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

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 a new study in the Journal of General Internal Medicine examining physician attrition by sex, age and specialty. She joins Medical Economics Senior Editor Richard Payerchin to explain what's behind that 15-year gap, why it holds in rural and urban settings alike, and which fixes could actually keep women physicians at the bedside, from time-based billing to ambient documentation to giving physicians back control over their own workflow.

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 Cold open. Rotenstein previews the episode's central paradox: the practice patterns that serve patients well may be making the job unsustainable.

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

1:32 Meet Lisa Rotenstein. Rotenstein introduces her work directing the Center for Physician Experience and Practice Excellence and outlines what the study set out to measure.

2:58 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 The 15-year gap. Median attrition age is 49 for women and 64 for men. Rotenstein describes the bimodal pattern in the data and why the first decade and a half of practice is the critical window.

7:53 Rural and urban alike. The sex-based attrition gap holds regardless of setting, with particular consequences for access in rural communities.

9:02 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 P2 Management Minute. Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

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

14:35 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 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 paperwork are the next frontier.

18:35 Control, not ownership. Clinician-owned practices show lower burnout, but Rotenstein says the real variable is agency, and systems can give some of it back.

21:03 What she wants physicians to take away. The profession is losing decades of expertise from a highly trained workforce.

21:55 Closing thoughts and outro.

S1 Ep170: Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.

Off the Chart: A Business of Medicine Podcast

S1 Ep170: Better care, shorter careers for women physicians, with Lisa Rotenstein, M.D., MBA, M.Sc.