SAN FRANCISCO — Burned out physicians are more likely to leave their job, and replacing them could be costing your institution millions of dollars each year, researchers reported October 13 at the 2017 American Conference on Physician Health.
Burnout is widespread among physicians in the United States, with numerous surveys showing rates above 50%. However, the effect of burnout on physician turnover in hospitals and academic medical centers is less well understood.
To learn more about its effects, Maryam S. Hamidi, PhD, associate director of scholarship and health promotion at Stanford Medicine WellMD Center in Palo Alto, California, and colleagues conducted a longitudinal study of physicians at Stanford Health Care and Stanford Children's Health.
Of 831 physicians invited, 473 completed the Stanford Physician Wellness Survey in 2013 and consented to have their unique identifier numbers included for data linkage. The survey included questions on burnout, work hours, and surgical specialty, and assessed depression, anxiety, and sleep issues through the PROMIS assessment tools. As reported previously, 25.8% of respondents were burned out.
Using the unique identifier numbers, Dr Hamidi and colleagues determined that 21% of burned out physicians had left Stanford by 2015 compared with just 10% of their non-burned-out peers. The authors estimate that the 11% difference between the groups was the proportion who departed because of burnout.
After adjusting for other factors, such as depression or work hours, they found that the odds of leaving the institution were 2.68-fold higher among burned out vs non-burned-out physicians. In addition, burnout was the only factor significantly related to departure in various models, Dr Hamidi said.
Recruitment Costs Run High
When the researchers extrapolated the 11% departure rate caused by burnout to all 2023 medical faculty at Stanford Medicine, they estimate the institution would lose 58 physicians in a 2-year period.
The cost to recruit a new physician to Stanford runs between $268,000 and $957,000, according to data from the university's chief financial officer (CFO). Thus, replacing burned out physicians costs the institution between $15,544,000 and $55,506,000 in a 2-year period, Dr Hamidi told a standing-room-only audience.
After Dr Hamidi's presentation, several audience members asked what was included in the recruitment figure. Dr Hamidi and coauthor Bryan Bohman, interim director of Stanford Medicine WellMD Center, chief medical officer at University Healthcare Alliance, and clinical associate professor of anesthesia and critical care at the Stanford School of Medicine, emphasized that the estimated costs do not include any salary. Dr Bohman did note that some of the cost may be unique to Stanford because of the high cost of living, and that new-hire packages include housing support. But even if the number were cut in half, it is still a large cost, they note.
"I hear that number of $250,000 thrown around, but how do we get to that number?" one audience member asked. He noted that taking such a "dramatic number" to his CFO could be challenging.
"We actually got that data from our CFO," Dr Hamidi responded. "They have that data. That is a known number. They just hadn't linked it to burnout, which is what we've done here."
Chris Sinsky, MD, vice president of professional satisfaction at the American Medical Association and an internist at Medical Associates Clinic and Health Plans in Dubuque, Iowa, concurred with their findings. "Several pieces of data are completely aligned with what you have just presented," said Dr Sinksy, who was not involved in the study. "For example, some of the [healthcare chief executive officers] in the country have identified $500 to more than $1 million as the cost for recruitment for a physician. Also, the recruitment company Cejka has published their estimates, and they estimate it at $500 to $1.3 million, depending on whether there is a 6- or 12-month vacancy."
She also said that she and several colleagues recently published a calculator in JAMA Internal Medicine that allows anyone interested to estimate the how much their institution spends to replace burned out physicians. "And it is very similar data to what you have here," she remarked.
Dr Bohman also noted that senior leadership at Stanford Medicine became much more interested in dealing with the issue of burnout after seeing these data. "After we engaged our CFO from the school of medicine in this study, the receptivity and interest in forming our WellMD Center and recruiting Tait [Shanafelt, MD, to lead it], had a significant inflection point."
"Aside from the other reasons that we need to take care of physicians and reduce burnout, aside from the humanistic reasons, we are trying to make a point that institutions should invest in preventing burnout because if they don't do that, it will have a high financial cost," Dr Hamidi said.
The authors have disclosed no relevant financial relationships.
2017 American Conference on Physician Health. Presented October 13, 2017.
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