Burnout's triple threat: Compromising care, clinicians, and cash flow

Since well before the pandemic, healthcare system leaders and hospital executives have been focused on clinician burnout, and for good reason. In 2017, the National Academy of Medicine published a call to explore and address the problem, highlighting burnout as an “underrecognized threat to safe, high-quality care.” They noted that more than half of U.S. physicians were experiencing substantial symptoms of burnout and that 35% of hospital nurses had high degrees of emotional exhaustion. Again, this was a paper from 2017, long before COVID-19 decimated the ranks of healthcare professionals across the spectrum.

In the last three years, things have gone from bad to worse with respect to burnout. In 2022, researchers found that 63% of physicians surveyed had at least one manifestation of burnout. The authors state that “... given the association of physician burnout with quality of care, turnover, and reductions in work effort, these findings have profound implications for the US health care system.” I agree; healthcare leaders should be concerned because quality of care is indeed harmed by clinician turnover and workforce reductions.

If we needed yet another reason to address burnout, there is no need to look any further than the bottom line: dollars and cents. Let’s focus on the seemingly innocuous term physician turnover. A physician who is overwhelmed and doesn’t want to practice anymore is much more likely to retire earlier than they had anticipated, look for a new line of work, or choose to practice in a different setting, often in a different part of the country. Under any of these circumstances, their employers will find themselves minus one physician.

A recent Becker’s article spelled out some often-overlooked financial “penalties” that are paid when a doctor leaves a medical group or hospital. Obviously, top revenue-generating proceduralists such as interventional cardiologists and orthopedic surgeons bring in a lot of money annually, as in over $3 million per year. We’re not talking about how much money these doctors make for themselves; instead, I’m referring to the money the hospital generates in OR and room fees for the procedures and operations the doctors perform.

... [F]or every month a hospital or healthcare system is missing an internist, pediatrician, or family physician, [hospitals] might be losing out on $125,000 in revenue.

Even lowly primary care doctors (don’t @ me; I’m one of them!) who do not fill up operating rooms with expensive cases can routinely bring in $1.5 million per year to hospitals based on their patients’ room and ancillary fees. This means that for every month a hospital or healthcare system is missing an internist, pediatrician, or family physician, they might be losing out on $125,000 in revenue. That’s real money, and that’s every month!

For every candidate physician a hospital interviews, sock away about $30,000 in direct charges. Also note that, on average, it takes over four months to fill an open family medicine role, and 5-10 months to fill a specialist role. Oh yeah, and don’t forget about relocation costs ($10,000-$15,000) and even student loan repayment promises that are often offered ($75,000-$99,000). Oops! I almost forgot about signing bonuses. Ninety-one percent of organizations offered signing bonuses typically averaging $20,000-$30,000. But that’s for primary care docs. If you’re recruiting a specialist, you might want to reserve up to $250,000.

Does any of this matter anyway? Sure, clinician burnout is a bad thing: Bad for good patient care, bad for our clinicians themselves, and bad for the organization’s bottom line. Yet, we know that we can’t undo how we pay for and operate the medical system in the U.S. (at least not without lots of time, buy-in, and interest from all the relevant parties). And we can’t retroactively cancel the novel coronavirus pandemic. (Remember when most people had never heard of a coronavirus or a pandemic? Ahh, good times.) But we can decrease burnout.

We can decrease burnout by getting rid of stupid stuff. (Please allow me to add a shameless plug for our new book, which includes a chapter dedicated to this very topic. Hint: see chapter 3. It’s titled “GROSS: Getting Rid of Stupid Stuff.”) We can practice digital minimalism. We can use tried and true methods to tame the electronic health record’s inbox. Heck, we can even teach and preach to our physicians that their progress notes can be theirs again! There’s lots to be done to mitigate clinician burnout, and it’s a great return on investment in every way imaginable.