Estimates of costs of primary care physician turnover

To provide estimates of the institutional costs associated with primary care physician (PCP) turnover (job exit).

A cohort of 533 postresident, nonfederal, employed PCPs younger than 45 years of age, in practice between 2 and 9 years, participated in national surveys in 1987 and 1991. Data from a national study of physician compensation and productivity and data from physician recruiters were combined with PCP cohort data to estimate recruitment and replacement costs associated with turnover.

By the time of the 1991 survey, slightly more than half (n = 279 or 55%) of all PCPs in this cohort had left the practice in which they had been employed in 1987; 20% (n = 100) had left 2 employers in that same 5-year period. Among those who left, self-designated specialties and proportions were general/family practice (n = 104 or 37%); general internal medicine (n = 91 or 33%); and pediatrics (n = 84 or 30%). Estimates of recruitment and replacement costs for individual PCPs for the 3 specialties were $236,383 for general/family practice, $245,128 for general internal medicine, and $264,645 for pediatrics. Turnover costs for all PCPs in the cohort by specialty were $24.5 million for general/family practice, $22.3 million for general internal medicine, and $22.2 million for pediatrics.

Turnover was an important phenomenon among the PCPs in this cohort. This turnover has major fiscal implications for PCP employers because loss of PCPs causes healthcare delivery systems to lose resources that could otherwise be devoted to patient care.