Shasha Han, MS; Tait D. Shanafelt, MD; Christine A. Sinsky, MD; Karim M. Awad, MD; Liselotte N. Dyrbye, MD, MHPE; Lynne C. Fiscus, MD, MPH; Mickey Trockel, MD; Joel Goh, PhD
Acknowledgment: The authors thank the deputy editor, statistical editor, and 2 anonymous reviewers for their feedback, which helped us to improve this paper.
Grant Support: Dr. Dyrbye has received grants from the American Medical Association Accelerating Change in Medical Education Consortium, the Physicians Foundation, and the National Institutes of Health. Dr. Goh received a startup grant (R-314-000-110-133) from the National University of Singapore.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-1422.
Corresponding Author: Joel Goh, PhD, National University of Singapore Business School, 15 Kent Ridge Drive, #08-04, Singapore 119245, Singapore; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Han: National University of Singapore Business School, 15 Kent Ridge Drive, #08-69, Singapore 119245, Singapore.
Dr. Shanafelt: 300 Pasteur Drive, Suite 3215, Stanford, CA 94305.
Dr. Sinsky: American Medical Association, 330 North Wabash Avenue, Chicago, IL 60611.
Dr. Awad: 133 Brookline Avenue, Boston, MA 02215.
Dr. Dyrbye: Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905.
Dr. Fiscus: 613 Sugarberry Road, Chapel Hill, NC 27514.
Dr. Trockel: Psychiatry Clinic, 401 Quarry Road, Room 2303, Stanford, CA 94305.
Dr. Goh: National University of Singapore Business School, 15 Kent Ridge Drive, #08-04, Singapore 119245, Singapore.
Author Contributions: Conception and design: S. Han, T.D. Shanafelt, C.A. Sinsky, K.M. Awad, L.N. Dyrbye, L.C. Fiscus, M. Trockel, J. Goh.
Analysis and interpretation of the data: S. Han, T.D. Shanafelt, L.N. Dyrbye, J. Goh.
Drafting of the article: S. Han, K.M. Awad, J. Goh.
Critical revision for important intellectual content: S. Han, T.D. Shanafelt, C.A. Sinsky, L.N. Dyrbye, M. Trockel, J. Goh.
Final approval of the article: S. Han, T.D. Shanafelt, C.A. Sinsky, K.M. Awad, L.N. Dyrbye, L.C. Fiscus, M. Trockel, J. Goh.
Statistical expertise: S. Han, J. Goh.
Administrative, technical, or logistic support: T.D. Shanafelt, L.N. Dyrbye.
Collection and assembly of data: S. Han, T.D. Shanafelt, L.C. Fiscus, J. Goh.
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.
To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.
Cost-consequence analysis using a mathematical model.
Simulated population of U.S. physicians.
Model inputs were estimated by using the results of contemporary published research findings and industry reports.
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.
Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.
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.
Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. [Epub ahead of print 28 May 2019]170:784–790. doi: 10.7326/M18-1422
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Published: Ann Intern Med. 2019;170(11):784-790.
Published at www.annals.org on 28 May 2019
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