Physician Turnover Costs Millions in Excess Healthcare Spending

By Jonathan Springston, Editor, Relias Media

The results of a recently published analysis revealed job turnover among primary care physicians (PCPs) in the United States leads to $979 million in excess healthcare spending, of which $260 million is blamed on burnout.

The authors started with a cross-sectional survey of physicians conducted between Oct. 12, 2017, and March 15, 2018, to learn who intended to leave their practice within two years. They also pulled information from Medicare, estimates for non-Medicare patients, and the American Medical Association Masterfile.

Researchers estimated each Medicare patient spends an extra $189 in the first year after their PCP leaves, while the total is $61 per non-Medicare patient. Based on a panel size of 1,000 patients per PCP (196 Medicare, 804 non-Medicare), the authors calculated excess healthcare spending totals $86,336 per PCP. Assuming 11,339 PCPs leave their practice each year, that is $979 million in extra healthcare spending annually. (More details about how the authors calculated these numbers are in Table 1 and Table 2 included with the paper.)

“Continuity between patients and PCPs is important for quality of care and patient satisfaction as well as for total costs of care. If care shifts to higher-cost venues, such as the emergency department rather than the ambulatory setting, costs rise,” the authors explained. “For example, given the greater trust between patients and their physicians in an ongoing relationship, a course of observation may be more acceptable in the context of an established relationship, whereas an accelerated application of imaging and consultations may occur in the evaluation of undifferentiated symptoms outside of the context of an ongoing relationship.”

Digging deeper, the investigators calculated the portion of the $979 million that could be attributed specifically to physician burnout. They multiplied the $86,336 per PCP figure by an estimated 3,006 estimated PCP turnover attributed to burnout to reach a total of $260 million. (More details about these calculations are in Table 3 and Table 4 included with the paper.)

“Uncounted in this estimate are additional costs related to other consequences of burnout, such as reduced patient satisfaction, lower quality care, medical errors, associated morbidity and mortality, and increased medical malpractice claims,” the authors wrote. “Future research could quantify changes in healthcare expenditures when continuity is disrupted in non-primary care specialties. In addition, physicians experiencing burnout are more likely to reduce their clinical effort. It is unknown how such reduction in clinical full-time equivalent affects panel size, continuity, and excess healthcare expenditures.”

Burnout among healthcare professionals already was a problem, then COVID-19 made it worse. Today, there are reports of burnout among every specialty, from critical care professionals to infection preventionists to case managers — and nurses of all types.

Episode 15 of the Relias Media podcast series “Rounds with Relias” provides more details about physician burnout and its causes. In Episode 4 of the series, two nurses share how leaders can create an environment that could entice staff to stay in the profession.