In last week’s post, I discussed the lack of cohesive and coordinated attempts to address physician burnout on a national scale. I made a bold claim that linked charting (the number one cause of burnout) to healthcare access.
This week, I look at the financial costs of physician burnout to yet again bolster the call to tackle head-first this issue.
There is one hallmark paper on this very subject that this post leans on heavily. It was written by two preeminent physician burnout scholars who happen to be physicians: Tait Shanafelt, MD, of Stanford (burnout) fame, and Christine Sinskyj, MD, of AMA fame (referenced towards the end of last week’s post).
Read on!
If You Really Must Make It All About the Benjamins
We all understand the moral and ethical issues at play with physician burnout. We also understand that it needs to be addressed primarily for the sake of physicians, though downstream effects benefit the patients we serve.
However, as is too often the case, the motivation to address a pressing issue arises from the dollars involved. In this case, thankfully, the financial implications align with the goal of tackling burnout.
Studies have shown that overall costs to a health organization to replace a physician can be substantial. Some have landed on a figure between $500,000 to $1,000,000 (see here and here)!
There's Literally a Calculator for Everything
Yes, even this.
The AMA Steps Forward program has a calculator that organizations can use to calculate the cost of losing a physician.
Direct Vs. Indirect (No, Not Parts of Speech!)
These figures include both the direct and indirect costs driven by burnout.
Physician turnover, early retirement, and decreases in work hours all directly cost a health organization. Time is money, and that is no exception in medicine.
Time without a physician seeing patients generating ever precious medical widgets—err, RVUs—is lost income to an organization.
The emphasis on RVU production can make medicine feel like an assembly line.
Even after a replacement is hired (which itself can take months, if not longer), it takes time to onboard and get the new physician working at optimal efficiency.
The recruitment effort itself costs on average around $90,000, which includes marketing, sign-on and relocation bonuses, etc.
Even if a burned out physician doesn’t leave, it still can cost the organization in the form of indirect costs.
Examples of such costs include those associated with lower quality of care (including medical errors), decreased productivity, unnecessary testing and referring (including hospital admissions), higher malpractice risk, and decreased patient satisfaction.
Many of these costs are amplified in capitated or quality-based payment models like accountable care organizations (ACOs) or the never-ending alphabet soup of programs out of CMS: MIPS, APM, QPP, and so on and so forth.
A Butterfly Flaps Its Wings...
One often overlooked indirect cost from physician turnover is the impact on the other care team members including physician colleagues, who often bear the brunt of the workload from the departure often for no additional compensation.
This includes not only ensuring their former partner’s patients are seen, but also taking on their on-call duties, etc.
Thus, one physician departing can have a negative ripple effect, unintentionally propagating burnout.
Speak Their Language
You may be loath to frame physician burnout by its financial implications, but, for better or worse, money talks.
Furthermore, from a behavioral psychology perspective, we know that a loss hurts twice as much as the joy from a gain; lost revenue is something to which businesses including health organizations pay attention.
Addressing burnout keeps physicians working both longer and happier, both of which bolster the coffers.
Thus one strong avenue for physician wellness advocacy rests with the business case as outlined above. Financial alignment with the moral argument can help us achieve this goal.
I hope this post helped show that addressing physician burnout makes financial sense for healthcare organizations, and only adds greater impetus for tackling this issue head-on.
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