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30 May 2019

Doctor burnout costly for patients and health care system

Doctor burnout is known to be associated with increased physician turnover and reduced productivity.

Exhausted, stressed-out doctors are responsible for poorer care, patient dissatisfaction and malpractice lawsuits that carry a huge cost for US health care, researchers report.

In fact, it's calculated that physician burnout adds nearly $5 billion (R74 billion) a year to health care spending in the United States.

Many doctors suffer burnout

"Physician burnout is known to be associated with increased physician turnover and reduced productivity," said lead researcher Joel Goh, an assistant professor of analytics and operations at the National University of Singapore. "But the costs in monetary terms are poorly understood."

Because the impact of these costs has been unclear, so too have been the benefits that might accrue if programmes were in place to deal with doctor burnout.

Burnout includes emotional exhaustion, feelings of cynicism and detachment from work, along with a sense of poor personal accomplishment, according to the study published online in the Annals of Internal Medicine.

Many doctors suffer some level of burnout. In 2014, about 54% reported having at least one symptom of burnout – nearly double the rate for US workers, researchers said.

"Physicians find practicing medicine harder than ever because it is harder than ever," Dr Edward Ellison wrote in an editorial accompanying the study. He is co-CEO of the Permanente Federation and executive medical director for Southern California Permanente Medical Group in Pasadena.

Cost of doctor turnover

"Nearly everything a physician does in 2019 is monitored, rated, assessed and reported," Ellison wrote. "The electronic health record has many benefits but it can also be a burden, adding substantially to the time physicians spend in front of a computer screen while robbing them of what brings them joy: spending time with their patients."

For the study, Goh and a team of researchers from Stanford University, the Mayo Clinic, and the American Medical Association created a mathematical model to estimate the cost of doctor turnover and the shorter hours that result from burnout.

"We found that at an organisational level, the annual burnout-associated cost was estimated at approximately $7,600 (R112 billion) per physician per year," Goh said. "At a national level, the estimated cost ranged from $3 billion (R44.4 billion) to $6 (R88.7 billion) billion a year."

With that substantial economic toll, Goh said preventing and treating burnout "is not only good managerial practice, but it can also make good business sense."

Dr David Katz, director of the Yale-Griffin Prevention Research Center in New Haven, Connecticut, said physician burnout is a real and serious problem.

'Good business'

"These are challenging times in medicine, with diverse pressures on clinical practice models eroding the human interactions on which high-quality care depends," said Katz, who wasn't involved with the study.

The new study makes a convincing case that addressing and preventing physician burnout may simply be "good business", he said.

"I often lament how often monetary considerations take precedent over human considerations," Katz said. "But if aligning them, as this paper does, can help get this priority matter the urgent attention it warrants, I am delighted to see it done."

In his editorial, Ellison reflected on the high toll of doctor burnout.

"Beyond the anxiety, depression, insomnia, emotional and physical exhaustion, and loss of cognitive focus associated with physician burnout, an estimated 300 to 400 US physicians take their own lives every year," Ellison wrote. "That number is higher than the suicide rate for the general public by 40% for men and an astonishing 130% for women."

But there may be solutions. Ellison observed that "physician-led optimisation of the electronic health record is key to providing greater opportunity for physicians to regain time in their day and connect with their patients, thereby enhancing the joy of practice".

Image credit: iStock

 
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