Physician Intent to Reduce Hours and Intent to Leave Organizations

Importance: The COVID-19 pandemic was associated with a substantial prevalence of physicians intending to reduce their clinical hours (ITR) or intending to leave their current organization (ITL). It is unclear how work intentions have changed since that time. Objective: To characterize how the prevalence of ITR and ITL changed among physicians since the COVID-19 pandemic, factors associated with ITR and ITL, and factors associated with physicians' decision to remain at their current clinical workload or their current organization. Design, Setting, and Participants: This serial cross-sectional study was conducted from January 7, 2022, to November 3, 2024, among 160 organizations across the US with 100 or more physicians across specialties. Physicians responded to the American Medical Association's Organizational Biopsy study in 2022, 2023, or 2024. Main Outcomes and Measures: Main outcomes were ITR within the next 12 months and ITL within the next 24 months. Results: The sample consisted of 37 112 physicians (7176 physicians in 2022, 12 248 in 2023, and 17 688 in 2024; median organizational response rate of 41.5% IQR, 29%-60%; 18 626 of 35 202 male physicians 52.9%) from 160 organizations, including 81.4% physicians (25 381 of 31 182) who identified as practicing clinically full-time. The overall point prevalence of ITR decreased from 25.6% (1489 of 5815) in 2022 to 22.5% (3266 of 14 540) in 2024 (P = .002), while the prevalence of ITL decreased from 19.9% (1345 of 6760) in 2022 to 15.1% (2414 of 15 935) in 2024 (P = .002). Decreases in ITR and ITL were seen across multiple physician groups. In multivariable-adjusted models, female physicians had higher odds of ITR than male physicians (odds ratio OR, 1.11; 95% CI, 1.04-1.20), but lower odds of ITL (OR, 0.93; 95% CI, 0.87-0.99). Part-time physicians had 1.18 (95% CI, 1.09-1.29) times the odds of ITR and 1.35 (95% CI, 1.25-1.45) times the odds of ITL compared with full-time physicians. The most prevalent factors that would make respondents reconsider ITR or ITL-including a desire for increased workflow efficiency, improved staffing, and enhanced compensation-were common across the 2 outcomes. Conclusions and Relevance: This serial, cross-sectional, multisite study of US physicians suggests that while the prevalence of ITR and ITL have decreased since the COVID-19 pandemic, more than one-fifth of physicians continued to report ITR and nearly 1 in 6 reported ITL. In aggregate, compared with historical data, current rates represent mixed progress with favorable overall trends in ITL but unfavorable trends in ITR. Common factors, including greater workflow efficiency and consistent staffing, were reported as potentially mitigating both ITR and ITL. These findings can help leaders prioritize and target interventions to sustain the effort of the physician workforce.