succeed, into medical school. why keep so many out?
Many medical schools do a first cut using MCAT and GPA, but actual acceptances are more holistic, looking at the whole application and taking the interview into account.
Plus, I’m not sure “who” goes to medical school would solve the problem of people leaving the profession earlier than some think should happen.
Adding…for some who have been working as docs for over 20 years, they could easily be in their mid-50’s and planned well for an early retirement. Also, maybe some of the younger folks are leaving or reducing hours because they are starting families and wish to be home.
More people in could eventually make up for more people out.
There is already a shortage in many areas. Allowing more into these professions to start with should allow for increases in numbers in the professions. Let’s say we double the number of admitted students, not that it would probably happen, then that would certainly increase the providers eventually. I don’t see numbers of healthcare workers needed declining.
There ARE more people going to medical school now. There has been an increase in the number of MD and DO schools @WayOutWestMom probably has the statistics.
But since anyone admitted to med school today won’t be ready to be fully licensed for at least 7 years, this won’t sold a problem that is happening…now.
Is this in line with what has been happening all over…people leaving their jobs? I recently heard that a lot of this is due to early retirement.
I see it in the schools too. There are no subs, no bus drivers, people retiring now instead of in a few years, etc. I even see it with younger educators who have decided to leave the field entirely. Covid…on top of all of the crazy demands from the state, difficult parents, children with significant mental health issues sitting in classes with teachers who are not properly trained to handle the issues (listening to one of many videos assigned to us in September is not the solution) is really taking a toll…
Admitting more into medical and nursing schools won’t solve the problems that we hear about today…right now.
Have relatives that are nurses, some old and some new. A big thing now is contract nursing. They give up their standard job and work for a staffing agency who finds them work. Nephew just signed a 34 week contract at a hospital for about 3x the pay he was receiving. No benefits but he can buy health insurance and invest on his own and still be ahead.
Know a trauma surgeon who does this too. He’s guaranteed x hours per week and is only called in when there’s a trauma patient. He was in Chicago and was slammed but has moved to the suburbs and it’s quiet. Still gets paid for a guaranteed number of hours. Most weeks doesn’t work that much. Was getting burned out in Chicago. Says this is becoming quite common. It’s like he’s an independent consultant and picks contracts when he wants. Otherwise he’d leave medicine.
Would guess this is pretty much exasperation related to all things COVID-related. But with the huge debt most physicians carry, unlikely they’d quit.
Those are the ones that become into PA’s or Nurse practitioners. Less renumeration than Doctors, but they still do very well, and take on a good share of a Doctors workload.
As to reasons for quitting? In my area, the providers had to beg for proper masks and equipment during the height of the pandemic, contend with a sizable minority(actually a majority in the ER) that refuses to vaccinate themselves, and countless other factors that have made a tough job tougher.
Including patients demanding certain medications that show no therapeutic benefits, and healthcare workers across all fields being attacked verbally and physically.
We know 3 physicians who are quitting: NICU, Cardiothoracic and Anesthesiologist. All are mid 50s and have wanted to quit long before Covid. The ones we know are not leaving because of Covid fatigue; they’re leaving because of 2 words: Health Systems. They’ve had it with the bureaucratic mega system takeovers
The issue with nursing is that only now are people really starting to sit up and finally take notice of our staffing issues and burnout rates (thanks to the spotlight of Covid). These issues have been present for the 20+ years that I’ve been a nurse - nurse/patient ratios have always been an issue for as long as I can remember. Many experienced bedside nurses grow tired of it and either go back to school to become NP’s, or leave the bedside all-together. We get tired of raises being dependent on Press-Gainey scores. We get tired of the verbal and physical abuse. We get tired of having to skip meal breaks. The list goes on. Throw Covid into the mix where all of that and more gets exponentially worse and we are just fried. It also gets old when people who have never even set foot in a hospital during Covid talk like they know exactly what we are experiencing day in and day out.
The other issue is that brand new grad nurses typically are not able to hit the ground running. They need several weeks to a couple of months’ orientation (depending on clinical area) to be able to start to feel competent enough to be on their own to care for a full assignment. Due to staffing issues, many are not getting that and are burning out within their first year. Very unfair to the new grad nurses.
We are also seeing big sign-on bonuses to start a new job elsewhere when our current employers cannot even provide a COL raise that can keep up with inflation.
While Covid has definitely brought these issues more to the surface, they have been ongoing for many years. Nothing is new here.
So many issues with this.
the number of MD seats has increased 30% since 2001; the number of DO seats has increased 45% since 2001
medical schools require more than just classrooms and laboratories. Student need clinical preceptors (physician instructors) and access to a diverse group of patients with a range of illnesses, injuries and disabilities. It’s the latter that’s hard to come by.
just graduating from medical school isn’t enough. Med grads need to complete a medical residency before they are able to practice independently. (Residency is where med grads learn how to “be” doctors.) Medical licensing requires completing a minimum of 1-3 years of residency. (varies by state) Getting malpractice coverage and being able to get reimbursed for one’s services by insurance companies and medicare/medicaid requires having board certifications. (Which means completing a 3-10 years residency+ fellowship PLUS passing a series of oral and written exams)
the number of medical residencies has not increased since the early 1990s. Why? because Congress has consistently voted not to increase funding for residency training. (Nearly all medical residencies are funded by Medicare.) Letting more people into med school does no good if they can’t get a residency position.
My daughter (a EM doc) says that everyone who has 2 thumbs and a cell phone is now convinced that know more about how to do her job than she does.
Congress authorized an additional 1000 GME postions:
Congress Passes Historic GME Expansion | AAMC
There are residency slots for virtually every graduate of a US medical school-but everyone can’t be a dermatologist(many available IM or FP, for example). It’s the international graduates who have the most trouble finding residency slots. US grads-with many FP positions unfilled-93% match rate; IMGs about 55%.
2021 Match hits record highs despite pandemic’s disruptions | American Medical Association.