Female physicians stop practicing 15 years sooner than male colleagues, a disparity consistent across specialties and work environments. The median age for women leaving the field is 49, while men continue until 64, according to findings in the Journal of General Internal Medicine.
The same work habits that improve patient care may push women out of medicine earlier.
Longer visits, thorough documentation, and frequent patient messages create a problem. Lisa Rotenstein, a primary care physician at the University of California, San Francisco and the study’s lead author, called this a paradox. Practices that help patients can make the job impossible to sustain.
Rotenstein, who leads UCSF’s Center for Physician Experience and Practice Excellence, found the gap remained unchanged in rural and urban clinics. The research defined leaving as no Medicare billing for three straight years. Women in primary care were especially likely to depart.
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A hazard ratio of 1.55 for female primary care doctors means they were 55% more likely to stop billing Medicare during the study. The first 15 years of practice proved the most critical for keeping physicians in the field.
Earnings and payment structures
Female primary care doctors earn about 80 cents for every dollar male peers make, despite spending more time with patients. The current payment model rewards quantity over quality, putting doctors who prefer longer visits at a disadvantage.
Rotenstein suggested moving to time-based or value-based billing. Replacing a physician costs health systems $500,000 to $1 million, depending on specialty. Yet discussions often ignore the lower cost of keeping doctors through flexible schedules and less paperwork.
Women now make up over half of medical students. Rotenstein argued the profession has to show them clinical medicine is a sustainable path.
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Automated tools, like AI scribes and prior authorization systems, have helped reduce burnout. A Physicians Foundation-funded study found burnout reductions tied to AI scribes across two health systems. Rotenstein said prior authorization and general paperwork are the next frontier.
Clinician-owned practices show lower burnout, but Rotenstein said the variable that matters is agency, and large systems can give some of it back.
The trend threatens to waste years of expertise from a highly trained workforce. Rotenstein argued society has a direct stake in keeping it.
