Psychiatry, primary care, and OB/GYN subspecialties hit hardest by physician attrition

Embargoed for release until 5:00 p.m. ET on Monday 6 October 2025   

Follow @Annalsofim on X, Facebook, Instagram, Bluesky, and Linkedin             
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
----------------------------    

1. Psychiatry, primary care, and OB/GYN subspecialties hit hardest by physician attrition

Analysis characterizes increased physician attrition rates as physician shortage continues to worsen

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00564

URL goes live when the embargo lifts             

A nationwide, longitudinal study characterized how physician attrition rates from clinical practice have changed and the factors associated with a differential likelihood of attrition. The study found that the rate of physicians’ attrition from clinical practice has increased from 2013 to 2019. Female physicians, those practicing in a rural area, and those practicing outside of the Northeast region had a greater risk of clinical attrition. The findings are published in Annals of Internal Medicine. 

Researchers from University of California at San Francisco, University of California at Los Angeles, and Yale School of Medicine studied data from 712,395 physicians caring for Medicare beneficiaries across six broad specialty categories described in the Medicare Data on Provider Practice and Specialty documentation: primary care, medical specialty, surgical specialty, obstetrics and gynecology, hospital-based specialty, and psychiatry. The primary outcome was attrition from clinical practice, defined as exit of a physician without reentry for at least three years. The researchers found that unadjusted rates of attrition increased overall from 3.5% in 2013 to 4.9% in 2019. Attrition rates increased among both male and female physicians, those in urban and rural areas, across all geographic locations, and across all specialties. Practicing in psychiatry, primary care, and obstetrics and gynecology were associated with greater risk for attrition compared with a hospital-based specialty. Medicare beneficiary factors associated with a higher risk of attrition included greater average beneficiary risk score, greater average beneficiary age, and greater percentage of dual-eligible beneficiaries. These findings underscore critical challenges related to sustaining the physician workforce amid known physician shortages and difficulties with access to care. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Lisa S. Rotenstein, MD, MBA, MSc please email Chad Burns at Chad.Burns@ucsf.edu.

----------------------------   

2. Modern-day analysis of 1918 birth records highlight importance of protecting pregnant women from flu

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03796

URL goes live when the embargo lifts             

A modern-day analysis of historical birth records in a Swiss city suggests that maternal infection with flu-like illness during the 1918 influenza pandemic may have contributed to an increase in premature births and other adverse outcomes, with male infants being hardest hit. The 1918 influenza pandemic was the most severe of the last century, and as influenza pandemics regularly occurred throughout history, they are bound to reoccur in the future. These findings emphasize the importance of mitigating exposure to influenza during pregnancy through effective preventive measures. The analysis is published in Annals of Internal Medicine.

Researchers from the Institute of Evolutionary Medicine at the University of Zurich, Zurich, Switzerland studied 2,177 historical birth records between 1918 to 1920 from University Maternity Hospital of Lausanne to estimate whether in utero exposure to maternal influenza-like illness during the 1918 pandemic was associated with pregnancy outcomes and whether associations varied depending on the trimester of this illness during pregnancy or on fetal sex. They found that maternal influenza-like illness, particularly during the third trimester, may have triggered premature birth. Birthweight and other anthropometric measures were lowered by maternal influenza-like illness (ILI), especially in the case of third trimester exposure. This outcome disproportionately affected male offspring, as males exposed to ILI during the third trimester had a lower birthweight and a higher risk of stillbirth than exposed females. Additionally, less males were born to mothers who experienced ILI in the first trimester compared with mothers who were not affected by influenza: this is a hint that ILI early in pregnancy is associated with miscarriage among males.  This hypothesis should be further researched with data from various other maternities.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Mathilde Le Vu, PhD please email mathilde.levu@iem.uzh.ch or to contact author Kaspar Staub, PhD please email kaspar.staub@iem.uzh.ch. 

----------------------------   

3. 1 in 3 NIH F32 grant recipients in internal medicine receive mentored development grants

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03445

URL goes live when the embargo lifts             

A brief research report assessed National Institute of Health (NIH) F32 grants to internal medicine (IM) trainees and quantified their conversion to mentored development grants (K-awards) across the over 30-year history of F32 funding. The report found that about 1 in 3 F32 awardees in IM received K-awards, and pulmonary and critical care medicine (PCCM), cardiology and nephrology fellows comprise the majority of F32 recipients. The study is published in Annals of Internal Medicine.  

Researchers from the University of Virginia used NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) to identify 735 F32 grants awarded to IM trainees between 1989 and 2021. NIH RePORTER was used to identify subsequent K-awards to F32 recipients. F32s awarded to IM trainees accounted for $61,983,550 and 1,759 unique publications. 54% of awards were granted by the National Heart, Lung, and Blood Institute (NHLBI) and 28% were awarded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NHLBI awarded 84% and 98% of F32s for PCCM and cardiology trainees, respectively. The NIDDK awarded 90% of F32s to nephrologists. 262 F32 recipients received K-awards (35.6%), totaling $168,044,829 and 3,084 unique publications. This conversion rate is higher than the ~7.5% conversion rate seen for surgery residents awarded F32s and the T32 to K-award conversion rate of 11.9%. The findings quantify how F32 grants to IM trainees have supported the development of physician-scientists over the past 30 years. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Neeral Shah, MD please email Eric Swensen at ews3j@virginia.edu.

----------------------------   

Also new this issue:

GRADE Guidance: Using Thresholds for Judgments on Health Benefits and Harms in Decision Making

Wojtek Wiercioch, MSc, PhD, et al.

Research and Reporting Methods

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02013  

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03828  

----------------------------