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1.
J Gen Intern Med. 2019 Nov 16. doi: 10.1007/s11606-019-05376-x. [Epub ahead of print]

Relationship Between Burnout, Professional Behaviors, and Cost-Conscious Attitudes Among US Physicians.

Author information

1
Mayo Clinic, Rochester, MN, USA. dyrbye.liselotte@mayo.edu.
2
Mayo Clinic, Rochester, MN, USA.
3
American Medical Association, Chicago, IL, USA.
4
Stanford School of Medicine, Stanford, CA, USA.
5
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

Despite the importance of professionalism, little is known about how burnout relates to professionalism among practicing physicians.

OBJECTIVE:

To evaluate the relationship between burnout and professional behaviors and cost-conscious attitudes.

DESIGN AND PARTICIPANTS:

Cross-sectional study in a national sample of physicians of whom a fourth received a sub-survey with items exploring professional behaviors and cost-conscious attitudes. Responders who were not in practice or in select specialties were excluded.

MEASURES:

Maslach Burnout Inventory and items on professional behaviors and cost-conscious attitudes.

KEY RESULTS:

Among those who received the sub-survey 1008/1224 (82.3%) responded, and 801 were eligible for inclusion. Up to one third of participants reported engaging in unprofessional behaviors related to administrative aspects of patient care in the last year, such as documenting something they did not do to close an encounter in the medical record (243/759, 32.0%). Fewer physicians reported other dishonest behavior (e.g., claiming unearned continuing medical education credit; 40/815, 4.9%). Most physicians endorsed cost-conscious attitudes with over 75% (618/821) agreeing physicians have a responsibility to try to control health-care costs and 62.9% (512/814) agreeing that cost to society is important in their care decisions regarding use of an intervention. On multivariable analysis adjusting for personal and professional characteristics, burnout was independently associated with reporting 1 or more unprofessional behaviors (OR 2.01, 95%CI 1.47-2.73, p < 0.0001) and having less favorable cost-conscious attitudes (difference on 6-24 scale - 0.90, 95%CI - 1.44 to - 0.35, p = 0.001).

CONCLUSIONS:

Professional burnout is associated with self-reported unprofessional behaviors and less favorable cost-conscious attitudes among physicians.

KEYWORDS:

health care costs; physicians; professional burnout; professionalism

2.
Ann Intern Med. 2019 Oct 15;171(8):600-601. doi: 10.7326/L19-0522.

Estimating the Attributable Cost of Physician Burnout in the United States.

Author information

1
Mayo Clinic, Rochester, Minnesota (L.N.D.).
2
Atrius Health, Boston, Massachusetts (K.M.A.).
3
University of North Carolina Physicians Network, Morrisville, North Carolina (L.C.F.).
4
American Medical Association, Chicago, Illinois (C.A.S.).
5
Stanford University School of Medicine, Palo Alto, California (T.D.S.).
PMID:
31610567
DOI:
10.7326/L19-0522
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3.
Ann Intern Med. 2019 Oct 15;171(8):600. doi: 10.7326/L19-0521.

Estimating the Attributable Cost of Physician Burnout in the United States.

Author information

1
Oregon Health & Science University, Portland, Oregon (D.E.G., D.A.N., D.H.H., T.G.).
PMID:
31610566
DOI:
10.7326/L19-0521
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4.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med. 2019 Jul;27(4):384-388. doi: 10.32687/0869-866X-2019-27-4-384-388.

[The conflict of interests and organizational structures in conditions of health care commercialization].

[Article in Russian]

Author information

1
The Federal State Budget Institution of Science «The Institute of Social Economic Problems of Population» of the Russian Academy of Sciences , 117218, Moscow, Russia, a762rab@mail.ru.
2
The Federal State Budget Educational Institution of Higher Education «The Financial University under the Government of the Russian Federation», 125993, Moscow, Russia.
3
The State Autonomous Educational Institution of Higher Education «The Moscow Municipal University of Management of the Moscow government», 107045, Moscow, Russia.

Abstract

The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.

KEYWORDS:

conflict of interests; management of a medical organization; medical services; organizational culture

[Indexed for MEDLINE]
5.
Ann Intern Med. 2019 Jun 4;170(11):784-790. doi: 10.7326/M18-1422. Epub 2019 May 28.

Estimating the Attributable Cost of Physician Burnout in the United States.

Author information

1
National University of Singapore, Singapore (S.H.).
2
Stanford University School of Medicine, Palo Alto, California (T.D.S., M.T.).
3
American Medical Association, Chicago, Illinois (C.A.S.).
4
Atrius Health, Boston, Massachusetts (K.M.A.).
5
Mayo Clinic, Rochester, Minnesota (L.N.D.).
6
University of North Carolina Physicians Network, Morrisville, North Carolina (L.C.F.).
7
National University of Singapore, Singapore, and Harvard Business School, Boston, Massachusetts (J.G.).

Abstract

Background:

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.

Objective:

To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels.

Design:

Cost-consequence analysis using a mathematical model.

Setting:

United States.

Participants:

Simulated population of U.S. physicians.

Measurements:

Model inputs were estimated by using the results of contemporary published research findings and industry reports.

Results:

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.

Limitations:

Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated.

Conclusion:

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.

PMID:
31132791
DOI:
10.7326/M18-1422
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6.
Pract Radiat Oncol. 2019 Jul - Aug;9(4):231-238. doi: 10.1016/j.prro.2019.02.015. Epub 2019 Mar 7.

A Burnout Reduction and Wellness Strategy: Personal Financial Health for the Medical Trainee and Early Career Radiation Oncologist.

Author information

1
Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. Electronic address: trevor_royce@med.unc.edu.
2
Department of Emergency Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina.
3
Utah Emergency Specialists, Salt Lake City, Utah; The White Coat Investor, LLC, Salt Lake City, Utah.

Abstract

PURPOSE:

Physician burnout is reported in more than one out of every 2 practicing clinicians and is just as prevalent in training physicians. Burnout severity is also associated with increasing levels of financial debt. Medical professionals are notable for their high and increasing levels of debt; despite this, financial literacy is poor among physicians, and financial education is largely absent from medical education. Radiation oncologists (ROs) are no different in this regard, with 33% of residents reporting high levels of burnout symptoms, 33% carrying >$200,000 of educational debt, and 75% reporting being unprepared to handle future financial decisions. To fill this gap, we reviewed the basic tenets of personal financial health for the early career RO.

METHODS AND MATERIALS:

The core concept of financial independence (FI) is introduced, and we review 4 basic tenets of personal financial health for the young medical professional: debt, behavior, investment, and asset protection strategies.

RESULTS:

FI is achieved by saving until the desired quality of life can be maintained, independent of employment income. Debt strategy involves minimizing debt accrual, understanding student loans, and having a debt management plan. Behavioral strategy involves setting financial goals, calculating worth and a savings rate, budgeting, and frugal living. The basics of investing include asset allocation, diversification, rebalancing, and minimizing expenses. Finally, asset protection includes insuring against catastrophic events with disability, life, health, liability, and property insurance.

CONCLUSIONS:

Healthy financial practices can lead to FI and may facilitate professional and personal freedoms with the goal of mitigating burnout-associated stressors. The tenets of strong financial health for ROs in the early stages of their career include sound debt, behavioral, investment, and asset protection strategies. Furthermore, initial and continuing financial education is an overlooked but important curriculum component. ROs with their financial houses in order can devote more resources to learning and practicing good medicine while living healthy, rewarding lives.

PMID:
30853541
DOI:
10.1016/j.prro.2019.02.015
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Publication type

Publication type

7.
BMC Health Serv Res. 2018 Nov 27;18(1):851. doi: 10.1186/s12913-018-3663-z.

Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study.

Author information

1
Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Office 1320, Stanford, CA, 94305, USA.
2
Stanford Medicine Well MD Center, Stanford University, Stanford, CA, 94305, USA.
3
Stanford Health Care, 300 Pasteur Dr, Stanford, CA, 94305, USA.
4
Stanford Children's Health | Lucile Packard Children's Hospital, Pediatric Rheumatology, 730 Welch Rd, Palo Alto, CA, 94304, USA.
5
Stanford Emergency Department, 300 Pasteur Dr, Palo Alto, CA, 94304, USA.
6
Stanford Children's Health | Lucile Packard Children's Hospital, 725 Welch Rd, Palo Alto, CA, 94304, USA.
7
The Risk Authority Stanford, 1510 Page Mill Road, Palo Alto, CA, 94304, USA.
8
Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Office 1320, Stanford, CA, 94305, USA. trockel@stanford.edu.
9
Stanford Medicine Well MD Center, Stanford University, Stanford, CA, 94305, USA. trockel@stanford.edu.

Abstract

BACKGROUND:

Awareness of the economic cost of physician attrition due to burnout in academic medical centers may help motivate organizational level efforts to improve physician wellbeing and reduce turnover. Our objectives are: 1) to use a recent longitudinal data as a case example to examine the associations between physician self-reported burnout, intent to leave (ITL) and actual turnover within two years, and 2) to estimate the cost of physician turnover attributable to burnout.

METHODS:

We used de-identified data from 472 physicians who completed a quality improvement survey conducted in 2013 at two Stanford University affiliated hospitals to assess physician wellness. To maintain the confidentially of survey responders, potentially identifiable demographic variables were not used in this analysis. A third party custodian of the data compiled turnover data in 2015 using medical staff roster. We used logistic regression to adjust for potentially confounding factors.

RESULTS:

At baseline, 26% of physicians reported experiencing burnout and 28% reported ITL within the next 2 years. Two years later, 13% of surveyed physicians had actually left. Those who reported ITL were more than three times as likely to have left. Physicians who reported experiencing burnout were more than twice as likely to have left the institution within the two-year period (Relative Risk (RR) = 2.1; 95% CI = 1.3-3.3). After adjusting for surgical specialty, work hour categories, sleep-related impairment, anxiety, and depression in a logistic regression model, physicians who experienced burnout in 2013 had 168% higher odds (Odds Ratio = 2.68, 95% CI: 1.34-5.38) of leaving Stanford by 2015 compared to those who did not experience burnout. The estimated two-year recruitment cost incurred due to departure attributable to burnout was between $15,544,000 and $55,506,000. Risk of ITL attributable to burnout was 3.7 times risk of actual turnover attributable to burnout.

CONCLUSIONS:

Institutions interested in the economic cost of turnover attributable to burnout can readily calculate this parameter using survey data linked to a subsequent indicator of departure from the institution. ITL data in cross-sectional studies can also be used with an adjustment factor to correct for overestimation of risk of intent to leave attributable to burnout.

KEYWORDS:

Burnout; Intent to leave; Physician well-being; Turnover

PMID:
30477483
PMCID:
PMC6258170
DOI:
10.1186/s12913-018-3663-z
[Indexed for MEDLINE]
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8.
J Grad Med Educ. 2018 Oct;10(5):524-531. doi: 10.4300/JGME-D-18-00273.1.

The Correlation of Stress in Residency With Future Stress and Burnout: A 10-Year Prospective Cohort Study.

Abstract

Background :

Residents and practicing physicians displaying signs of stress is common. It is unclear whether stress during residency persists into professional practice or is associated with future burnout.

Objective :

We assessed the persistence of stress after residency and its correlation with burnout in professional practice. We hypothesized that stress would linger and be correlated with future burnout.

Methods :

A prospective cohort study was conducted over 10 years using survey instruments with existing validity evidence. Residents over 3 academic years (2003-2005) were surveyed to measure stress in residency. Ten years later, these residents were sought out for a second survey measuring current stress and burnout in professional practice.

Results :

From 2003 to 2005, 143 of 155 residents participated in the initial assessment (92% response rate). Of those, 21 were excluded in 2015 due to lack of contact information; follow-up surveys were distributed to 122 participants, and 81 responses were received (66% response rate and 57% of original participants). Emotional distress in residency correlated with emotional distress in professional practice (correlation coefficient = 0.45, P < .0001), emotional exhaustion (correlation coefficient = 0.30, P = .007), and depersonalization (correlation coefficient = 0.25, P = .029). Multivariate linear regression showed that emotional distress in residency was associated with future emotional distress (β estimate = 0.57, P = .005) and depersonalization (β estimate = 2.29, P = .028).

Conclusions :

We showed emotional distress as a resident persists into individuals' professional practice 10 years later and has an association with burnout in practice.

PMID:
30386477
PMCID:
PMC6194879
DOI:
10.4300/JGME-D-18-00273.1
[Indexed for MEDLINE]
Free PMC Article
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Conflict of interest statement

Conflict of interest: Dr Raimo is a member of the American Board of Internal Medicine (ABIM) Examination Committee. To protect the integrity of Board Certification, ABIM strictly enforces the confidentiality and its ownership of ABIM examination content, and Dr Raimo has agreed to keep ABIM examination questions confidential. No ABIM examination questions are shared or otherwise disclosed.

9.
Cureus. 2018 Jul 30;10(7):e3076. doi: 10.7759/cureus.3076.

The Impact of the Hippocratic Oath in 2018: The Conflict of the Ideal of the Physician, the Knowledgeable Humanitarian, Versus the Corporate Medical Allegiance to Financial Models Contributes to Burnout.

Author information

1
Plastic Surgery/chief, Mills-Peninsula Medical Center, San Mateo, USA.

Abstract

The tradition in medical school includes taking the Hippocratic Oath usually at graduation. The purpose of this review is to examine what that oath has been, what forms it currently has, and the implications for physicians in today's healthcare environment. The changes in health economics affect physicians as they try to follow the oath's allegiance to the individual patient's needs. At times, this goal conflicts with the perspective of the financial world's controls of insurance companies and medical groups and institutions. This difference of the physicians' ethical perspectives from the business leaders regarding the philosophy of the value of the individual's health and life may be related to some aspect of physician burnout.

KEYWORDS:

burnout; declaration of geneva; economics; ethics; hippocratic oath; mba oath; pledge; profession of medicine; safety; trade

Conflict of interest statement

The authors have declared that no competing interests exist.

Publication type

Publication type

12.
FP Essent. 2018 Aug;471:25-28.

Physician Well-Being: Financial Aspects.

Author information

1
Southern Regional Area Health Education Center, 1601 Owen Dr, Fayetteville, NC 28304.

Abstract

The US health care system has an unequal distribution of physician supply, is poorly accessible in some areas, and has wide disparities in patient health status. The Patient Protection and Affordable Care Act (ACA) was intended to address these issues by providing affordable health insurance coverage, Medicaid expansion, and care delivery system redesign (particularly through physician payment reform). As part of payment reform, the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect in January 2017. Under MACRA, physicians receive payment under the Quality Payment Program (QPP). Starting January 1, 2019, the QPP pays physicians Medicare part B payments based on their 2017 performance via one of two ways: an advanced alternative payment model or the Merit-Based Incentive Payment System (MIPS). Most physicians will be placed in the MIPS. This shift to performance-based payment requires practices to optimize financial aspects of practice management and improve critical workflows and care delivery processes.

PMID:
30107107
[Indexed for MEDLINE]
13.
J Eval Clin Pract. 2018 Aug;24(4):713-717. doi: 10.1111/jep.12949. Epub 2018 May 25.

The correlation between intensive care unit attending physician continuity of care with financial and clinical outcomes.

Author information

1
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
2
Johns Hopkins University School of Nursing, Baltimore, MD, USA.
3
Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

Abstract

PURPOSE:

"Attending rotations" on intensive care unit (ICU) services have been in place in most teaching hospitals for decades. However, the ideal frequency of patient care handoffs is unknown. Frequent attending physician handoffs could result in delays in care and other complications, while too few handoffs can lead to provider burnout and exhaustion. Therefore, we sought to determine the correlation between frequency of attending shifts with ICU charges, 30-day readmission rates, and mortality rates.

METHODS:

We performed a retrospective cohort study at a large, urban, academic community hospital in Baltimore, MD. We included patients admitted into the cardiac or medical ICUs between September 1, 2012, and December 10, 2015. We tracked the number of attending shifts for each patient and correlated shifts with financial outcomes as a primary measure.

RESULTS:

For any given ICU length of stay, we found no distinct association between handoff frequency and charges, 30-day readmission rates, or mortality rates.

CONCLUSIONS:

Despite frequent handoffs in care, there was no objective evidence of care compromise or differences in cost. Further validation of these observations in a larger cohort is justified.

KEYWORDS:

continuity of patient care; hospital charges; hospital mortality; intensive care units; patient handoffs; patient readmission

PMID:
29797761
DOI:
10.1111/jep.12949
[Indexed for MEDLINE]
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14.
Prog Cardiovasc Dis. 2018 Mar - Apr;60(6):586-592. doi: 10.1016/j.pcad.2018.03.007. Epub 2018 May 1.

Medical Management of Functional Impairment in Peripheral Artery Disease: A Review.

Author information

1
Northwestern University Feinberg School of Medicine, United States. Electronic address: mdm608@northwestern.edu.

Abstract

Lower extremity peripheral artery disease (PAD) now affects 200 million people worldwide and is a major cause of disability. Cilostazol is the only Federal Drug Administration approved medication for PAD-related ischemic symptoms that is recommended by clinical practice guidelines. Supervised treadmill exercise significantly improves treadmill walking performance in PAD. Recent evidence shows that home-based exercise interventions that include occasional medical center visits and incorporate behavioral change techniques also significantly improve walking endurance in PAD. Upper and lower extremity ergometry (cycling) also improve walking ability in PAD. A recent decision by the Center for Medicaid and Medicare Services to cover supervised exercise for people with symptomatic PAD will increase access to exercise for the large number of people disabled by PAD.

KEYWORDS:

Claudication; Exercise; Peripheral artery disease; Physical functioning

PMID:
29727608
PMCID:
PMC6690383
DOI:
10.1016/j.pcad.2018.03.007
[Indexed for MEDLINE]
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17.
Acad Med. 2018 Nov;93(11):1607-1609. doi: 10.1097/ACM.0000000000002215.

Addressing Student Burnout: What Medical Schools Can Learn From Business Schools.

Author information

1
A.S. Pathipati is an MD/MBA student, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0003-2367-4174. C.K. Cassel is executive advisor to the dean, Kaiser Permanente School of Medicine, Pasadena, California.

Abstract

Although they enter school with enthusiasm for a career in medicine, medical students in the United States subsequently report high levels of burnout and disillusionment. As medical school leaders consider how to address this problem, they can look to business schools as one source of inspiration. In this Invited Commentary, the authors argue-based on their collective experience in both medical and business education-that medical schools can draw three lessons from business schools that can help reinvigorate students. First, medical schools should offer more opportunities and dedicated time for creative work. Engaging with diverse challenges promotes intellectual curiosity and can help students maintain perspective. Second, schools should provide more explicit training in resiliency and the management of stressful situations. Many business programs include formal training in how to cope with conflict and how to make high-stakes decisions, whereas medical students are typically expected to learn those skills on the job. Finally, medical schools should provide better guidance on practical career considerations like income, lifestyle, and financial skills. Whether in medicine or business, students benefit from open discussions about their personal and professional goals. Medical schools must ensure that students have an outlet for those conversations.

PMID:
29538108
DOI:
10.1097/ACM.0000000000002215
[Indexed for MEDLINE]
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18.
BMJ Open. 2018 Feb 2;8(2):e021273. doi: 10.1136/bmjopen-2017-021273.

'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care.

Author information

1
University of Exeter Medical School, University of Exeter, Exeter, UK.
2
Wellcome Centre for Cultures and Enviroments of Health, University of Exeter, Exeter, UK.
3
Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK.
4
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
5
Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.

Abstract

INTRODUCTION:

Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments.

METHODS AND ANALYSIS:

Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory.

ETHICS AND DISSEMINATION:

Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues.

PROSPERO REGISTRATION NUMBER:

CRD42017069870.

KEYWORDS:

health policy

PMID:
29420234
PMCID:
PMC5829880
DOI:
10.1136/bmjopen-2017-021273
[Indexed for MEDLINE]
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19.
Med Teach. 2018 Oct;40(10):1069-1071. doi: 10.1080/0142159X.2018.1428292. Epub 2018 Jan 29.

Popping the medical education bubble before it forms: It's about dollars and sense.

Author information

1
a Yale-New Haven Hospital, Yale University School of Medicine , New Haven , CT , USA.
2
b Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.

Abstract

Headlines have previously acknowledged the risk of a "bubble and crash" phenomenon in the physician workforce pipeline. A growing number of medical career dissatisfiers, including emotional and physical burnout, loss of autonomy and burdensome regulations, compound the longstanding fundamental issue of the prohibitive direct and opportunity costs associated with medical training. For U.S. medical education and, in turn, healthcare to remain robust and high-quality, creative solutions are needed to address the untenable physician debt-to-income ratios and to ensure not only that the quantity and quality of medical school aspirants remains favorable to the profession, but that the profession remains responsible to its future members. Creating fiscally healthy physicians is a societal imperative.

PMID:
29374997
DOI:
10.1080/0142159X.2018.1428292
[Indexed for MEDLINE]
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20.
JAMA Intern Med. 2017 Dec 1;177(12):1826-1832. doi: 10.1001/jamainternmed.2017.4340.

The Business Case for Investing in Physician Well-being.

Author information

1
Stanford University, Palo Alto, California.
2
National University of Singapore Business School, Singapore.
3
Harvard Business School, Boston, Massachusetts.
4
American Medical Association, Chicago, Illinois.

Abstract

Importance:

Widespread burnout among physicians has been recognized for more than 2 decades. Extensive evidence indicates that physician burnout has important personal and professional consequences.

Observations:

A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (eg, return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization's long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all US health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization's journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level.

Conclusions and Relevance:

Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization's ethical responsibility, it is also the fiscally responsible one.

PMID:
28973070
DOI:
10.1001/jamainternmed.2017.4340
[Indexed for MEDLINE]
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