Physician Burnout: Its Cost and Treatment

A recent study estimates that physician burnout costs the United States healthcare industry roughly $4.6 billion annually and notes that industry-wide investment in burnout prevention policies would have significant financial benefits.

Researchers Report High Costs of Burnout

A study on the costs of physician burnout, “Estimating the Attributable Cost of Physician Burnout in the United States” was recently published in the Annals of Internal Medicine. Researchers from National University of Singapore, Stanford University School of Medicine, American Medical Association, Atrius Health, Mayo Clinic, University of North Carolina Physicians Network, and Harvard Business School contributed to the work.

Lead author Shasha Han, M.S., of the National University of Singapore and her colleagues utilized a data review and cost-consequence analyses to determine that the U.S. healthcare industry loses approximately $4.6 billion each year as a result of physician burnout. This figure translates to approximately $7,600 in U.S. healthcare costs per employed physician, annually.

The researchers suggest that significant financial benefits would result from an industry-wide movement toward implementing burnout prevention policies.

In an accompanying editorial, Edward M. Ellison, M.D., executive medical director/chairman of the board of Southern California Permanente Medical Group and chairman of the board and CEO of The Southeast Permanente Medical Group, called the research “a valuable step in an overdue and important conversation we need to have in the healthcare community.”

Connecting Physician Burnout and Healthcare Costs

The researchers began the study because they were curious about potential connections between burnout and healthcare costs. Researcher Joel Goh, Ph.D., of the National University of Singapore Business School told OTW, “I had been interested in the relationship of workplace stress and health costs for some time now and had some prior work in this field. Through a mutual contact, I got to know Dr. Christine Sinsky, a co-author on this study, who asked me if I was interested in doing something that was focused specifically on physician burnout.”

Goh continued, “From my prior research, I had read about how burnout was particularly salient for healthcare providers but had not done any deep dives into this topic. I thought that this was a good opportunity to study this important question together with some of the key thought leaders in this field.”

The researchers feel that an integrative, broad assessment of the extensive costs of physician burnout is needed for healthcare organizations to move forward with informed decision-making around investing in wellness programs than can reduce burnout.

A Cost-Consequence Analysis of Physician Burnout

Han and colleagues developed a mathematical model to estimate physician burnout costs. The researchers used this model to estimate fiscal impact on the U.S. healthcare system using a cost-consequence analysis. Specifically, the authors focused on the costs of turnover and reduced clinical hours.

The researchers gathered input from a literature review of recent, pertinent, peer-reviewed journals. Costs were inflation-adjusted via the Consumer Price Index medical care component. The researchers described their model’s primary output as burnout-attributable cost.

The researchers estimated national burnout-attributable costs at between $2.2 billion and $6.7 billion annually. The model did not include other potentially negative costs associated with burnout such as decreased patient satisfaction and malpractice lawsuits. Therefore, Han and colleagues characterized their cost estimates as conservative.

The study authors wrote, “Traditionally, the case for ameliorating physician burnout has been made primarily on ethical grounds. Our study provides the tools to evaluate the economic dimension of this problem…our results suggest that a strong financial basis exists for organizations to invest in remediating physician burnout.”

Characteristics of Physician Burnout

Social and health psychologist Christina Maslach, Ph.D., professor emerita of psychology at the University of California at Berkeley has characterized workplace burnout symptoms to include three primary features:

• feelings of emotional exhaustion
• a lowered sense of personal accomplishment
• a sense of detachment or cynicism related to work

Authors of the Annals study report that research indicates over 50% of physicians identify at least one burnout symptom, roughly twice the instance reported by the general population. Possible contributing factors include high patient volumes, difficult work hours and the increasing demands of electronic record keeping.

Physician burnout symptoms can also lead to a decreased quality of care for patients. Extensive electronic documentation protocols often pressure providers to decrease patient care time in order to satisfy clerical requirements.

Dr. Ellison stated in his editorial that “An unwell and unhappy workforce may result in high turnover and replacement, low-quality care, a high risk for medical errors and malpractice claims, and suboptimal outcomes.”

Psychological Costs of Burnout

Physician burnout also has high psychological costs.

Dr. Ellison wrote that “beyond the anxiety, depression, insomnia, emotional and physical exhaustion, and loss of cognitive focus associated with physical burnout, an estimated 300-400 U.S. physicians take their lives every year.” Dr. Ellison reported that the suicide rate among doctors is 40% higher for men and 130% higher for women than general population suicide rates.

Ellison cited suicide rates among physicians as higher than those among combat veterans and wrote “Although the fiscal impact of physician burnout is important, we cannot underestimate the urgency, severity, and tragedy of the human cost.”

Increased Public Awareness

Public interest and media coverage on burnout has also increased, in part due to the World Health Organization’s (WHO) recent classification of workplace burnout as an International Classification of Diseases diagnostic code. On May 28, 2019, WHO announced that the ICD-11 revision now includes burnout. WHO classifies burnout an occupational hazard; not as a medical condition. Additionally, the WHO is developing evidence-based suggestions to promote workplace mental wellness.

Han and co-authors cited a 2018 study in which 10 U.S. CEOs from a prominent healthcare organization called physician burnout a public health crisis and called upon other leading healthcare executives to work on this issue collaboratively.

Dr. Goh told OTW, “There are some promising signs indicating that there’s growing awareness and interest to study this problem.”

However, the researchers noted that “Despite the recent public interest in the subject, only a few studies have attempted to quantify the magnitude of burnout in the form of easily understandable metric.”

Effective Burnout Prevention and Treatment

The authors concluded, “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.”

What types of burnout prevention programs are effective?

Dr. Goh told OTW, “There have been quite a number of interventions studied by researchers. Some focus on systemic changes in work processes, and others focused on individual-level interventions that aim to help physicians with stress management and coping.”

A 2016 research review in The Lancet suggested that both physician-focused individual supports and larger organizational policy changes can decrease physician burnout rates.

Dr. Ellison reported that the Southern California Permanente Medical Group (SCPMG) has had success in reducing burnout by utilizing an “intentional, holistic view of the physician work environment.”

SCPMG provides both emotional support and peer counseling as well as implementing ongoing wellness and self-care strategies. This along with addressing organizational stressors in practice environments such as scheduling and support staff needs has reportedly resulted in decreased or stable turnover rates over the past five years, as well as increased overall physician well-being.

Dr. Ellison calls for other healthcare industry leaders to adopt increased supports for physicians under stress and implementation of mental wellness programs for providers.

How to garner more interest?

Medscape Medical News reported that former hospital chief executive Ronald A. Paulus, M.D., posited that highlighting the economic benefits of addressing burnout is the most effective route toward garnering investment in wellness programs for providers.

At a National Academy of Medicine meeting last month, Dr. Paulus stated, “You frame it in a context they can relate to” such as the concept of return on investment or ROI. He emphasized, “People always want to know about ROI. ROI is dramatic in this space.”