While the number of physicians working with Medicare patients increased between 2013 and 2023, Medicare’s exit rates in rural and underserved areas also increased, according to a recent analysis of Medicare claims data published in JAMA.
The analysis was conducted by Christopher Whaley, PhD, of Brown University in Providence, R.I. The analysis utilized Medicare fee-for-service data between 2013 and 2023. Researched calculated the number of physicians participating in Medicare over this 10 year period and used multivariable logistic regression to examine associations between program exit that accounted for physician sex, age in 2013, National Provider Identifier enumeration after 2013, specialty, practice location’s county-level metropolitan status, Health Professional Shortage Area status in 2023, and state fixed effects, as well as percentage-point correlates of the likelihood of program exit.
Here are five takeaways from the study:
1. The proportion of physicians participating in Medicare overall grew by 6.3% from 2013 to 2023. But physicians living in nonmetropolitan counties were more likely to exit the program compared with their metropolitan counterparts, as were physicians living in either full or partial HPSAs when compared with metropolitan physicians.
2. While burnout and early retirement were heavily discussed during the COVID-19 pandemic, the analysis suggests only a “modest increase” in Medicare exits during the pandemic, Dr. Whaley said in an Oct. 20 report by Medpage Today.
3. “There certainly was an increase in physicians leaving the workforce during COVID … but [it is] not substantially different from what we’ve seen in the pre-COVID period,” he noted, adding that this was a “little surprising.”
4. The disproportionate increase in exit rates in HPSA and rural areas is the larger concern, Dr. Whaley said. The researchers found that physicians who were female, older and working in primary care were all more likely to exit Medicare when compared with other physicians. Female physicians left Medicare at a rate of 3.16%, compared with 2.39% for male physicians. Dr. Whaley noted that female physicians are overrepresented in primary care compared with other specialties, so these exits may “go hand in hand.”
5. Dr. Whaley noted that female physicians earn roughly $2 million less over a 40-year career period than their male counterparts, which suggests finances may contribute to them leaving the Medicare program.
