The moral and ethical reason for physician practices, hospitals and academic centers to address physician burnout should be obvious, but a new medical journal article makes the case for why addressing doctors’ well-being is also the financially responsible thing for health care organizations to do.
“Understanding the business case to reduce burnout and promote engagement, as well as overcoming the misperception that nothing meaningful can be done, are key steps for organizations to begin to take action,” according to “The Business Case for Investing in Physician Well-being,” published online in JAMA Internal Medicine. “Evidence suggests that improvement is possible, investment is justified and return on investment measureable.”
Research has shown that physician burnout leads to a higher rate of physician turnover, lower productivity, lower quality of care, decreased patient satisfaction and increased patient safety problems. All of these have measurable financial costs, conclude the article’s authors, Stanford University’s Tait Shanafelt, MD, Joel Goh, PhD, of Harvard Business School, and Christine Sinsky, MD, a general internist and the AMA’s vice president of Professional Satisfaction.
For example, the authors noted, replacing a physician costs a practice two to three times the annual salary of the physician who left. The JAMA Internal Medicine article references a 2012 Association of Staff Physician Recruiters report showed that the average “hard costs” associated with recruiting a physician—recruiting agency fees, interview costs, advertisements and other expenses—were $88,000 before tallying the revenue lost during the recruitment-and-onboarding process.
The actual lost revenue of one of the association’s clients was $990,000 per full-time-equivalent physician. Similarly, an Atrius Health analysis found that it cost their organization between $500,000 and $1 million to replace a physician.
Decreasing productivity means physicians are, for example, seeing fewer patients or performing fewer elective surgical cases. Estimating lost revenue associated with decreased productivity from burnt out physicians can be hard to quantify, the authors note, but some efforts have been undertaken to to do just that.
For example, a longitudinal study of payroll records of 2,500 physicians at Mayo Clinic found there was a 30–50 percent greater chance that physicians reduced their professional work effort in the 24 months after a one-point increase in burnout (on a seven-point scale) or a one-point decrease in professional satisfaction (on a five-point scale.)
“Due to the high fixed costs of many health care organizations, even a small change (1–2 percent) in productivity can have large effects on an organization’s bottom line,” wrote the authors of the JAMA Internal Medicine article.
Problem demands system-level response
Health care organizations can—and need—to take control, the article’s authors concluded.
“Burnout is primarily a system-level problem driven by excess job demands and inadequate resources and support, not an individual problem triggered by personal limitations,” they wrote.
First, health care organizations need to understand what is driving burnout and physician engagement. Factors include:
- Workload.
- Efficiency.
- Flexibility and/or control.
- Culture and values.
- Work-life integration.
- Community at work and meaning at work.
The article’s authors argue that organizations can make “profound and effective” changes in these areas with limited investment. Although changes won’t cost practices much out of their pockets, that doesn’t mean the changes are easy, the authors wrote: “They typically require a strategic plan customized to the local environment along with prioritization, commitment and follow through at the highest level of the organization.”
A new STEPS Forward™ module, “Creating the Organizational Foundation for Joy in Medicine™,” outlines nine steps to create the structures that can result in more satisfied and productive physicians and other health professionals. The module also includes a way for health care organizations to track the business case for well-being by estimating their own cost of physician burnout and return on investment for interventions to tackle the problem.
The free module may be completed for continuing medical education credit. The AMA’s STEPS Forward collection features 49 practice-improvement modules, including more than a dozen that focus on how to change key workflows and processes, such as pre-visit planning and synchronized prescription renewal. The AMA also offers other online CME to improve physician well-being.
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