Physician Burnout Costs Pegged at $4.6 Billion

Kerry Dooley Young

May 28, 2019

The price tag for physician burnout runs at $4.6 billion annually when the costs associated with turnover and reduced clinical hours are tallied.

To sharpen the discussion around physician burnout, Shasha Han, MS, of the National University of Singapore, and coauthors performed a cost-consequence analysis. The team, which included researchers from Stanford University and the Mayo Clinic, as well as Christine A. Sinsky, MD, of the American Medical Association, published their results online Monday in Annals of Internal Medicine.

Burnout is widely recognized as an urgent issue for the medical profession, with about 54% of physicians reporting one or more symptoms in previous studies. The condition is marked by emotional exhaustion, feelings of cynicism and detachment from work, and a sense of low personal accomplishment.

"Traditionally, the case for ameliorating physician burnout has been made primarily on ethical grounds," write Han and colleagues. "[O]ur results suggest

that a strong financial basis exists for organizations to invest in remediating physician burnout."

Estimating Economic Burden

The authors developed a mathematical model drawing from published research and industry reports to estimate burnout-associated costs.

The authors describe their analysis as a "conservative" estimate of the economic toll of physician burnout. For example, their work did not factor in related costs of burnout that are difficult to quantify, such as reduced quality of patient care and malpractice lawsuits, which would likely add to the current estimates.

Rather, Han and coauthors focused on turnover and reduction in clinical hours because these factors directly relate to what they termed "the net supply of clinical capacity."

Looking at the costs for healthcare organizations, they found an annual cost attributable to burnout estimated at roughly $7600 per physician. The analysis does not fully factor in potential costs to a practice or hospital, as it captures only direct revenue losses as a result of a physician vacancy, the authors note. Indirect costs may include a loss of patients to other practices when a physician leaves.

"In addition, as patient satisfaction diminishes with reduced quality of care from physician burnout, the organization may enjoy less favorable contracting with payers or see reduced annual reimbursements drop because of low patient satisfaction scores," the authors write.

The authors considered several factors in estimating the cost of replacing physicians, including search costs, hiring costs, and physician startup expenses, or what are termed friction costs by economists.

However, they included the lost income from unfilled positions only in the organizational-level analysis. "We excluded this component from the national-level analysis because at that level the lost income from physicians leaving 1 organization is gained by the new organization they join, unless the physician leaves medical practice permanently," the authors write.

In an accompanying editorial, Edward M. Ellison, MD, executive medical director and chairman of Southern California Permanente Medical Group (SCPMG), says that SCPMG has had stable or declining physician turnover in recent years — currently in the low single digits —  which may be linked to efforts to combat burnout. 

"Broadly speaking, our physicians tend to be more professionally satisfied and less stressed compared with national statistics," he writes.

SCPMG in 2013 appointed a physician chief wellness officer. It has created opportunities for more back-office support and a flexible work environment, Ellison notes. In addition, the company provides personal assistance from a trained peer or behavioral counselor for physicians experiencing burnout.

SCPMG also is starting to look at whether gender or specialty is related to physicians' decisions to seek reduced schedules or early retirement, he said. And SCPMG is working to help physicians win back time that has been claimed by the demands of electronic health records, he said.

"Physicians find practicing medicine harder than ever because it is harder than ever," Ellison writes. "Nearly everything a physician does in 2019 is monitored, rated, assessed, and reported."

Ellison notes that the suicide rate among physicians tops that of combat veterans. About 300 to 400 US physicians take their own lives every year, a rate that is higher than that of the general public "by 40% for men and an astonishing 130% for women," Ellison writes.

"Although the fiscal impact of physician burnout is important, we cannot underestimate the urgency, severity, and tragedy of the human cost," Ellison continues. "Having lost colleagues to suicide, beginning with medical school classmates more than 30 years ago, and having looked into the eyes of heartbroken family members, I know that the human cost is inestimable."

Authors reported financial ties, including royalties and speaking fees, from CWS Inc, the American Medical Association, and "several health care organizations in the USA," which were not otherwise identified. Ellison has disclosed no relevant financial relationships.

Ann Intern Med. Published online May 27, 2019. Abstract, Editorial

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