Sex Differences in Physician Attrition from Clinical Practice Across Specialties: A Nationwide, Longitudinal Analysis

Abstract Background The USA faces a predicted shortage of 36,500 physicians by 2036, with an increasing proportion of physicians leaving clinical practice or expressing an intent to do so. Female physicians have known differential workplace experiences, and prior studies have demonstrated higher attrition rates by sex in specific specialties. Objective To characterize nationwide hazards of attrition from clinical practice by physician sex across specialties. To describe the relative age at attrition by sex among physicians who leave clinical practice. Design Nationwide, longitudinal study based on national Medicare administrative data. Setting and Participants Physicians across clinical settings who provided care to Medicare patients from 2013 to 2023. Measurements Time to attrition from clinical practice. Results The sample consisted of 707,934 physicians of which 217,013 (30.7%) were female. Over the study period, female physicians had a higher likelihood of clinical practice attrition (HR: 1.43 (95% CI: 1.41, 1.44) compared to male counterparts across physician ages. Hazards of attrition were additionally greater for female physicians across multiple specialty categories (HRs ranging from 1.26 (9% CI: 1.23, 1.28) for hospital-based specialties to 1.72 (95% CI: 1.65, 1.78) for psychiatry specialties) and in both rural (HR: 1.42 (95% CI: 1.37, 1.47) and urban areas (HR: 1.43 (95% CI: 1.41, 1.44). Among physicians who left clinical practice, the median (IQR) age at attrition was significantly lower for females than males (49 (39–61) vs. 64 (53–70) years). Conclusions US female physicians are significantly more likely to leave clinical practice than male counterparts at every age, across specialties and practice locations. Among physicians who leave clinical practice, female physicians are younger when they do so. Given projected clinical workforce shortages, health systems and policymakers should pursue interventions and policies that mitigate the concerning trends identified.