Primary Care Burnout: The $260 Million Problem

Sharon Donovan

March 02, 2022

Turnover in primary care leads to nearly $1 billion a year in excess healthcare expenditures, of which an estimated $260 million is attributable to physician burnout, researchers have found.

The analysis, led by the American Medical Association (AMA) and published in Mayo Clinic Proceedings, is based on a prepandemic estimate of annual turnover of 11,339 primary care providers. Burnout-related turnover was estimated to affect 3006 of those practitioners.

Dr Christine Sinsky

"Turnover of primary care physicians is costly to public and private payers, yet there is an opportunity to decrease unnecessary healthcare expenditures by reducing burnout-related turnover," Christine Sinsky, MD, the lead author of the study and the AMA's vice president for professional satisfaction, told Medscape Medical News. "Physician burnout is preventable, and payers, healthcare organizations, and others have a vested interest in making meaningful changes to reduce physician burnout."

"This is the kind of thing that further strengthens that we need to do something as a society," Sterling N. Ransone, Jr, MD, FAAFP, president of the American Academy of Family Physicians (AAFP), said. "It's costing all of us when the primary care workforce has job turnover."

The notion that primary care providers are struggling in their practice is not new. "I'm glad we now have some financial numbers to back that up," Ransone told Medscape. "A lot of times, we hear about burnout, but now we can attach numbers to that problem. We can advocate on behalf of physicians and show how this is affecting the federal government."

Physician burnout is also associated with higher malpractice claims, reduction in clinical hours, and other organizational costs. Physician burnout affects society and the entire healthcare delivery system through higher costs of care and a reduced physician workforce, according to the researchers.

First Look at the Cost of Discontinuous Care

Previous work has focused on the effect of physician burnout on lost productivity, recruitment, and replacement but has not accounted for the greater healthcare expenditures that accompany a break in continuity between patients and their clinicians. The AMA investigators sought to estimate aggregate excess annual US healthcare expenditures due to turnover in primary care, and burnout-related turnover specifically, for all patients in the United States.

The investigators compiled data from a cross-sectional survey of 5197 US physicians conducted between October 12, 2017, and March 15, 2018, to estimate the prevalence of burnout and intention to leave one's current practice within 2 years (likely or definitely) by specialty.

The authors defined primary care specialties as family medicine, general internal medicine, general pediatrics, geriatrics, general medicine, general preventive medicine, and obstetrics/gynecology.

Using the excess expenditures for Medicare ($189) and non-Medicare ($61) patients, the researchers estimate that in the first year after leaving practice, the excess healthcare expenditures per primary care provider totaled $86,386.

The authors note several limitations of their study, including use of a conservative estimate of primary care providers' patient pool of 1000 and the absence of recent data on the excess of healthcare expenditures attributable to the loss of a primary care provider in the non-Medicare population.

Margot L. Savoy, MD, MPH, FAAFP, senior vice president for education at the AAFP, said that while the cost of turnover is a crucial factor, the long-range growth of the workforce of primary care providers and healthcare workers also is critical in the financial equation.

One area that warrants further study in turnover, she said, is how the pandemic affected primary care providers who already were burned out. "I worry about overall job turnover with primary care being more of a woman-driven specialty," Savoy told Medscape.

Telehealth that surfaced as an important resource during the pandemic will help address some of the burnout stress among primary care providers, Savoy added. "Improved work/life balance is another challenge for physicians that could be impacted by use of telemedicine," she said. "By having the option to work from home at times, the physician can both address the patient care needs while seeing their child off to school or simply avoiding one day of traffic. Increased time to spend on family or other non-work interests/activities during down time is a significant improvement of physician burnout."

Funding for the study was provided by Stanford Medicine WellMD Center, the AMA , and the Mayo Clinic Program on Physician Well-being.

Mayo Clin Proc. Published online February 26, 2022. Full text

Sharon Donovan is a New Orleans-based freelance writer who has written for ASCO Post, Pharmacy Practice News, and Clinical Oncology News, as well as daily newspapers, wire services, and consumer magazines.

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