Wellness: Is it Worth the Cost?

We know from my previous post on physician burnout that burnout is both prevalent (in residents and attendings), costly (as much as $250,000-$1,000,000 per physician who leaves because of burnout), and deadly (an estimated 400 attending physicians end their life each year).  As an organization, administrators and executives are ethically bound to help prevent burnout and to produce physician wellness, but the question we will answer today is: Does this provides a good return on investment?

The problem and case for wellness

Burnout is a combination of symptoms including increasing exhaustion, depersonalization from people in your life (including patients and staff), and decreasing value in your work and accomplishments.  It is extremely prevalent.

In one study, 45.8% of physicians admitted to at least one symptom of burnout

In the same study, they noted that burnout disproportionately affected physicians in “front-line” fields such as emergency medicine (>60% of EM physicians!), internal medicine, and family medicine. Surprising to me, my own field (anesthesiology) was also up there.

Physician Burnout by Specialty
From Shanafelt’s study on Burnout in JAMA: October 2012. Burnout as it relates to specialty

These numbers are also substantially higher than the general population where overall burnout was found to be 37.9% in the physician population compared to 23.5% in the general population.

As mentioned in my previous post on burnout, not only is this problem prevalent; it costs a hospital a bunch of money every time a physician leaves.  Depending on experience, specialty, and skill of the physician it will cost the hospital anywhere between $250,000 to $1,000,000 to replace a physician lost to burnout.

In addition, there is good evidence that losing any staff member (nurse, nursing assistant, physician) to burnout that causes a transition to a job somewhere else can increase the burnout in the individuals left behind.  This only fuels the flame to burnout leading to more turnover and lost revenue.

The problem is vast and costly, but what can be done?

Most people view this problem as being impossible to correct.  It is an epidemic of the highest proportions.  What can a hospital do to fix these problems?

The fact is that the majority of burnout comes from institutional limitations, excess work demands, and a lack of support.  It does not (typically) come from individual life demands or limitations, though these problems can make burnout worse.

A study published in the Lancet has shown that both institutional and individual-focused interventions can decrease levels of burnout in physicians by about 10%. Examples of institutional based interventions include duty hour requirements and support for clinical based processes.  Examples of individualized interventions include mindfulness training, stress management training, and small group discussions.

Yeah, but is it worth the cost (What is the ROI)?

We have established that physician burnout is both common and costly.  It affects patients care.  It is linked to higher rates of depression and suicide.  There is clearly a moral and ethical imperiative to address this probelm… but every administrator bent on looking at the bottom line wants to know…what is the return on investment for helping produce physician wellness and prevent burnout?  In other words, we know its a problem, but is there really any cost effective way we can help the problem?  Or are we just throwing money at something that will never get better?

Thought Experiment for Return on Investment (ROI)

If an organization loses 30 physicians per year, and each physician on average costs the organization $500,000.

In one year, that organization would lose $15,000,000 to physician turnover.

Now, you may be thinking that there are a lot of reasons that physicians leave (family lives somewhere else, better job offer, etc), but physician burnout has been linked to physician turnover.  In fact, of the 30 physicians that left in the example above, it could be assumed that at least one third of those physicians turned over because of burnout, which would still cost $5,000,000 per year.  That’s a lot of money!

If an organization put in place a $1.5 million intervention in place and decreased that turnover rate due to burnout in half, they would save $2.5 million dollars and their ROI would be $1,000,000.

In addition to this ROI, there would be some compounded interest on that ROI seen in better patient care, more academic productivity, and continued decline in burnout that would have been caused from the contagious nature of burnout in groups.

The ROI is good, but what can be done?

The major determinant preventing hospital administrators (department chairs, CMO’s, etc) from investing in this obviously good return on investment is that they don’t feel that they have a good intervention to put in place to really help fix the problem.

One big problem that we have all faced is being brought into meetings to help address these issues and we are faced with wellness initiatives that are one-size-fits-all.  They are not specific to our field or to our problems.  They are not adequate forms of allowing us to vent the frustration we have.  Therefore, hospitals and departments should aim to make changes specific to the specialty.

In fact, an intervention that is not helpful can INCREASE burnout as it is viewed as another form of adminstrative requirement that must be met.  However, a COSTLY but EFFECTIVE intervention may have a much better effect and, therefore, return on investment.

What do you think?  Have you seen effective wellness initiatives put in place?  Are you burned out?  How does burnout and wellness affect your practice?






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