The Business Case for Investing in Physician Well-Being

Tait D. Shanafelt; Joel  Goh; Christine A. Sinsky

Article | JAMA Internal Medicine

The Business Case for Investing in Physician Well-Being

by Tait D. Shanafelt, Joel Goh and Christine A. Sinsky

Abstract

Importance: Widespread burnout among physicians has been recognized for more than two decades. Extensive evidence indicates that physician burnout has important personal and professional consequences.
Observations: A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (e.g., return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization’s long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all U.S. health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization’s journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level.
Conclusions and Relevance: Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization’s ethical responsibility, it is also the fiscally responsible one.

Keywords: Physicians; well-being; ROI; Health; Welfare or Wellbeing; Ethics; Investment Return; Health Industry;

Format: Print

Find at Harvard Purchase

Citation:

Shanafelt, Tait D., Joel Goh, and Christine A. Sinsky. "The Business Case for Investing in Physician Well-Being." JAMA Internal Medicine 177, no. 12 (December 2017): 1826–1832. (doi:10.1001/jamainternmed.2017.4340.)

Article | Annals of Internal Medicine | 2010

Estimating the Attributable Cost of Physician Burnout in the United States

Shasha Han, Tait D. Shanafelt, Christine A. Sinsky, Karim M. Awad, Liselotte N. Dyrbye, Lynne C. Fiscus, Mickey Trockel and Joel Goh

Background: Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout.
Objective: To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.
Design: Cost-consequence analysis using a mathematical model.
Setting: United States.
Participants: Simulated population of U.S. physicians.
Measurements: Model inputs were estimated by using the results of contemporary published research findings and industry reports.
Results: On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.
Limitations: Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.
Conclusion: Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.

Keywords: Physicians; burnout; Health; Health Care and Treatment; Employees; Cost; Programs; Policy; Health Industry;

Citation:

Han, Shasha, Tait D. Shanafelt, Christine A. Sinsky, Karim M. Awad, Liselotte N. Dyrbye, Lynne C. Fiscus, Mickey Trockel, and Joel Goh. "Estimating the Attributable Cost of Physician Burnout in the United States." Annals of Internal Medicine 170, no. 11 (June 4, 2019): 784–790. View Details

Cite View Details Read Now

Recent Medicare legislation seeks to improve patient care quality by financially penalizing providers for hospital-acquired infections (HAIs). However, Medicare cannot directly monitor HAI rates and instead relies on providers accurately self-reporting HAIs in claims to correctly assess penalties. Consequently, the incentives for providers to improve service quality may disappear if providers upcode, i.e., misreport HAIs (possibly unintentionally) in a manner that increases reimbursement or avoids financial penalties. Identifying upcoding in claims data is challenging due to unobservable confounders (e.g., patient risk). We leverage state-level variations in adverse event reporting regulations and instrumental variables to discover contradictions in HAI and present-on-admission (POA) infection reporting rates that are strongly suggestive of upcoding. We conservatively estimate that 10,000 out of 60,000 annual reimbursed claims for POA infections (18.5%) were upcoded HAIs, costing Medicare $200 million. Our findings suggest that self-reported quality metrics are unreliable and thus, recent legislation may result in unintended consequences.

Faculty & Research

The Business Case for Investing in Physician Well-Being

Abstract

Citation:

More from these Authors