Physician burnout is established at $ 4.6 billion

The cost of physician burnout is $ 4.6 billion annually, once the costs associated with staff turnover and the reduction of clinical hours have been calculated.

To refine the discussion on burnout of physicians, Shasha Han, MS, of the National University of Singapore, and his co-authors conducted a cost-consequence analysis. The team, made up of researchers from Stanford University and the Mayo Clinic, and Christine A. Sinsky, MD, of the American Medical Association, published its results online Monday at Annals of Internal Medicine.

Burnout is widely recognized as an urgent problem for the medical profession, with approximately 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 feeling of low personal achievement.

"Traditionally, arguments in favor of a reduction in the burnout of doctors were mainly based on ethical reasons," write Han and his colleagues. "[O]your results suggest

that there is a solid financial base allowing organizations to invest in solving the problem of burnout of doctors. "

Estimate of the economic burden

The authors developed a mathematical model based on published research and industry reports to estimate the costs associated with burnout.

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

Han and his co-authors focused instead on staff turnover and the reduction in the number of clinical hours, as these factors are directly related to what they called "the net supply of clinical capabilities." ".

At acting costs for health care organizations, they found an annual cost attributable to burnout estimated at about $ 7,600 per physician. The analysis does not fully take into account the potential costs of a firm or hospital because it only takes into account the direct income losses resulting from a doctor's vacancy. , note the authors. Indirect costs may include the loss of patients by other practices after the doctor's departure.

"In addition, as patient satisfaction declines as health care decreases due to physician burnout, the organization may benefit from less favorable contracts with payers or see repayments." Reduced annuals decrease due to low levels of patient satisfaction, "write the authors.

The authors considered several factors in estimating physician replacement cost, such as research costs, hiring costs and start-up costs for physicians, or so-called friction costs by economists.

However, they included the loss of income from unfilled positions solely in the analysis at the organizational level. "We have excluded this component of the analysis at the national level because, at this level, the loss of income of doctors who leave an organization is won by the new organization to which they adhere, unless the doctor leaves permanently the medical office, "write the authors.

In an accompanying editorial, Edward M. Ellison, MD, medical director and president of the Southern California Permanente Medical Group (SCPMG), says the turnover of medical staff has been stable or declining in recent years – currently to a number be related to the efforts to fight against burnout.

"In general, our doctors tend to be more satisfied professionally and less stressed compared to national statistics," he writes.

In 2013, the SCPMG appointed a Chief Medical Officer in charge of Wellness. Ellison notes that this has created opportunities for more administrative support and a flexible work environment. In addition, the company provides personal assistance to a trained peer or behavioral counselor for burn-out physicians.

The SCPMG group is also beginning to determine whether gender or specialty is related to physicians' decisions to request reduced hours or early retirement, he said. And SCPMG is using it to help doctors recover the time claimed by the requirements of electronic medical records, he said.

"Doctors find the practice of medicine more difficult than ever because is "More difficult than ever," writes Ellison. "Almost everything that a doctor does in 2019 is monitored, noted, evaluated and reported."

Ellison notes that the suicide rate among physicians is higher than that of veterans. Approximately 300 to 400 American doctors commit suicide each year, a rate higher than that of the general public "of 40% for men and 130% for women," writes Ellison.

"While the financial impact of physician burnout is significant, we can not underestimate the urgency, severity, and tragedy of the human cost," Ellison added. "Having lost colleagues to suicide, starting with comrades in the medical school more than 30 years ago, and looking into the eyes of broken-hearted family members, I know the human cost is invaluable. "

The authors reported financial links, including royalties and speech fees, from CWS Inc, the American Medical Association and "several health care organizations in the United States," which Have not been identified. Ellison did not reveal any relevant financial relationship.

Ann Intern Med. Posted online 27th May 2019. Abstract, Editorial

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