Seasoned Doctors Want to Leave Medicine.

Medicine gets “harder” in many ways the longer you’re in it. Sure, some things become easier, but you understand how little we know and how badly some things can end.

The illusion of expertise fades shortly after fellowship training– or at least it should. Gradually, it is replaced by wisdom—fluid over crystalline knowledge. You become an expert in your micro-domain. You’ve seen this movie before– you’re teaching newbies how to manage it, and you’re comfortable without being overconfident. You’ve moved far to the right on the Dunning-Kruger curve.

After 20 years, we’re often far better doctors- or should be. But the system harmed many of these experienced, seasoned souls. And now that experience is vanishing as older docs leave in droves. Replacing them isn’t enough—it’ll take decades to regain what’s lost.

When experienced doctors leave, we lose more than just hands—we lose capable minds. The expertise gained from decades of patient care is not easily replaced.

Medicine relies on crystalline and fluid intelligence—the ability to see patterns, anticipate complications, and adjust when the standard answer isn’t correct. New graduates, nurse practitioners (NPs), and physician assistants (PAs) may possess up-to-date medical knowledge (crystalline intelligence). Still, they often lack the fluid intelligence (wisdom) from seeing thousands of complex cases over decades.

This gap matters when guidelines don’t fit the patient in front of you. The system will try to respond with more staffing, training, and coverage, but you can’t fast-track experience.

If we don’t address why seasoned providers are leaving—burnout, moral injury, loss of autonomy—we won’t just face a staffing crisis. We’ll face a wisdom crisis, and the cost will be paid by patients and the system itself.

Reasons Behind the Exodus

1. Burnout My least favorite term… and it’s certainly not unique to medicine. But… “Burnout rates among physicians are reported to be at an all-time high. Talking to many of my buddies and colleagues bears this out. The emotional exhaustion, depersonalization, and lack of fulfillment are driving many to consider leaving medicine altogether. We shoulder all the responsibility and all the accountability… but for all the employed docs out there– little of the autonomy.

2. Administrative Burden The practice of medicine has become increasingly bureaucratic. Physicians now spend over 50% of their workday on administrative tasks—charting, insurance pre-authorizations, and regulatory compliance—rather than treating patients.

3. Loss of Autonomy The corporatization of healthcare has placed decision-making in the hands of administrators and insurance companies. Physicians are forced to comply with rigid protocols and cost-saving measures that may not align with the best interest of the patient. This loss of autonomy, added to the fact that we shoulder most of the risk, is a key driver of professional dissatisfaction.

4. The Epic Problem The rise of Epic and similar electronic health record (EHR) systems has turned physicians into data entry clerks. Epic, which now dominates over 50% of the U.S. hospital market, has become a monopolistic monster that dictates how physicians chart, order tests, and communicate with patients. Epic was designed for billing and compliance, not clinical efficiency. Its user interface is clunky, unintuitive, and loaded with redundant clicks. Constant alerts and reminders contribute to alert fatigue and cognitive overload, leading to increased medical errors and physician frustration. Instead of improving efficiency, Epic has created a barrier between doctors and patients, stripping away the human side of medicine and fueling the sense of detachment and moral injury.

5. The ACA and the Emotional Toll The Affordable Care Act (ACA)—often hailed as a landmark achievement—has had devastating unintended consequences for the medical profession.

6. Aging Workforce and Retirement Wave A substantial portion of the physician workforce is nearing retirement age. In 2015, 23% of practicing physicians were 65 years or older, indicating a looming wave of retirements. Approximately 71,300 physicians left the profession between 2021 and 2023 alone—a loss of nearly 7% of the active workforce. Approx 20% (maybe much higher) of physicians plan to leave their current practice within two years, and roughly one-third intend to reduce work hours in the next 12 months.

State and local governments will predictably respond to this crisis by trying to replace doctors with more NPs and PAs. While these providers play a valuable role in the healthcare ecosystem, they cannot replicate the fluid intelligence from decades of clinical experience. A newly trained NP or PA will follow protocols because that’s what they’ve been taught to do.

A seasoned physician knows when the protocol is wrong. They know when to wait and when to intervene. Medicine is not just about knowledge; it’s also about judgment. And judgment is built over tens of thousands of patient encounters, mistakes, and successes.

Replacing seasoned physicians with less experienced providers might patch the staffing gap, but it will not close the wisdom gap. Without that hard-earned, intuitive expertise, patient care will suffer. What we are facing is not just a staffing crisis—it’s a knowledge crisis. A wisdom crisis. And the real cost will be paid by patients. If the healthcare system continues to sacrifice physician autonomy, overburden providers with administrative nonsense, and let Epic and the ACA dictate care, the exodus will continue.

You can’t fast-track experience. And once it’s gone, there’s no getting it back.

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