Primary care physician turnover leads to almost $980M in excess healthcare costs

Nearly one billion dollars in annual excess health care expenditure are due to turnover of primary care physicians, and work-related burnout is a significant driver of those costs, according to a new American Medical Association-led study published in Mayo Clinic Proceedings.

The new analysis found that job turnover in the primary care physician workforce leads to an additional $979 million in annual excess health care costs across the U.S. population, with $260 million (27%) attributable to burnout. 

The cost analysis is based on a pre-pandemic annual turnover estimate of 11,339 primary care physicians. Out of the total annual estimate, burnout-related turnover was estimated to impact 3,006 primary care physicians.

Physician burnout is especially costly to public and private payers, who bear most of these excess healthcare costs.

WHAT’S THE IMPACT

There are a number of plausible reasons for the increase in healthcare expenditures that take place when patients lose their PCPs. For one, 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.

Also, to the extent that patients replace primary care with non–primary care, they may receive more low-value care.

The $260 million per year in excess healthcare expenses linked to PCP turnover is distinct from the estimated $4.6 billion borne annually by healthcare organizations in costs attributable to burnout linked to reduced productivity from vacant positions, and the costs associated with replacing physicians.

Collectively, these costs would translate to a nearly $5 billion increase in healthcare expenditures each year due to burnout-related turnover costs, results showed. And that’s not counting potential additional costs related to things like reduced patient satisfaction, lower quality care, medical errors and increased medical malpractice claims.

Though the problem is widespread, there are measures organizations can take, authors said. 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 reduce burnout and improve professional fulfillment.

THE LARGER TREND

The pandemic is taking a toll on the mental and emotional wellbeing of physicians, with female physicians and those in critical care and infectious disease reporting the highest burnout rates during the public health emergency, according to findings from a December physician burnout report from Medscape.

Burnout and the stress of the pandemic – including factors such as personal risk, social distancing and financial uncertainty – appeared to diminish physicians’ overall work life happiness, with only 49% reporting they were happy in 2020, versus 69% pre-pandemic. More than one-third (34%) reported feeling unhappy last year, compared with 19% in 2019.

Nearly 80% of physicians said they felt burned out prior to the pandemic, but one in five said their burnout emerged only last year. Critical care (51%), rheumatology (50%) and infectious disease specialists (49%) ranked among the highest in reporting burnout for the first time since Medscape began surveying on the issue in 2013.

Even prior to the pandemic, burnout among healthcare professionals was a pervasive public health concern, with some studies reporting burnout for more than 50% of clinicians.

One recent study found reducing provider burden by optimizing flowsheets may have an appreciable effect on this trend.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com