Perspectives on Attrition Among Emergency Physicians.

Importance: Physician attrition has dramatically increased, and emergency physician attrition threatens safety-net stability. Understanding key factors associated with attrition is necessary to develop structural interventions to promote career longevity. Objective: To examine why emergency physicians leave and to develop strategies to promote retention. Design, Setting, and Participants: This national qualitative study took place from August 8, 2024, to April 11, 2025, and involved semistructured video interviews with board-certified or board-eligible emergency physicians who had either left clinical emergency medicine or seriously contemplated leaving. Participants were recruited via social media, residency alumni networks, and snowball sampling, with purposive sampling by gender, community vs academic practice, region, and years in practice. Main Outcomes and Measures: Key themes associated with attrition and potential strategies for retention were identified through iterative thematic analysis. Results: Among 46 participants, 28 (61%) were women, and 24 (53%) were community based, with a median (IQR) of 6 (4-10) years in practice. Most (34 participants [74%]) no longer practiced emergency medicine; 9 (19%) practiced emergency medicine part-time, and 3 (6%) practiced emergency medicine full-time. Physicians described a growing mismatch between increasing clinical demands and stagnant resources that prevented them from providing safe, high-quality patient care. These tensions were aggravated by the persistent emphasis on volume, efficiency, and patient satisfaction over safety and clinical outcomes. Physicians described pervasive disrespect, interpersonal conflict, and devaluation of the work of emergency medicine. Institutional responses promoting individual resilience exacerbated distress. Limited opportunities for growth and rigid career structures demanding the same intensity of shifts across life stages led to feelings of stagnancy even among those with fewer negative experiences. Women more frequently described gender inequities in advancement and inadequate support for new parents as drivers of attrition. Participants identified improved staffing, less emphasis on throughput and satisfaction, career flexibility to support life phases and caregiving, mentorship, opportunities for professional growth, and gender equity in advancement as strategies to enhance retention. Conclusions and Relevance: In this qualitative study, emergency physicians felt driven out by structural health system failures, including misaligned incentives and inadequate resources. Institutional accountability for adequate staffing, metrics prioritizing safety over throughput and satisfaction, and career adaptability across life stages may promote retention and access to high-quality emergency care.