$4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States.
The annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.
Annals of Internal Medicine
ACP Journals
managedhealthcareexecutive
Shasha Han, MS, Tait D. Shanafelt, MD, Christine A. Sinsky, MD, Karim M. Awad, MD, Liselotte N. Dyrbye, MD, MHPE, Lynne C. Fiscus, MD, MPH, Mickey Trockel, MD, Joel Goh, PhD
4 June 2019
Background:
Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout.
Objective:
To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.
Design:
Cost-consequence analysis using a mathematical model.
Setting:
United States.
Participants:
Simulated population of U.S. physicians.
Measurements:
Model inputs were estimated by using the results of contemporary published research findings and industry reports.
Results:
On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States.
This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses.
At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.
Limitations:
Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.
Conclusion:
Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.
About the authors
Shasha Han, MS, Tait D. Shanafelt, MD, Christine A. Sinsky, MD, Karim M. Awad, MD, Liselotte N. Dyrbye, MD, MHPE, Lynne C. Fiscus, MD, MPH, Mickey Trockel, MD, Joel Goh, PhD
National University of Singapore, Singapore (S.H.)
Stanford University School of Medicine, Palo Alto, California (T.D.S., M.T.)
American Medical Association, Chicago, Illinois (C.A.S.)
Atrius Health, Boston, Massachusetts (K.M.A.)
Mayo Clinic, Rochester, Minnesota (L.N.D.)
University of North Carolina Physicians Network, Morrisville, North Carolina (L.C.F.)
National University of Singapore, Singapore, and Harvard Business School, Boston, Massachusetts (J.G.)
This article was published at Annals.org on 28 May 2019.
COMMENTS ABOUT THE PAPER
What’s The Economic Cost Of Physician Burnout?
HBS Working Knowledge @ Forbes
by Michael Blanding
Jan 9, 2020
Physician burnout costs the United States health care industry $4.6 billion a year, a number that brings a new spotlight to an age-old problem.
In a paper published in the journal Annals of Internal Medicine last June, a research team of seven co-authors, most of them doctors, concluded that the dollar losses were related to
- physician turnover and
- reduced clinical hours.
The research adds to previous work showing how physician stress generates negative clinical and organizational outcomes. No studies have previously been attempted to put a figure on burnout in the US on a national level. In part, that’s due to the difficulty of calculating the economic cost of all of the factors involved. For instance, some studies have associated burnout with an increase in medical errors, but calculating those costs are nearly impossible.
“Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians,” the study states.
It’s well understood that doctors are constantly asked to do more with less. In addition to a demand for physicians that outstrips the supply, new laws around electronic record-keeping have increased the administrative burden on doctors as well.
“Physicians don’t sign up for the job to stare at a screen. They are doing this to provide care for people,” says one of the study’s co-authors, Joel Goh, a visiting scholar in the Technology & Operations Management Unit at Harvard Business School. “It creates a high level of dissonance for them.”
“Physicians don’t sign up for the job to stare at a screen. They are doing this to provide care for people,”
According to one study, more than half of all doctors in the US report feeling at least one symptom of burnout: emotional exhaustion, a feeling of detachment, or a diminished sense of personal accomplishment — twice the rate of the general working population.
“Essentially it’s this feeling of being overwhelmed,” says Goh, who is also an assistant professor at the National University of Singapore (NUS) Business School. “You don’t feel like what you are doing is meaningful anymore.”
What’s the economic price of burnout?
Even though physician burnout is widespread, it’s difficult to put a price tag on the phenomenon in a way that medical institutions can understand.
In past research, Goh focused on calculating the cost of workplace stress on medical costs in the US. That led Christine Sinsky, vice president of the American Medical Association, to contact Goh to ask if he could calculate the medical costs of stress experienced by doctors themselves. Sinsky is one of the authors of the latest paper.
“It was a great opportunity to explore this issue with thought leaders on the subject,” Goh says. “I could provide my technical skills on modeling, and they could provide their contextual knowledge.”
The researchers focused on one aspect of the problem they could measure: lost income due to reduced hours and turnover.
To do so, they used a 2014 survey of some 7,000 doctors that asked questions about burnout and short-term career plans to estimate the percentage of doctors planning to reduce their hours or leave their jobs due to burnout.
They then correlated those numbers with the percentage of burnout experienced by doctors in different age groups and medical disciplines in order to estimate the overall effects of burnout on staffing nationwide.
They then created a formula to calculate the cost of lost hours — as well as the search, hiring, and training costs of filling vacant positions — to arrive at a total price tag for burnout from turnover.
A not insignificant number
Their final estimate, $4.6 billion annually, “is a decent amount that people should care about,” Goh says.
Drilling down to an organization level, that number comes out to $7,600 per physician per year.
Most of that cost, they determined, comes from turnover, which had five times the impact of reduced hours, due to all of the associated costs of filling a full-time equivalent position.
Of course, cost isn’t the only reason to deal with the issue of doctor burnout. “Organizations have an ethical imperative to take care of their employees,” Goh says. And doing so could help take care of patients as well by reducing medical errors.
Even so, the study shows that doing the right thing ethically can also make sense to the bottom line. “It’s not just going to be a waste of resources trying to deal with this problem,” Goh says. “Aside from all of the positive outcomes you generate, it’s probably a good financial return on investment as well.”
Goh and his colleagues further help organizations calculate that cost with a spreadsheet tool they developed that any organization can use to plug in their own figures and calculate their own potential costs of not dealing with burnout.
“In every other management decision, you try to have as complete a picture as possible,” he says. “This helps fill in some of those data points, not to supplant the ethical considerations, but to provide a more complete picture.”
For those ready to deal with the problem, says Goh, a range of interventions have been shown to be successful, including mindfulness exercises and stress-management training. To really make an impact, however, wider organizational changes are probably needed.
“One way to make a difference is by increasing the amount of administrative support doctors receive, so they are relieved of those burdens,” Goh says. “It may seem costly to hire that additional staff, but it will probably be beneficial in the long run.”
Originally published at https://www.forbes.com
