Burnout among doctors is costing the U.S. health-care system an estimated $4.6 billion a year in billings because of reduced hours, physician turnover, and expenses associated with finding and hiring replacements, according to a first-time analysis of the overall economic impact of the problem.
That figure, calculated by an international team of researchers led by Harvard Business School visiting scholar Joel Goh, is likely an underestimate, researchers said, because it doesn’t include the costs of burnout’s potentially significant downstream effects, such as increased medical errors, patient dissatisfaction, increased malpractice lawsuits, and the impact on other staff who must pick up the slack.
“What’s interesting is the magnitude of the effect, which is substantial,” said Goh, senior author of a paper published recently in the Annals of Internal Medicine. “It draws our attention to the fact that this is a problem worth looking at.”
Physician burnout has long been recognized as a significant problem.
According to a survey of nearly 7,000 doctors published in 2015, 54 percent reported at least one of three symptoms of burnout: emotional exhaustion, feelings of cynicism and detachment from work, and a sense of low personal accomplishment.
That rate is roughly double that of the general population.
Burnout among doctors has been associated with higher rates of medical errors, worse clinical outcomes for patients, increased absenteeism, and a rise in doctors wanting to reduce their work hours or leave the field entirely.
Goh became interested in the subject through his prior work on job stress.
He said that in the past burnout among America’s doctors has largely been examined through an ethical, instead of an economic, lens.
The new numbers, he said, show that it’s not just a problem affecting physicians’ happiness but one that has enough impact on the bottom line that it probably makes financial sense to invest in addressing it.
“Our study was not an intervention study,” Goh said, “but these numbers suggest [addressing the problem] is probably a good idea.”
The analysis was conducted by a team from HBS, the National University of Singapore, where Goh is an assistant professor, Stanford University, the American Medical Association, Atrius Health in Boston, the Mayo Clinic, and the University of North Carolina Physicians Network.
Beginning in 2017, researchers first constructed a mathematical model and then fed it data from existing studies to come up with their economic analysis.
The $4.6 billion annual estimate is the midpoint in a range of $2.6 billion to $6.3 billion nationwide.
The researchers conducted a similar analysis to find the cost of burnout per physician and found costs of about $7,600 per doctor, with a range of $3,700 to $11,000.
“To me, the punch line is that this stuff matters,” Goh said.
“There’s been a growing awareness of physician burnout … But as a health care executive, when you’re trying to make a decision you want all the evidence, all the data, in front of you.
And if you’re trying to quantify the dollars and cents, addressing this may be worthwhile even from a business point of view.”
What does physician burnout look like?
Burnout among doctors is generally described in terms of a loss of enthusiasm for one’s work, a decline in satisfaction and joy, and an increase in detachment, emotional exhaustion, and cynicism.
It manifests in disproportionately high rates of depression, substance abuse, and suicide.
Annually, approximately 400 physicians take their own lives in the United States.
A 2016 study published by the Mayo Clinic showed a high and increasing rate of physician burnout.
Of the almost 7,000 physicians who responded to the survey, 54.4% “reported at least one symptom of burnout in 2014 compared with 45.5% in 2011.”
Satisfaction with work-life balance also declined, but this is no huge surprise given that, as a whole, physicians are working more and earning less.
In other words, more than half of US physicians are experiencing at least some degree of burnout.
Moreover, many doctors are leaving medicine mid-career, which, among other things, causes patients to have to start all over again with a new doctor.
Other physicians are cutting back their hours, which makes it more difficult for patients to obtain timely appointments.
These developments are expected to worsen the projected shortage of physicians that our country will be facing over the next few decades, estimated to be up to 100,000 doctors by 2030, according to a study commissioned by the American Association of Medical Colleges.
Why are doctors so burned out?
The causes of physician burnout are complex, but have to do in part with increasing workload, constant time pressures, chaotic work environments, declining pay, endless and unproductive bureaucratic tasks required by health insurance companies that don’t improve patient care, and increasingly feeling like cogs in large, anonymous systems.
Parasitic malpractice lawyers are always circling, which causes us to waste an enormous amount of time with defensive documentation.
The transition from paper charts to electronic medical records, which seemingly were designed to maximize revenues instead of clinical care, has created a technological barrier between doctor and patient, and between doctors.
Physician burnout compromises patient care
There is good evidence that physician burnout results in more expensive healthcare and less satisfied patients.
Demoralized doctors can suffer from impaired memory and attention, and poor decision-making.
They can be distracted, and their communication with both patients and peers deteriorates.
They feel less empathetic and engaged in the outcomes of their day-to-day decisions. Their bedside manner worsens.
They can make mistakes, sometimes devastating.
While this is a difficult phenomenon to measure, a 2014 study of intensive care doctors showed that emotional exhaustion among physicians predicted a higher mortality rate among the patients they cared for.
And according to a research review in The BMJ from 2017, “there is moderate evidence that burnout is associated with safety-related quality of care.”
What can we do to address physician burnout?
Sadly, hospitals and other medical institutions have tended to address the problem of physician burnout merely by giving their doctors inspirational talks about “resilience,” patting them on the shoulder, and then sending them back into their deteriorating clinical lives with no material change in circumstances.
Sometimes they throw in a yoga mat.
The physician then continues to suffer in silence, leaves medicine, or encounters some other tragic endpoint.
Recently, there appears to be more awareness of, and concrete attention being paid to, this issue.
Some medical schools and hospitals have started including physician wellness in their curriculums, and even dedicating some faculty time to help monitor and ensure the well-being of their staff physicians.
The problem of physician burnout is complex and there is no easy solution in sight. In my personal experience as a primary care physician over the last 20 years, the insurance companies won’t flinch at wasting a doctor’s time, even deliberately, if it will increase their profits.
Hospitals will choose a medical record system that prioritizes their revenues, and which has the doctor facing the screen and pecking away, over one that allows for doctors and patients to speak with each other, comfortably, face to face. As with most things, it comes down to the bean counters, and the bottom line.
Addressing the human cost of physician burnout
The losers in all this, equally, are the doctors and the patients.
If you are receiving substandard care from a seemingly burnt-out or distracted doctor, you obviously need to report it, and advocate for your own care.
However, it is also critically important to remember that doctors are people too, not robots. As with most things in life, empathy is a two-way street. Doctors and patients need to put their heads together and try to find a way to regain what is being lost in terms of the once strong doctor-patient bond. We need to reclaim healthcare, for the good, and the safety, of us all.
More information: Shasha Han et al. Estimating the Attributable Cost of Physician Burnout in the United States, Annals of Internal Medicine(2019). DOI: 10.7326/M18-1422
Journal information: Annals of Internal Medicine
Provided by Harvard University
