• Ryan O'Connell, Fatima Hosain, Leah Colucci, Bidisha Nath, and Edward R Melnick.
• From the Yale University, New Haven, Connecticut (RO); Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut (FH, LC, BN, ERM); Department of Biostatistics (Health Informatics), Yale School of Public Health, New Haven, Connecticut (ERM).
• J Am Board Fam Med. 2024 Jan 5; 36 (6): 105010571050-1057.

BackgroundPhysician departure causes considerable disruption for patients, colleagues, and staff. The cost of finding a new physician to replace the loss coupled with lost productivity as they build their practice can cost as much as $1 million per departure. Therefore, we sought to characterize drivers of departure from practice with the goal of informing retention efforts (with a special emphasis on the connection between electronic health record (EHR)-related stress and physician departure).MethodsThis qualitative study of semistructured interviews was conducted between October 2021 and April 2022 among 13 attending physicians who had voluntarily departed their position from 2018 to 2021 in a large multispecialty, productivity-based, ambulatory practice network in the Northeast with a 5% annual turnover rate to understand their reasons for departing practice.ResultsAmong the 13 participants, 8 were women (61.5%), 3 retired (23.1%), and 6 (46.2%) left for new positions. Major domains surrounding the decision to depart included current features of the health care delivery landscape, leadership/local practice culture, and personal considerations. Major factors within these domains included the EHR, compensation model, emphasis on metrics, leadership support, teamwork/staffing, burnout, and work-life integration.ConclusionsOpportunities for medical practices to prevent ambulatory physicians' turnover include: (1) addressing workflow by distributing responsibility across team members to better address patient expectations and documentation requirements, (2) ensuring adequate staffing across disciplines and roles, and (3) considering alternative care or payment models.© Copyright by the American Board of Family Medicine.

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