Physicians Leaving Medicare Remains High After the Pandemic, Raising Concerns About Workforce Stability

Physicians removing themselves from traditional Medicare has steadily increased over time and remained elevated after the COVID-19 pandemic, partially due to growing administrative burdens and a shift toward larger, consolidated practice settings.

These trends, highlighted in a new study published in JAMA Health Forum, have revisited concerns about the sufficiency of the U.S. physician workforce—an issue that researchers claim has long been at the center of healthcare policy discussions.

Past research has shown that physician exit from Medicare increased through 2014 but leveled off between 2014 and 2016.

The continued increase in Medicare exits, especially among primary care physicians and those in smaller practices, could reflect growing dissatisfaction with administrative demands and financial pressures.

The new study reviewed this question using updated Medicare data, tracking exit rates through 2024. Researchers aimed to understand whether newer stressors—including declining inflation-adjusted fees, expanding clinical documentation requirements and added communication responsibilities such as responding to patient portal messages—are contributing to sustained or accelerating physician departures.

The analysis used Medicare Part B billing data from 2010 to 2024 to identify active physicians and measure how many left traditional Medicare each year. Researchers used National Provider Identifiers (NPIs) to track individual doctors, grouping them by specialty and the size of the practices in which they worked, based on the number of providers billing under the same Taxpayer Identification Number.

To ensure consistency, physicians with fewer than 100 annual Medicare claims were excluded, and a full year without billing was considered an indicator of Medicare exit.

Data revealed that nearly 800,000 physicians submitted Medicare claims during the study period. The average physician age was around 45 years. Exit rates also rose from 1.8% in 2010 to 3.6% in 2024, with a notable spike during the COVID-19 years and no clear return to pre-pandemic levels afterward.

Primary care physicians (PCPs) saw the highest exit rate in 2023 at 4.41%, compared to 3.50% for hospital-based specialists, 2.99% for surgical specialists and 2.49% for medical specialists.

PCP exit rates have also grown more rapidly than those in any other specialty group since 2010—a trend that could further strain access to care if it continues.

Practice size also played a role. In 2023, solo practitioners had the lowest overall exit rate at 3.16%, but their rate of increase over time was steeper than that of physicians in medium or large practices.

Researchers indicate that while small independent practices could hold on to physicians year-to-year, they are increasingly vulnerable to the forces pushing doctors out of traditional Medicare and potentially into employment with larger systems.

Although Medicare exit rates have risen, formal opt-outs remain relatively rare.

A separate analysis from KFF found that as of late 2024, just 1.2% of non-pediatric physicians had officially opted out of Medicare, with participation still strong across most specialties. Psychiatrists, however, accounted for nearly 40% of all opt-outs, indicating that the challenges of Medicare participation may disproportionately affect certain types of care.

The stressors driving Medicare exits may also be contributing to broader workforce dissatisfaction.

Data from the American Medical Association (AMA) show that while physician burnout has improved since the height of the pandemic, it remains a serious concern. In 2023, 48.2% of physicians reported experiencing symptoms of burnout—marking the first time since 2020 that the rate fell below 50%. More doctors also reported feeling valued and satisfied in their work.

However, staffing shortages, administrative overload and time pressure continue to fuel stress, flagging that healthcare systems must continue working on long-term solutions.

This latest study offers insight into ongoing workforce shifts, supporting earlier findings while capturing new post-pandemic dynamics. The continued increase in Medicare exits, especially among primary care physicians and those in smaller practices, could reflect growing dissatisfaction with administrative demands and financial pressures.

It also raises concerns about market consolidation, as more physicians move from solo or small group practices to large healthcare organizations.

The study does, however, include several limitations.

It relied on Medicare fee-for-service claims and could not distinguish between physicians who left Medicare, those who retired or those who left clinical practice entirely. It also did not account for physician entry, so the broader picture of physician supply and replacement remains incomplete.

The authors stressed the need for continued monitoring of these trends. In particular, they called for more research to explore why some specialties and practice types are more affected than others and what steps can be taken to ensure a stable and sufficient physician workforce, especially in primary care.