Why Physicians Say No: Looking Past Compensation to the Real Drivers of Retention

When a physician declines an offer worth $400,000, it’s rarely about the money.  The real cost extends far beyond the initial disappointment with thousands of dollars in recruitment expenses, months of delayed revenue, greater risk for patient leakage and restarting the entire search process if other candidates moved on. 

Yet, most health care organizations often point to pay and benefits as the most powerful tools for recruiting and retaining physicians. Compensation is visible, measurable and, in many cases, the simplest lever to pull. But compensation alone doesn’t guarantee that physicians will stay. Retention depends on whether physicians feel supported, valued and able to build sustainable careers within their organizations. New findings from the Association for Advancing Physician and Provider Recruitment (AAPPR) Benchmarking Report highlight a growing challenge; physicians are accepting only 71% of offers compared to 80% for advanced practice providers (APPs). That difference may seem small, but what about the physician offers that go unaccepted? In a workforce already stretched thin, every declined offer represents lost time, resources and momentum, and highlights a missed opportunity to understand what physicians are really looking for.

At the same time, median turnover rates for physicians (7.3%) and APPs (7.9%) remain higher than pre-pandemic levels. 

Each vacant physician position costs organizations $7,000-$9,000 daily in lost revenue, making it essential to understand the career-stage factors that influence physician decisions.

 For healthcare organizations, the challenge goes beyond how competitive their offers are. Every declined offer tells a story, and understanding why physicians say no requires collaboration across the recruitment continuum. Gathering these insights is essential not only for recruiters but for leaders throughout the organization, as they inform strategies that strengthen retention, employee engagement, and long-term organizational stability.  

Retirement and the Knowledge Gap

For late-career physicians, retirement is actually the leading driver of turnover. Instead of pursuing more lucrative opportunities, they are stepping away from medicine altogether. In fact, retirement accounted for nearly one in three physician departures in recent years, a trend that continues to climb as the workforce ages. When organizations are unprepared for these departures, they lose more than their staffing capacity. They lose decades of institutional knowledge, mentorship and patient relationships that cannot easily be replaced.

One way to ease this transition is to recognize retirement not as an end point, but a natural continuation of the workforce. Phased retirement schedules allow physicians to gradually scale down while maintaining patient continuity and mentoring younger colleagues. Advisory or part-time roles can keep experienced clinicians connected to the organization while lightening their workload. By treating retirement as a stage to be managed rather than a sudden departure, health systems can retain expertise longer and give themselves more time to plan replacements.

Mid-Career Pressures

Physicians earlier in their careers face very different pressures. They are still building professional identities and are often navigating demanding workloads, family responsibilities and an employing healthcare system that feels increasingly bureaucratic and removed. Compensation matters, but burnout looms larger. Mid-career physicians are more likely to walk away when rigid schedules, limited autonomy, or a lack of professional growth leave them feeling stuck.

Recruitment strategies that address these concerns resonate far more than incremental pay increases. Offering flexible scheduling options, such as compressed workweeks or protected administrative time, can help physicians sustain their careers and sense of purpose. Providing clear advancement pathways into leadership, teaching or research roles signals that the organization sees them as more than just clinical workhorses. Investing in professional development and peer support systems demonstrates that the organization values their long-term contribution. But without these alternatives, organizations shouldn’t be surprised when physicians expect significant pay increases to offset the professional frustrations and burnout.

A Shifting Landscape for Early-Career Physicians

Today’s early-career physicians are motivated by more than career advancement. Many younger physicians intentionally seek balance between professional ambition and personal well-being, more than their predecessors. They are drawn to organizations that prioritize mentorship, community and mission-driven care. Early career physicians want clear growth pathways and organizational investment in their development.

These physicians seek growth opportunities, clear development pathways and, often, structured mentorship from experienced colleagues they can learn from.  For many, a slightly lower salary may be acceptable if the role provides structured mentorship, an approach that research shows can improve retention by more than 10 percentage points. On the flip side, early-career physicians are likely to turn down positions that feel isolating or where they don’t have clear support structures, even if the initial compensation is higher. 

Recent research reinforces this approach. A 2025 study found that structured mentorship programs achieved 96% first-year retention compared to just 85% for non-participants—translating to organizational savings exceeding $1 million by preventing turnover among early-career providers. Multiple studies now confirm that mentorship programs are vital to retention and wellbeing, giving concrete evidence for these support structures.

The Danger of One-Size-Fits-All

The common thread across career stages is that motivations differ, and strategies must adjust accordingly. Treating all physicians as if they are motivated by the same levers, primarily money, oversimplifies a complex workforce challenge. Instead, health systems should take a segmented approach.

• Early-career physicians may value mentorship, growth and meaningful engagement.
• Mid-career physicians often seek stability, autonomy and relief from burnout.
• Late-career physicians need transition opportunities that respect their legacy while addressing organizational needs.

Recruitment and retention strategies that acknowledge these nuances can improve acceptance rates and reduce turnover. Ignoring them will only perpetuate the cycle of open searches, costly locum coverage and stressed clinical teams.

Rethinking Recruitment as a Relationship

Ultimately, recruitment is not a single transaction but the beginning of a relationship. When organizations treat it as a simple exchange of salary for service, they miss the opportunity to build lasting trust. The most effective recruitment strategies listen closely to candidates, align offers with their personal and professional priorities, and stay flexible as those priorities evolve over time.

Physicians want to know that their employers understand them as people, not just providers. They want to believe their organization will support them through different stages of their career. When health systems deliver on that promise, they gain more than a signed contract. They gain loyalty, continuity of care, and stability in a market where all three are in short supply.

Looking Beyond the Numbers

The gap between physician and APP acceptance rates is more than a data point. It is a signal that compensation alone will not solve the workforce crisis. Health systems that continue to compete primarily on pay will find themselves chasing candidates who are motivated by more complex factors. Organizations that take the time to understand why physicians walk away and build strategies that address those reasons will be best positioned to secure and retain the clinical talent their communities depend on.