Physician Exodus from Medicare Surges Post-COVID: Alarming Rise Among Primary Care Providers

A recent analysis of traditional Medicare billing patterns reveals a sharp increase in physician departures from the Medicare program, raising pressing questions about workforce adequacy and potential coverage implications, especially in primary care. The study, which examined 100% of Medicare Part B fee-for-service claims between 2010 and 2024, found that physician exit rates reached their highest level in over a decade during the post-COVID period, with concerning disparities across specialties and practice sizes.

Among a cohort of 791 025 physicians billing Medicare during the study period, the share of physicians exiting Medicare in any given year rose from 1.80% in 2010 to 3.60% in 2023. The trajectory showed distinct phases: a gradual increase from 2010 to 2013, plateauing between 2014 and 2016, followed by a steady rise leading up to a pandemic-era spike in 2020-2021. Notably, while exit rates decreased slightly after the pandemic peak, they stabilized at levels significantly higher than pre-pandemic rates.

Primary care physicians (PCPs) were disproportionately affected. In 2023, the exit rate among PCPs stood at 4.41%, outpacing hospital-based specialists (3.50%), surgical specialists (2.99%), and medical specialists (2.49%). Over the 13-year period, the age-adjusted annual increase in exit rate among PCPs (0.21 percentage points) far exceeded that of other specialties, highlighting a growing vulnerability in the foundation of outpatient care.

While age-adjusted 2023 exit rates were lowest among solo practitioners (3.16%), their rate of annual increase (0.18 percentage points) surpassed those in medium and large group practices. This trend suggests heightened attrition pressure on smaller, independent practices, which may accelerate market consolidation and reduce patient choice in the Medicare population.

The study's findings suggest structural strains that may be prompting more physicians—especially PCPs and those in small practices—to reduce or abandon participation in Medicare. Cited contributors include declining inflation-adjusted fees, increasing administrative burdens, and new clinical expectations, such as electronic communication via patient portals.

"The findings may reflect multiple factors, including the greater burden of new communication methods (eg, portal messages) and demands for clinical documentation," the authors stated, underscoring how cumulative operational pressures could be driving exits.

These trends warrant attention from payers and policymakers alike. Sustained exit rates, particularly among primary care providers, may limit access for Medicare beneficiaries and strain existing networks. If left unchecked, these patterns could undermine continuity of care and hinder effective care coordination, especially in rural or underserved areas where PCPs are already in short supply.

The researchers acknowledged limitations in their methodology, including an inability to distinguish between physicians who left Medicare vs those who retired or transitioned to non-Medicare patient panels. The study also did not account for new physician entrants, meaning it cannot speak directly to net physician supply.

Key takeaways for coverage policy center on addressing the growing pressures driving physician exit from Medicare. The rising exit rates—particularly among primary care physicians—highlight the need for more vigilant monitoring of network adequacy to ensure beneficiary access to essential services. Small and solo practices appear especially vulnerable, suggesting that targeted policy interventions may be necessary to sustain independent providers and prevent further consolidation. Additionally, administrative and documentation burdens may represent modifiable factors that, if addressed, could reduce attrition and support continued physician participation. Finally, the observed variation in exit trends across specialties indicates that coverage planning should be tailored to specific physician types, especially in regions already experiencing limited access to certain specialties.

Reference

Neprash HT, Chernew ME. JAMA Health Forum. 2025;6(7):e252267. doi:10.1001/jamahealthforum.2025.2267