Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Ophthalmology, Augusta University Medical College of Georgia, Augusta, Georgia.
Ophthalmology. 2023 Sep;130(9):973-981. doi: 10.1016/j.ophtha.2023.05.003. Epub 2023 May 8.
Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover.
Retrospective cross-sectional study.
Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021.
We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic.
Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next.
Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021).
One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
医生离职对医疗保健系统来说代价高昂，并且由于护理的连续性中断，会影响患者的体验。本研究旨在评估眼科医生离职的频率，并确定与离职相关的医生和实践特征。
回顾性横断面研究。
2014 年至 2021 年期间，美国医疗保险和医疗补助服务中心医师比较和医师及其他供应商公共使用文件中纳入的在职眼科医生。
我们收集了与实践/机构相关的每位眼科医生的数据，然后计算了每年在每个年份窗口中的离职率，以及从 2014 年到 2021 年的累积比例。多变量逻辑回归分析用于确定与离职相关的医生和实践特征。我们还评估了围绕 2019 年冠状病毒病（COVID-19）大流行的离职特征。
眼科医生离职，定义为眼科医生的国家提供者标识符（National Provider Identifier）实践隶属关系从一年到下一年的变化。
在与 3306 个独特实践相关联的 13264 名眼科医生中，有 34.1%的医生在 2014 年至 2021 年间至少与 1 个实践分离。年度离职率从 3.7%（2017 年）到 19.4%（2018 年）不等，平均离职率为 9.4%。与离职增加相关的因素包括个体执业（调整后的优势比 [aOR]，9.59）、大学附属机构（aOR，1.55）、东北部的执业地点（aOR，1.39）和 2 至 4 名成员的执业规模（aOR，1.21；所有 P<0.05）。与离职减少相关的因素包括男性（aOR，0.87）和超过 5 年的从业经验：6 至 10 年（aOR，0.63）、11 至 19 年（aOR，0.54）、20 至 29 年（aOR，0.36）和≥30 年（aOR，0.18；所有 P<0.05）。在 COVID-19 大流行的第一年（2020 年），年度离职率从 7.8%增加到 11.0%，然后在疫苗接种后时期（2021 年）降至 8.7%。
2014 年至 2021 年期间，三分之一的美国眼科医生至少与 1 个实践分离。离职模式因各种医生和实践特征而异，这可能用于制定未来的劳动力稳定策略。由于管理数据不能单独确定离职的原因，鉴于潜在的临床和财务影响，进一步的调查是必要的。
