Abstract
Physician shortage is problematic, but the percentage of physicians who left patient care in Switzerland is unclear. We set out to describe this percentage and determine whether gender or language region was associated with leaving patient care. We analysed the National Registry (Medreg) of all physicians who graduated between 1980 and 2009 in Switzerland. Based on the last known working status noted in Medreg, physicians were classified as “probably involved in patient care” or “potentially left patient care”. We drew an unrestricted random sample of 250 from each category. We searched professional directories / social media to classify each sample. Those with undetermined status received a questionnaire that asked their working status. We quantified the percentage of physicians who left patient care and used Poisson and Cox regression to determine rates and the association of leaving patient care with gender, language region, and year of graduation. We identified 23,112 living physicians in Medreg in 2015. Of these, 18,406 (79.6%) were probably involved in patient care and 4706 (20.4%) had potentially left patient care. In the random sample of 250 physicians probably involved in patient care, 237 were involved in patient care, 11 had left and the status of 2 was undetermined (0.8%). In the random sample of 250 physicians who had potentially left patient care, 109 were involved in patient care, 109 had left, and the status of 32 was undetermined (12.8%). We estimated that 13.6% of physicians had left patient care (95% confidence interval [CI] 11.1–16.1%). According to the most realistic scenario, the rate of physicians who had left patient care was 1.2 per 100 physicians/year (95% CI 0.9–1.6) for those who had graduated between 1980 and 1994, and 1.8 per 100 physicians/year (95% CI 1.4–2.3) for those who graduated between 1995 and 2009 (adjusted hazard ratio 1.74, 95% CI 1.12–2.71). There was no evidence that the risk of leaving patient care was associated with gender or language region. Approximately one in seven physicians in Switzerland who graduated between 1980 and 2009 left patient care. Leaving patient care was not associated with gender, but the probability of leaving patient care was increased considerably in physicians who graduated more recently. Interventions that aim at keeping physicians in the work force and encourage their return to practice are sorely needed.
Highlights
Physician shortage is an increasing problem in many countries
In the random sample of 250 physicians probably involved in patient care, 237 were involved in patient care, 11 had left and the status of 2 was undetermined (0.8%)
Leaving patient care was not associated with gender, but the probability of leaving patient care was increased considerably in physicians who graduated more recently
Summary
Physician shortage is an increasing problem in many countries. Too few young physicians enter the profession, and many practicing physicians leave patient care. There is much debate over why physicians leave practice, and reasons may differ across countries and healthcare systems. As the medical profession has become more feminised [1], media and politicians have often assumed a causal link between feminisation and physician attrition. A politician in the UK recently warned that “female doctors are putting a strain on the NHS” [2]. A US study speculated that female physicians are less productive because they work fewer hours [3]. A systematic review in 2014 found that women physicians spent more time with their patients and that any negative effect feminisation has on the workforce is probably small [4]
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