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.
Do you have questions regarding an Orthopedic injury or longevity?
Do you want to talk to an expert who can listen to you for 45-60 minutes and explain the options in detail?
Dr. Howard Luks offers remote guidance sessions to review your X-ray or MRI images and explain your options.
Dr. Luks has also received hundreds of requests for educational sessions on the topics discussed in his book, Longevity Simplified.
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.
·
Chris Misciagno
This is 100% accurate and beautifully explained.
Mark Landers MD
Well said and unfortunately very true. Plan to leave the profession in the next 1.5 years as I am 61 and overwhelm with the workload despite 2 NP’s. Graduated 1990 and completed EP fellowship 1998. Cannot recruit physicians due to lack of number of applicants in a “rural” area.
Eve Gillespie,MD,PHD
Your comments are right on. When I joined my practice I was the youngest member. Now I am the oldest. When I try to interject some wisdom at our meetings, I feel that I am talking to strangers rather than my colleagues. It is very frustrating and sad. Practicing for 27 yearse.
PATRICK BITTER
Very keen insight and razor sharp commentary like this could only come from a “seasoned clinician” with experience and wisdom gained over decades.
Irma Lopez, MD
Very true. Experience and wisdom come with many hours of direct patient care. And today’s patients are very difficult, too. With technology, patients want to turn a few minutes of reading into medical decisions. It takes too much time to try to educate your patients that their reading is missing many important details. I find it very frustrating.
Paul
The system does not want fluid intelligence or personalized care, as it is inefficient and less profitable. Algorithms keep people moving and revenue flowing. The system also knows we still need to provide for ourselves and our families, so most will trudge on. The disillusionment is difficult to bear. Nevertheless, it’s also emotionally difficult to leave our hard earned clinical skills behind.
John L. Skosey, MD, PhD
Another factor: the virtual Zoom visit, that is often transferred to the office where the physician sometimes doesn’t even touch the patient.
Bruce Frantz DO
Dr.Luks is correct. I experience it everyday when my CRNP asks me a question about patient management because she is not knowedgeable enough to know how to handle a situation. It’s not her fault as she is not trained well enough and does not have the experience. Administrators find wasteful things for docs to do,and private equity firms invest in institutions and then tell them how to cut costs so they can gain in wealth which is hownthey measure success.
Is there a way back? I cannot see it now but there may be a change when patients suffer due to the lack of training and experience these “other PROVIDERS” lack. I guess lawyers will be the answer!
Larry Cohen
Well said, Unfortunately so true.
Dan Glatt
Howard–sadly well said! Best to you!
S K Rao
Thanks for sharing your story which is many of ours aswell.I don’t see any end of this bureaucratic nightmare unfortunately.it’s deteriorating fast and god knows what it will be in the future.
Stephen Walling
It is ironic that, prior to the introduction of the EMR, most physician’s notes were efficient and conveyed useful information, but were illegible because of poor handwriting, while, since the introduction of the EMR, the notes are eminently legible, but are inefficient and convey little useful information.
Harvey Samowitz, M.D.
Bravo. Very thoughtful article that emphasizes the loss of experience and wisdom, fluid intelligence, and intuitive thinking. Patients and illness do not always fit into nice neat little boxes, and new is not always better. Even though I cannot quote to you every nuance of a protocol or current guideline off the top of my head, or trained on the latest surgical device, I think I am a better doctor and surgeon now than when I just finished fellowship 30 years ago, and could regurgitate specifics. And for those procedures that I have performed thousands, the patients still have excellent outcomes. I have seen new devices and treatments come and go, and could usually predict which ones would prevail. It has gotten more difficult to tell which since there is so much financial influence dependent on if a treatment gets a favorable CPT code.
John B
I agree with all of the above– but it seems I have been reading the same list of problems for the last 20 years. I have just retired after 35 yr of private practice and am enjoying a better healthier life. “Physician , heal thyself. ” I suggest older practitioners retire ASAP and system will equilibrate and move on without us old docs.
Irma Lopez
Agree
Alexis McQuitty
Thank you for publishing this—it needs to be on a billboard. The public needs to be more aware of our current physician issues. Well-written! —from a physician of 25 yrs with too much call and too little time for admin duties.
Jeffrey Christenson
You missed the number one reason I left my practice of thirty years. I found I had nothing in common with my younger colleagues. Unlike the bonds I shared with those that imparted their knowledge on me, I found few similarities between the way I practiced or the values I treasured, with those recently entering the field.
Dave S.
Jeffrey, truer words were never spoken. The young physicians are not trained as scientists. They have become drones of the Borg.
Joey L
I agree that “burnout” is a bad term. It implies the doctor has some type of problem, while the true problem is a medical delivery system that prioritizes billing and chart completion over patient care. Great article!
Dan
To a large degree that fluid knowledge is really no longer valued by the patients, by administrators, or by the system in general.
We who are retiring generally won’t be missed. Perhaps we should be missed or maybe we shouldn’t, but that is generally true.
Bring on the AIs! That’s what a whole lot of administrators and younger patients want. It’s a brave new world!
Carolee Cutler Peck, MD, MPH
I miss the knowledge. It is difficulty for me to find a doctor I can trust will take care of me rather than push me through their clinic…. or break up my testing/clinic visits so I have to have 3 appointments rather than one (thank you administrators who are after the $$$)…
Kenelm McCormick MD
“A newly trained NP or PA will follow protocols because that’s what they’ve been taught to do.” And, as you point out, that’s what the suits want done.
Johann Peikert
Good points, but wisdom is crystalline rather than fluid intelligence. We have very smart fluid, intelligent graduates coming out, and I’m so grateful for them. The older, experienced physicians play a tremendous role, though with less attention. Important not to take our eyes off of those. There is tremendous value in crystalline intelligence or wisdom in the workplace. When will administrators ever learn?
Michael Bryan
never
Jim D.
Learn? Never! I don’t see an end to this progression of poor patient care. We are the only ones who can halt this, albeit with some sacrifice…….amount to be determined.
A Mancuso
Brilliant and true
The problem is re-doubled at the academic level, where the loss of wisdom impacts training significantly so that there will be less of a Headstart on our trainees To a state of fluid intelligence and reasoning In medical decision-making
Michael Mitchell
Very well put!
As another “seasoned” physician, I would love to continue practice, but every idiotic peer review, stupid x-ray ordered to get an MRI, ridiculous prior auth to get a patient the best treatment is wearing thin. Longer vacations, fewer patients, just don’t seem to carry me forward the way it used to do against the onslaught of idiocracy, mediocrity and cost “saving” that doesn’t take an MBA to figure out it costs more in the long run.
I feel your pain. If I won the lottery tomorrow, I would retire the day after…….
Brian Joseph
Exactly! But despite the many articles published by many clinicians regarding this topic , nobody does anything- not the AMA or anyone else- the Hippocratic oath losses to the business model – caveat emptor – let the buyer beware.