I still remember a stretch early in my career—barely two years out of residency—when I would sit in my car after clinic, hands on the steering wheel, and just cry. Not every day, but often enough that it started to feel like part of the routine. I was doing everything I thought I was supposed to do: seeing patients efficiently, staying on top of documentation, trying to be present for families. And yet, I felt depleted in a way that didn’t make sense to me. I remember wondering, very seriously, What is wrong with me?
It took time—and a lot of honest reflection—to realize that the problem wasn’t me. It was the system.
A recent nationwide longitudinal study published in JAMA Internal Medicine helps put data behind what many of us have felt. Across more than 700,000 physicians, female physicians were 43% more likely to leave clinical practice than their male counterparts, across every age group, specialty, and geographic setting . Even more striking, when women do leave, they do so significantly earlier—the median age of attrition was 49 years for women compared to 64 for men .
This isn’t a small difference. It represents an entire phase of a physician’s career—years of experience, mentorship, and clinical impact—lost.
And when we zoom in on primary care, the signal becomes even louder. The study found that the gap in attrition is particularly pronounced in primary care specialties, where female physicians face some of the highest relative risks of leaving practice . That matters deeply for us as pediatricians, because we are already practicing in a field that is both relationally intense and structurally under-supported.
Layer onto that what we already know about the lived experience of female physicians: more time spent with patients, more time in the electronic health record, more patient messages, lower compensation per hour, and greater expectations around communication and emotional labor . These are not minor differences—they fundamentally shape the day-to-day experience of practicing medicine.
And then there is everything outside of medicine.
Many female physicians carry a disproportionate share of caregiving, household management, and emotional labor at home. The study references broader literature on work–family conflict and domestic responsibility as key contributors to burnout and attrition . When combined with a traditional primary care model built around high volume and rigid schedules, the result is a system that simply does not fit the reality of many physicians’ lives.
Something has to give.
Too often, what gives is the physician.
But here’s where the story gets more interesting—and, I would argue, more hopeful.
In pediatric DPC, we are seeing something very different. While women make up roughly 70% of the general pediatric workforce, anecdotally, they represent well over 90% of pediatric DPC physicians. That discrepancy is telling us something important.
Female physicians are not just leaving traditional models. They are leading the redesign.
DPC offers something that the traditional system struggles to provide: alignment. Alignment between time and values. Alignment between incentives and patient care. Alignment between professional identity and personal life.
Instead of compressing 25–30 visits into a day, physicians can intentionally design smaller panels that allow for presence and depth. Instead of endless inbox management spilling into evenings, communication becomes structured and sustainable. Instead of productivity metrics defining worth, success becomes tied to relationships, outcomes, and meaning.
These shifts are not just operational—they are psychological.
For many female physicians, the transition to DPC represents a reclaiming of autonomy. It allows space to practice medicine in a way that honors both the physician and the patient, without requiring constant self-sacrifice. It creates the possibility of a career that is not only impactful, but also sustainable.
Interestingly, the same study that highlights higher attrition among women also notes that patients of female physicians often experience better outcomes and higher-quality care . In other words, the very physicians we are losing at higher rates are those delivering exceptional care.
That should give us pause.
Because the issue is not capability. It is not commitment. It is not resilience.
It is fit.
The traditional healthcare system was not designed with the realities of today’s physician workforce in mind—particularly not a workforce that is increasingly female. And rather than continuing to adapt ourselves to a misaligned system, many physicians are choosing a different path altogether.
DPC is one manifestation of that shift.
It is not the only solution, and it is certainly not the easiest path. Building a practice requires courage, risk tolerance, and a willingness to think differently about medicine and business. But it does offer something that feels increasingly rare in healthcare: the ability to design a career on purpose.
If there is one takeaway from both the data and our collective experience, it is this:
When female physicians leave traditional medicine, it is not because they are less committed—it is often because they are no longer willing to participate in a system that requires them to give more than is sustainable.
And when they stay—on their own terms—they don’t just survive.
They lead.
They build practices that are more relational, more thoughtful, and more aligned with what patients actually need. They model a different way forward for the profession as a whole.
The workforce crisis we are facing is real. But within it is an opportunity.
Because the question is no longer just how to retain physicians within the existing system.
It’s whether we are willing to build a better one.If you’d like more guidance launching or growing your own direct care practice, DPC Pediatrician offers a free startup guide, coaching programs, on-demand courses, and even one-on-one consulting.
