Primary care physician burnout estimated to cost U.S. health care system $260 million annually

Interventions to boost practice efficiency, organizational culture, interpersonal connections with colleagues, and local leadership can improve professional fulfillment and reduce burnout, suggested the authors of a new study.

Turnover of U.S. primary care physicians (PCPs) for any reason results in approximately $979 million in excess health care expenditures for public and private payers annually, with $260 million attributable to burnout, a recent study estimated.

To estimate the excess health care expenditures due to PCP turnover, both overall and specific to burnout, researchers compared data from Medicare, estimates for non-Medicare patients, and data from the American Medical Association Masterfile. In addition, data from a cross-sectional survey of 5,197 physicians conducted between October 2017 and March 2018 were used to estimate the prevalence of burnout and intention to leave current practice within two years (likely or definitely) by specialty. The study was funded by Stanford WellMD Center, American Medical Association, and Mayo Clinic Program on Physician Well-being, and one of the authors is employed by the American Medical Association. Results were published by Mayo Clinic Proceedings on Feb. 25.

Turnover intention was defined as the intent to leave current practice for any reason. Researchers assumed that 25% of physicians intending to leave their current position would actually do so, which they noted as the most conservative estimate published. Of the 316,471 total PCPs in the U.S., 152,205 are expected to experience burnout, according to national studies, and published studies show that physicians with burnout have a 2.16 higher odds of intending to leave their current practice. The study authors estimated the departure rate during two years to be 9.22% (14,028/152,205) for PCPs with burnout and 5.27% (8,651/164,266) for PCPs without burnout. The difference between these two percentages (3.95%) is the risk of turnover during two years that is attributable to burnout. Applying this attributable risk to the estimated 152,205 PCPs with burnout predicted 6,012 PCP turnovers in two years or 3,006 PCP turnovers annually, the researchers estimated.

The researchers then used a conservative estimate of 1,000 patients in a physician's panel and a published estimate of excess expenditures for Medicare and non-Medicare patients the first year after their physician leaves practice ($189 and $61, respectively) to calculate excess health care expenditures per departing physician of $86,336. This added up to $260 million in excess health care expenditures attributable to burnout-related turnover in PCPs, the authors wrote.

“Although widespread, the current high levels of physician burnout are not inevitable,” the authors wrote. “Interventions to improve practice efficiency, such as through advanced models of team-based care with in-room support, can reduce burnout. Likewise, interventions to improve organizational culture, including interpersonal connections with colleagues and improved local leadership, can improve professional fulfillment and reduce burnout.”