Physician Transitions Out of Clinical Practice: Age, Sex, Generational and Specialty Effects
Erin FraherAbstract
Introduction
Estimates of physician workforce attrition typically rely on Medicare claims data, which cannot distinguish reasons for exit from clinical practice. We used licensure data to examine how age, sex, generational cohort, race/ethnicity, specialty, and rural practice location are associated with retirement and temporary exit from clinical practice.
Methods
We analyzed 636,418 physician-year observations from 74,271 physicians licensed in North Carolina from 2005-2024 (excluding 2020-2021), using logistic regression to model a physician's first transition into retirement and first temporary exit.
Results
Female physicians had higher odds of temporary exit than male physicians, particularly at younger ages. Compared to male physicians the same age, female physicians age 35 and younger had nearly 10 times the odds of temporary workforce exit, compared to 2.4 times the odds at ages 56-65. Primary care physicians had higher odds of temporary exit but not retirement, while rural physicians had lower odds of both.
Conclusion
Licensure data reveal attrition patterns obscured in claims-based studies. As the nation faces a projected physician shortage, expanding reentry pathways for physicians who temporarily leave practice, particularly female early- and mid-career physicians, represents an important but often overlooked policy lever.