Written by Jason Lesnick
On average, female EM physicians leave clinical practice 12 years younger than their male counterparts, after fewer years of practice, and the amount of time spent in the workforce is decreasing over time. We need to identify and implement systemic fixes to stop this.
We need to support our colleagues
Diversity matters and improves patient outcomes. This study showed a higher mortality for female patients with heart attacks when cared for by a male physician and when male physicians had more exposure to female physicians, these differences were smaller. There’s evidence patients cared for by female internists have lower mortality and 30-day readmissions compared to male internists.
The study we’re reviewing today utilized CMS and ABEM data to analyze rates of attrition in EM physicians from 2013-2020 by gender (the data set uses gender and sex interchangeably), age, and median number of years since residency graduation. In 2013 there were 24,832 (6,753 female, 18,079 male) practicing EM physicians and by 2019 there were 30,442 (9,135 female, 21,307 male) practicing EM physicians.
Of those, 8,368 EM physicians (2,463 female, 5,905 male) met the definition of leaving the workforce (defined here as an absence for at least 3 consecutive years). The female physicians left the workforce at a median age of 44.0 years (IQR 38.0-53.9) while the male physicians left at a median age of 56.4 years (IQR 44.5-65.4).
The authors found that being categorized as female was associated with attrition from the workforce (aOR = 2.30, 95%CI: 1.82 to 2.91). Of those who left, the median amount of time post-residency that female physicians spent in the workforce prior to leaving was 10.5 years (5.5-18.5) compared to 17.5 years (9.5-22.5) for males. 1 in 10 females left within five years of residency graduation compared to 1 in 13 for males.
They also identified that the median age for both female and male EM physicians exhibiting attrition decreased considerably from 59.2 and 45.6 years in 2013 to 53.5 and 43.7 years in 2019, significantly below prior estimates that generally physician retirement occurs between the ages of 60-69. Keep in mind this data is pre-COVID, and we know that early on in COVID the rates of attrition went from about 5% to 8.2%.
The authors offer some reasons why female EM physicians are leaving: promotion discrepancies, salary deficits, burnout, traditional societal ‘norms’, sexual harassment, mistreatment, and gender bias in the workplace.
How will this change my practice?
Thankfully, some organizations are working to combat this problem and have developed resources that are, in my opinion, a good place to start so we can learn how to help support our female emergency physician colleagues.
Bottom line – this is bad for our colleagues, our patients, and our future. We all need to do what we can to fight this systemic issue.
Emergency medicine physician workforce attrition differences by age and gender. Acad Emerg Med. 2023 Jun 14. doi: 10.1111/acem.14764. Online ahead of print.