Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.

Female physicians spend more time with their patients, write longer notes and field more messages, and research suggests patients are better off for it. They also leave clinical practice at a median age of 49, compared with 64 for their male colleagues.

Lisa Rotenstein, M.D., MBA, M.Sc., a primary care physician at the University of California, San Francisco, and director of the Center for Physician Experience and Practice Excellence, is the corresponding author of an April study in the Journal of General Internal Medicine examining physician attrition by sex, age and specialty. The 15-year gap held across every specialty category the researchers looked at, and in both rural and urban settings.

She sat down with Medical Economics Senior Editor Richard Payerchin to talk through what is driving the earlier exit, what turnover actually costs a practice and which levers practice leaders can pull to keep these physicians at the bedside.

Don't miss our recent episodes on direct primary care, site-of-service pricing, practice valuation and concierge medicine.

Music Credits:
Ocean Calm by Cephas - stock.adobe.com
A Textbook Example by Skip Peck - stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:17 | Cold open Rotenstein on the paradox at the center of the episode: the practice patterns that serve patients well may be the ones making the job unsustainable.

0:17 – 1:32 | Introduction Austin Littrell introduces the episode, the guest and the study's headline finding.

1:32 – 2:58 | Meet Lisa Rotenstein Rotenstein describes her work directing the Center for Physician Experience and Practice Excellence and what the study set out to measure.

2:58 – 5:17 | What a 1.55 hazard ratio actually means Female primary care physicians are among the likeliest to leave, and Rotenstein explains how the study defined leaving: no Medicare billing for three consecutive years.

5:17 – 7:53 | The 15-year gap Median attrition age is 49 for women and 64 for men. Rotenstein walks through the bimodal pattern in the data and why the first decade and a half of practice is the critical window.

7:53 – 9:02 | Rural and urban alike The attrition gap holds regardless of setting, with particular consequences for access to care in rural communities.

9:02 – 11:22 | What the payment model rewards Female physicians generate 80 cents of revenue for every dollar earned by male primary care physicians, even while spending more time with patients. Rotenstein makes the case for time-based billing and value-based payment.

11:22 – 12:13 | P2 Management Minute Keith Reynolds shares practice management tactics and invites listeners to submit their own workflow ideas.

12:13 – 14:35 | The math health systems are missing Physician turnover runs $500,000 to $1 million per physician depending on specialty, but Rotenstein says the near-term cost of retention is what keeps the conversation from happening.

14:35 – 16:17 | What to tell medical students More than half of matriculating medical students are women, and Rotenstein argues the profession has to show them clinical medicine is a sustainable path.

16:17 – 18:35 | Can AI keep women physicians in practice? A Physicians Foundation-funded study found burnout reductions tied to AI scribes across two health systems. Rotenstein says prior authorization and general paperwork are the next frontier.

18:35 – 21:03 | Control, not ownership Clinician-owned practices show lower burnout, but Rotenstein says the variable that matters is agency, and large systems can give some of it back.

21:03 – 21:55 | What she wants physicians to take away The profession is losing decades of expertise from a highly trained workforce, and Rotenstein argues society has a direct stake in keeping it.

21:55 – 23:14 | Closing thoughts and outro Payerchin thanks Rotenstein and Littrell wraps the episode.