Clinical Context

The principal dimensions of occupational burnout include emotional exhaustion, feelings of cynicism and detachment from work, and a sense of low personal accomplishment. More than half of US physicians have at least one of these symptoms, according to the authors of the current study, and that can lead to poor job satisfaction, depression, and even suicide.

Panagioti and colleagues explored the cost to patients of physician burnout in a meta-analysis published in the October 1, 2018 issue of JAMA Internal Medicine.^[1,2] They included 47 studies with data of 42,473 physicians in their analysis. Physician burnout was associated with a near 2-fold increased risk for patient safety incidents. Burnout more than doubled the odds ratios for reduced quality of care because of poor professionalism and reduced patient satisfaction. Residents and physicians early in their career appeared particularly prone to negative effects of burnout in patient outcomes.

There has not been an economic analysis of the cost of physician burnout in the United States, but these data can be valuable for policymakers and health systems. The current study by Han and colleagues addresses this issue.

Study Synopsis and Perspective

The price tag for physician burnout runs at $4.6 billion annually when the costs associated with turnover and reduced clinical hours are tallied.

To sharpen the discussion around physician burnout, Shasha Han, MS, of the National University of Singapore, and colleagues performed a cost-consequence analysis. The team, which included researchers from Stanford University and the Mayo Clinic, as well as Christine A. Sinsky, MD, of the American Medical Association, published their results online May 28 in the Annals of Internal Medicine.^[3]

Burnout is widely recognized as an urgent issue for the medical profession, with about 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 sense of low personal accomplishment.

"Traditionally, the case for ameliorating physician burnout has been made primarily on ethical grounds," wrote Ms Han and colleagues. "[O]ur results suggest that a strong financial basis exists for organizations to invest in remediating physician burnout."

Estimating Economic Burden

The authors developed a mathematical model drawing from published research and industry reports to estimate burnout-associated costs.

The authors described their analysis as a "conservative" estimate of the economic toll of physician burnout (eg, their work did not factor in related costs of burnout that are difficult to quantify, such as reduced quality of patient care and malpractice lawsuits, which would likely add to the current estimates).

Rather, Ms Han and coauthors focused on turnover and reduction in clinical hours because these factors directly relate to what they termed "the net supply of clinical capacity."

Looking at the costs for healthcare organizations, they found an annual cost attributable to burnout estimated at roughly $7600 per physician. The analysis does not fully factor in potential costs to a practice or hospital, as it captures only direct revenue losses as a result of a physician vacancy, the authors noted. Indirect costs may include a loss of patients to other practices when a physician leaves.

"In addition, as patient satisfaction diminishes with reduced quality of care from physician burnout, the organization may enjoy less favorable contracting with payers or see reduced annual reimbursements drop because of low patient satisfaction scores," the authors wrote.

The authors considered several factors in estimating the cost of replacing physicians, including search costs, hiring costs, and physician start-up expenses, or what are termed friction costs by economists; however, they included the lost income from unfilled positions only in the organizational-level analysis.

"We excluded this component from the national-level analysis because at that level the lost income from physicians leaving [one] organization is gained by the new organization they join, unless the physician leaves medical practice permanently," the authors wrote.

In an accompanying editorial,^[4] Edward M. Ellison, MD, executive medical director and chairman of Southern California Permanente Medical Group (SCPMG), said that SCPMG has had stable or declining physician turnover in recent years -- currently in the low single digits -- which may be linked to efforts to combat burnout. 

"Broadly speaking, our physicians tend to be more professionally satisfied and less stressed compared with national statistics," he wrote.

SCPMG in 2013 appointed a physician chief wellness officer. It has created opportunities for more back-office support and a flexible work environment, Dr Ellison noted. In addition, the company provides personal assistance from a trained peer, or behavioral counselor, for physicians experiencing burnout.

SCPMG also is starting to look at whether sex or specialty is related to physicians' decisions to seek reduced schedules or early retirement, he said, and SCPMG is working to help physicians win back time that has been claimed by the demands of electronic health records.

"Physicians find practicing medicine harder than ever because it is harder than ever," Dr Ellison wrote. "Nearly everything a physician does in 2019 is monitored, rated, assessed, and reported."

Dr Ellison noted that the suicide rate among physicians tops that of combat veterans. About 300 to 400 US physicians take their own lives every year, a rate that is higher than that of the general public "by 40% for men and an astonishing 130% for women," Dr Ellison wrote.

"Although the fiscal impact of physician burnout is important, we cannot underestimate the urgency, severity, and tragedy of the human cost," Dr Ellison continued. "Having lost colleagues to suicide, beginning with medical school classmates more than 30 years ago, and having looked into the eyes of heartbroken family members, I know that the human cost is inestimable."

Authors reported financial ties, including royalties and speaking fees, from CWS Inc, the American Medical Association, and "several health care organizations in the USA," which were not otherwise identified. Ellison has disclosed no relevant financial relationships.

Clinical Implications

• A previous meta-analysis by Panagioti and colleagues found that physician burnout was associated with higher rates of patient safety incidents, a higher risk for worse quality of care because of low professionalism, and a higher risk for low patient satisfaction.
• Estimates for the annual national cost of physician burnout, according to the current study by Han and colleagues, was $4.6 billion, with a cost of approximately $7600 per case of physician burnout for institutions.
• Implications for the Healthcare Team: The healthcare team should be aware of the risk for burnout among its members and should take advantage of institutional resources to reduce the effect of burnout. In turn, institutions should provide these resources to providers.

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