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The True Cost of Physician Burnout

By the acknowledgement of just about everyone in healthcare, physician burnout has become a significant problem. But what is the cost of that problem for hospitals and is there justification for spending money on fixing it?

Those were the questions three researchers tried to answer in a recent article in the JAMA Journal. In The Business Case for Investing in Physician Well-Being, researchers Tait Shanafelt, MD, Joel Goh, PhD, and Christine Sinsky, MD first outlined the true costs of physician burnout.

The picture wasn’t pretty.

The Cost of Physician Burnout

In numerous studies they cited, they showed that physician burnout was prevalent throughout healthcare, especially among specialties at the front of access to care, and it’s growing. According to the researchers, burnout among physicians is nearly twice as common as U.S. workers in other fields. In addition, in a study conducted in 2014, researchers found that physician burnout had increased 9% compared to a similar study conducted in 2011.

Evidence suggests that burnout is a major driver of physician turnover as well, with some studies demonstrating that physicians’ intent to leave correlates with actual departures. Further buttressing that evidence, one longitudinal study of faculty physicians at Stanford University found that the actual 2-year rate of turnover among physician faculty who were burned out was double that of non-burned out faculty.

The personal toll on physician burnout is significant as well.

Population studies have linked burnout to cardiovascular disease, as well as evidence to suggest that it is associated significantly with shorter life expectancy, alcohol use, broken relationships, depression and even suicide.

Hospitals are equally affected, especially economically.

According to the researchers, historical studies suggest the cost of replacing a physician is 2 to 3 times the physician’s annual salary. For example, in a 2012 report the Association of Staff Physician Recruiters indicated that the average “hard costs” with recruiting a physician (which included recruiting agency fees, advertisements, and interview costs) averaged around $88,000.

But those costs are only a small fraction of the total costs. A report by Atrius Health suggested that their organizational cost to replace a physician was $500,000 to $1 million. One reason for the high costs – the effect of turnover on physician productivity. In a longitudinal study of 2,500 physicians by the Mayo Clinic, a 1-point increase in burnout and a 1-point decrease in professional satisfaction (on 7-point and 5-point scales) resulted in a 30-50% increase in the likelihood that physicians would reduce their professional work effort over the following 24 months.

This is not a trivial matter.

 According to the researchers, even a small change in productivity can have large effects on an organization’s bottom line because of high fixed costs.

Physician burnout affects quality of care and patient outcomes as well. Studies suggest a higher burnout score increases the risk of errors for the next three months, while others show a correlation between burnout and other suboptimal patient care behaviors, such as failing to full discuss treatment options and answering patient’s questions.

One physician’s burnout can also affect others on his or her team, with cynicism and loss of engagement spreading from one member of the care team to another. Burnout can also lead to an erosion of teamwork, resulting in decreased patient safety both directly and indirectly, and it has been linked to deteriorating patient satisfaction as well.

Addressing the Problem

How should hospitals address the problem?

These researchers suggest a significant investment in organizational intervention. For example, they say that if $1 million was put towards reducing physician burnout, a hospital with 450 physicians could realize savings of $1.125 million, or a 12.5% ROI (return-on-investment). Researchers say their estimated ROI is conservative because it doesn’t account for lost revenue to decreased productivity among burned out physicians who do not turn over. Nor does it consider other benefits of reduced burnout with respect to patient satisfaction, quality and safety and potential reductions in litigation risk.

The bottom line—researchers say that not only does a healthcare organization have an ethical responsibility towards reducing burnout and turnover, but a fiscal responsibility as well.

Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. Published online September 25, 2017. doi:10.1001/jamainternmed.2017.4340