Post Pandemic Trends Show Continued Physician Departures from Medicare

A recent study tracking physician activity between 2010 and 2024 shows that the rate at which doctors are exiting traditional Medicare has almost doubled over the past decade, reigniting concerns about the adequacy of the U.S. physician workforce. The results indicate that while the COVID-19 pandemic may have accelerated these exits, the trend continued even after the peak of the crisis, indicating deeper, systemic issues within the healthcare system. 

The analysis included data on 791,025 physicians (mean age, 44.6 ± 12.0 years), focusing on Medicare Part B claims linked to National Provider Identifiers (NPIs). Researchers assessed the number of annual claims billed per physician using 100% of fee-for-service Medicare claims. The study was approved by the University of Minnesota Institutional Review Board and classified as exempt from human subjects’ research. This study was conducted in accordance with the STROBE reporting guidelines. 

Medicare’s Provider Practice and Specialty files were used to classify physicians into the broad specialty groups, such as primary care, surgical, medical, and hospital-based. The size of the group practice was also determined by the number of unique NPIs associated with the same Taxpayer Identification Number. To eliminate discrepancies, the study excluded physicians who billed less than 100 Medicare claims annually. 

Physician “exit” was defined as a full 12-month period without any Medicare claims. With this measure, the researchers found a gradual rise in the exit rate between 2010 and 2013, followed by a period of stabilization between 2014 and 2016. Exit rates increased again between 2017 and 2019, increased further during the COVID-19 pandemic (2020-2021), and remained high in 2023, clearly surpassing pre-pandemic levels. 

The turnover of physicians in Medicare was 1.80% (95% confidence interval [CI], 1.75%-1.85%) in 2010. Since 2023, this number has reached 3.60% (95% CI, 3.56%-3.65%). The primary care physicians (PCPs) had the highest exit rate in 2023 (4.41%; 95% CI, 4.33%-4.50%) when compared to 3.50% (95% CI, 3.42%-3.58%) in hospital-based specialists, 2.99% (95% CI, 2.88%-3.10%) in surgical specialists, and 2.49% (95% CI, 2.40%-2.59%) in medical specialists. Among PCPs, the number of exit rates that increased most dramatically between 2010 and 2023 was age-adjusted, increasing at a rate of 0.21 percentage points (95% CI, 0.20-0.21) per year. This growth was higher than in other specialties: 0.14 (95% CI, 0.14-0.15) percentage points in surgical specialties, 0.08 (95% CI, 0.07-0.09) in hospital-based specialties, and 0.06 (95% CI, 0.05-0.06) in medical specialties. 

While the age-adjusted exit rate was the lowest in 2023 among solo practitioners, 3.16% (95% CI, 3.03%-3.30%). But their rate of exit accelerated annual increases by an increment of 0.18 (95% CI, 0.17-0.18) percentage points per year, in contrast to medium (0.15 [95% CI, 0.14-0.16] percentage points) and big (0.08 [95% CI, 0.08-0.09] percentage points) group practices. This is a possible trend towards more practice consolidation, and it appears more likely as newer physicians become more attracted to enter larger healthcare systems. 

Several factors may be contributing to the growing physician exit rate. These include increasing administrative burdens, including clinical documentation and responding to patient messages via patient portals. Even though declining inflation-adjusted reimbursement rates may also play a role, they are unlikely to fully explain the relatively stable turnover rates observed between 2014 and 2016. 

The author of the study cautions that the results serve as a potential challenge in maintaining an adequate supply of primary care providers in the future, a concern that warrants serious attention. However, the study has limitations: it relies solely on Medicare fee-for-service data and does not differentiate between doctors who retired, abandoned clinical practice altogether, or merely quit billing Medicare. Moreover, it excludes an increase in new physicians to the workforce, thus providing an incomplete understanding of the total physician supply. 

The study provides timely information on evolving patterns within the U.S. healthcare workforce and raises critical questions about the long-term sustainability of physician participation in Medicare. 

References: Neprash HT, Chernew ME. Trends in physician exit from fee-for-service Medicare. JAMA Health Forum. 2025;6(7):e252267. doi:10.1001/jamahealthforum.2025.2267