A recent report highlighted by Becker's Hospital Review found that approximately 1 in 10 surgeons leave clinical practice within eight years. The study examined more than 200,000 surgeons and found that roughly 16,000 left clinical medicine during a median follow-up period of 8 years, resulting in a cumulative attrition rate approaching 10%.

Perhaps even more concerning was that some specialties appeared to be at particularly high risk, including plastic and reconstructive surgery.

The study itself didn't examine why surgeons left clinical practice. However, previous research from the American Medical Association and others has consistently pointed toward familiar themes: administrative burden, loss of autonomy, burnout, and growing dissatisfaction with the practice environment.

As a plastic surgeon, seeing my specialty listed among those at higher risk naturally caught my attention.

It also got me thinking about a question I've never seriously considered before: what would actually cause me to leave clinical practice?

The answer surprised me a little because despite writing and talking frequently about financial independence, I have no plans to leave medicine. In fact, I still genuinely enjoy what I do. I enjoy operating. I enjoy taking care of patients. Plus I enjoy helping people through some of the most difficult and vulnerable moments in their lives. The work remains deeply meaningful to me.

But meaningful work doesn't mean there aren't circumstances that could eventually push someone away from it.

One of the biggest misconceptions I see among physicians is that financial independence is primarily about retiring early. For me, it has never been about that. My interest in financial freedom has always centered around creating options rather than creating an exit.

There is a massive difference between working because you want to and working because you have to.

When you are financially dependent on your next paycheck, every workplace frustration carries more weight. Every compensation discussion feels more stressful. Every change in leadership feels more threatening. And every policy shift feels like something you simply have to accept.

When you have financial security, your relationship with work changes. You can evaluate situations more objectively. You can make decisions based on your values rather than your immediate financial needs. And perhaps most importantly, you have the ability to walk away from situations that are no longer healthy.

That doesn't mean you actually leave. It simply means you can.

3 Things That Would Sway Me to Leave Clinical Medicine

As I reflected on this study, I realized there are really three things that would make me seriously consider leaving clinical practice.

1. Loss of Autonomy

Of the three factors, this is probably the biggest one for me.

Despite being employed by a hospital system, I currently have a tremendous amount of autonomy over how I practice. I largely control my schedule. I choose which days I operate. If I need time off, I can generally arrange it. If I have a particularly long operative day, my schedule can be structured around that reality rather than forcing me to bounce between competing obligations.

The hospital's primary concern is that I remain productive and continue providing excellent care. Fortunately, they recognize that the best way for me to do that is by allowing me to structure my practice in a way that works.

That autonomy extends beyond scheduling. I also have significant freedom in how I build my practice. I am able to focus on the areas of plastic surgery that interest me most. Plus I can develop expertise in procedures I enjoy performing. I can care for patients in a way that aligns with my values and professional judgment.

That freedom matters more than many people realize.

As physicians, we spend more than a decade training to develop clinical expertise and judgment. When systems begin taking away the ability to exercise that judgment, frustration and burnout tend to follow quickly. I've watched colleagues become increasingly dissatisfied when decisions affecting patient care are made by individuals who have never actually cared for patients themselves.

If I ever reached a point where I no longer felt I had meaningful control over how I practiced medicine, that would be a major factor in deciding whether to continue.

2. Fair Compensation

Money isn't the primary reason most physicians go into medicine.

But pretending compensation doesn't matter isn't realistic either.

My own compensation arrangement is somewhat unusual. Rather than being paid primarily based on RVU production, I negotiated a flat salary model. I recognize that this isn't the right fit for everyone, but it works well for me because I know my own tendencies.

If my compensation were tied directly to RVU production, I would almost certainly chase those numbers to my own detriment. I'd see more patients, take on more cases, work longer hours, and likely accelerate my path toward burnout. The salary model protects me from constantly feeling pressure to maximize productivity at the expense of everything else.

That doesn't mean compensation becomes irrelevant.

Every few years, I renegotiate based on my production, contributions, and overall value to the organization. That process helps ensure that compensation remains aligned with reality.

The broader challenge facing physicians is that many feel increasingly disconnected from the decisions that determine how they are compensated. At the same time reimbursement continues to decline, physicians often have less representation in the rooms where those decisions are being made.

Most physicians aren't asking to be overcompensated.

They simply want compensation that reflects the value they create.

If I ever felt that my compensation no longer bore a reasonable relationship to my contribution, expertise, and productivity, it would absolutely affect my willingness to continue practicing within that system.

3. Unreasonable Administrative Burden

This is probably the issue I hear physicians complain about most frequently.

To be clear, I'm not talking about documentation that directly supports patient care. Good documentation matters. Accurate billing matters. Regulatory compliance matters. Those are necessary parts of modern healthcare.

What concerns me are the countless administrative tasks that seem to add little value while consuming increasing amounts of physician time.

The mandatory modules. The repetitive trainings. Add in the duplicated documentation requirements and the forms and checkboxes that exist primarily to satisfy bureaucratic processes rather than improve patient outcomes.

Over the past decade, physicians have gradually accepted many of these responsibilities as simply part of the job. Yet a large percentage of them could likely be performed by someone other than a physician.

At its core, my role is to take care of patients. Everything else should support that mission.

Unfortunately, there are times when it feels as though the opposite is happening. Administrative work continues to expand while time spent caring for patients becomes increasingly compressed.

If I ever felt that my role was shifting away from being a physician and toward being an administrator who occasionally practiced medicine, that would significantly influence my decision about whether to stay.

Why Financial Freedom Changes the Equation

One thing I've noticed as I've moved closer to financial independence is that many of the frustrations that once bothered me don't carry the same emotional weight anymore.

The frustrations themselves haven't disappeared.

My perspective on them has changed.

When you're living paycheck to paycheck, even as a high-income professional, every annoyance feels amplified because your livelihood depends entirely on maintaining the status quo. When you have financial flexibility, you gain the ability to view challenges through a different lens.

For example, if I found the perfect practice environment but the compensation was somewhat below market value, I might be willing to make that trade. Years ago, I probably wouldn't have considered it.

Similarly, if a job came with a few additional administrative responsibilities but offered tremendous professional satisfaction, I could view those tasks as a reasonable price to pay for doing work I genuinely love.

Financial freedom doesn't eliminate bad situations.

What it does is allow you to tolerate minor imperfections without feeling trapped by them.

That's an incredibly powerful position to occupy.

The Future of Medicine

Despite the concerns raised by this study, I remain optimistic.

For decades, physicians have steadily surrendered control over many aspects of medicine. Yet recently, I sense at least some movement in the opposite direction. More organizations seem to recognize that physician engagement matters. More leaders appear to understand that healthcare functions best when the people delivering care have meaningful input into how care is delivered.

There's still plenty of work to do.

Physicians need a stronger voice. We need greater autonomy. We need compensation models that make sense. And we need to reduce unnecessary administrative burden.

But I do believe there are reasons for hope.

At the end of the day, I still love medicine. I still find tremendous fulfillment in helping patients. I still enjoy operating. And I still really enjoy the relationships that develop through caring for people during difficult moments in their lives.

That's why I became a physician in the first place.

So while I have no plans to leave clinical practice anytime soon, studies like this serve as an important reminder that the factors pushing physicians away are real. If we want to retain talented doctors, we need to create environments where they can thrive.

And on an individual level, I continue to believe that financial freedom is one of the most powerful antidotes available. Not because it allows you to leave medicine. But because it gives you the ability to stay on your own terms. In fact, that's the big mission here at PPS: A world of financially free doctors would change healthcare in unimaginably great ways!

What do you think? What would it take for you to leave clinical practice? Do the results of this study surprise or worry you? Why or why not? Let me know in the comments below!