We’re Not Worthy: The Cost of Physician Burnout - Annals of Internal Medicine: Fresh Look Blog


Wednesday, October 9, 2019

We’re Not Worthy: The Cost of Physician Burnout

Losing a doctor is expensive—like billions of dollars a year expensive. A recent study published in Annals of Internal Medicine made headlines when it estimated that physician turnover and reduced clinical hours attributable to burnout in the United States cost approximately $4.6 billion each year (1). The authors admit they weren’t the first to investigate the impact of losing physicians to burnout, but the first to fully evaluate the price tag. So when theirs is the study that gets the publicity, it makes me wonder: is that all I’m worth to you? The cost of my replacement?

The authors admit that “despite the recent public interest in this subject and literature suggesting that burnout has the potential to be a major problem,” the previous dearth of information on the economic impact has left policymakers and leaders of health care organizations unable to “holistically assess the extent of the burnout problem … (or) make informed decisions when determining whether to invest scarce resources into programs to mitigate burnout” (1).

The argument reminds me of the scene in Wayne’s World when Wayne and Garth meet their idol, Alice Cooper, and bow before him, “We’re not worthy!” Clearly they had proven themselves enough to get the backstage introduction, but their imposter syndrome was part of their charm. It became a common joking refrain of my youth, but I worry many of us have grown up to think that it’s true.

As a result, our own suffering has been seen as a rite of passage rather than a call to action; a side note in boardroom discussions, prefacing pleas for systematic changes to address burnout with apologies and caveats. “We’re not worthy! But while we have your ear, we were wondering if maybe, uh, sort of, if you could, if you wouldn’t mind … I’m miserable …”

Our experiences hadn’t been enough to make headlines because until recently, we hadn’t proved convincingly that physicians who are unfulfilled, exhausted, and subjected to moral injury (previously known as burnout) don’t do good work. Most of the time, doctors prioritize patient care over self-care, and the frequently used markers of patient harm and medical error hadn’t budged when doctors were pushed to their emotional and physical limits. More recent data, including those cited by the authors, have found an increase in “higher rates of self-reported medical errors … and their patients have poorer clinical outcomes.”

In addition, as more and more organizations have started looking to quality metrics beyond the clinical outcomes to assess effectiveness (and—let’s be honest—to determine reimbursement), both value-based payment systems and fee-for-service systems have found failures in patient satisfaction scores that are often attributed to lack of empathy—one of many recognized manifestations of moral injury associated with burnout.

And yet, despite these findings, this article on the dollar cost of burnout is the one that received the loudest fanfare I’d seen recently. This is not to say that economic assessments are not important. But the very thought of having to prove the financial importance of maintaining happy and humanistic physicians seems dystopian when there are simultaneous reports worrying about lack of access to certain types of physicians—particularly primary care docs like me. When the boardroom is concerned about “investing scarce resources,” have they realized some of those resources are physicians themselves? The authors address this by noting that they chose physician turnover and reduction in clinical hours as their outcomes because they “directly affect the net supply of clinical capacity,” and they found that the cost of turnover was higher for younger (<55 years) physicians. This is not a problem that will age away any time soon.

So now we have the evidence. Share it. Cite it. Take it to your administrators and lawmakers. Fight for a work environment that minimizes administrative burdens, supports team-based care, instills “wellness” (whatever that means to you), and fosters a diverse workforce. Remind the world that we can’t take care of anyone else if we’re personally struggling to stay afloat. Maybe you don’t believe it yet, but now we’ve got science to confirm: You’re worth it.

  1. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170:784-790. [PMID: 31132791] doi:10.7326/M18-1422

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