America’s physician shortage is no longer a distant projection. It is happening now, steadily, one resignation, early retirement, and practice closure at a time.

A nationwide, longitudinal analysis published in Annals of Internal Medicine tracked more than 712,000 physicians caring for Medicare patients over a decade and found a troubling trend: Physician attrition from clinical practice rose from 3.5 percent in 2013 to 4.9 percent in 2019, across every specialty, region, age group, and gender. That increase may sound modest, until it is paired with projections estimating a shortage of up to 86,000 physicians by 2036.

What makes this study particularly sobering is not just the numbers, but where the losses are concentrated. Psychiatry, primary care, and obstetrics/gynecology (the specialties most dependent on time, continuity, and trust) showed the highest attrition rates. Psychiatry alone rose from 7.4 percent to more than 10 percent during the study period, rivaling OB/GYN at the top of the list. Female physicians were 44 percent more likely to leave practice than male colleagues, and rural physicians faced a 19 percent higher risk of attrition.

These are not marginal effects. They are structural fault lines.

The moral injury beneath the metrics

The study’s authors are careful not to reduce physician departure to individual weakness or burnout alone. Instead, they point to systemic pressures that have become ubiquitous: electronic health record burden, inadequate staffing, insurance barriers, and workflow constraints that leave physicians knowing the right thing to do for a patient but unable to do it within the system’s rules. That experience has a name: moral injury, and it has been a growing focus of attention, particularly as distinct from burnout.

As one of the study’s senior authors notes, physicians are stretched thin trying to care for increasingly complex patients in ever-shorter visits. When the system repeatedly blocks clinicians from practicing medicine as they were trained to do, leaving becomes a rational act of self-preservation rather than a failure of resilience.

The data support this interpretation. Physicians caring for more complex Medicare patients (those who are older, sicker, or dually eligible for Medicare and Medicaid) were significantly more likely to exit practice. Hospital-based physicians caring for these populations had a 57 percent increased likelihood of attrition. In other words, the more complex and vulnerable your patients, the higher your risk of being pushed out of medicine due to system constraints.

What the headlines miss, especially in psychiatry

Yet even this robust analysis leaves important questions unanswered.

Attrition in the study was defined by the absence of Medicare billing for three consecutive years. That is a defensible, pragmatic metric, but it may misclassify entire segments of psychiatric practice. An increasing number of psychiatrists have left insurance panels entirely, moving to cash-based, hybrid, or psychopharmacological-heavy practices precisely because reimbursement, administrative burden, and utilization management have made insurance participation untenable. However, leaving Medicare billing is not the same as leaving clinical practice.

At the same time, many psychiatrists report that even remaining in practice has become increasingly precarious. In large metropolitan markets, particularly in mental health, armies of poorly supervised midlevel clinicians, relaxed telehealth restrictions, and aggressive private equity consolidation have disrupted continuity of care and destabilized longstanding practices. Physicians describe competing in oversaturated markets while reimbursement stagnates, regulatory demands intensify, and quality oversight falls disproportionately on those already drowning.

This is not an argument against team-based care or telemedicine. It is an indictment of systems that expand access without safeguards, supervision, or accountability while expecting physicians to absorb the downstream harm.

Why women and rural physicians are leaving first

The study’s finding that female physicians face substantially higher attrition risk deserves particular attention. Women physicians are more likely to shoulder caregiving responsibilities, more likely to experience workplace inflexibility, and more likely to practice in fields requiring prolonged emotional labor. Yet they work within systems still designed around outdated assumptions of availability, endurance, and sacrifice.

Similarly, rural physicians practice closer to the edge of capacity. They serve sicker patients with fewer resources, fewer colleagues, and less institutional support. When one physician leaves a rural community, there is rarely a backup plan, only longer drives, delayed diagnoses, and deferred care. Attrition in these settings is not just a workforce issue. It is an access crisis.

Fixing burnout is not enough.

The study’s authors appropriately call for system-level interventions: caregiving supports, virtual resources for rural clinicians, and greater physician control over schedules and patient loads. These are necessary steps, but they are not sufficient. What physicians are describing, across specialties and regions, is not simply exhaustion. It is erosion: of autonomy, professional judgment, economic viability, and meaning.

Raising reimbursement for primary care matters. Reforming prior authorization matters. Reducing documentation burden matters. But so does something harder to quantify: restoring the physician’s role as a professional rather than a throughput unit in an assembly line. Until physicians are allowed to practice medicine without constant interference from entities that neither see patients nor bear liability for outcomes, attrition will continue no matter how many wellness modules are rolled out.

When physicians leave, patients pay the price.

Every physician who exits clinical practice leaves behind hundreds or thousands of patients. In psychiatry, where waitlists already stretch for months, those losses are catastrophic. In primary care and OB/GYN, they fracture preventive care, maternal health, and chronic disease management.

This study confirms what clinicians have been saying for years: The physician shortage is not just about training pipelines. It is about retention. And retention depends on whether medicine remains a sustainable profession or becomes an endurance test with no finish line.

Physicians are not abandoning patients. They are being pushed out by systems that make ethical, thoughtful care increasingly impossible. If we continue to treat attrition as an individual failure rather than a systemic warning, the exodus will accelerate and the access crisis will deepen. The data are no longer ambiguous. The question now is whether we are willing to act on what physicians have been telling us all along.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Against the Tide: A Doctor’s Battle for an Undocumented Patient.