Mayo Clinic Proceedings Available online 26 February 2022
Objective: To estimate the excess health care expenditures due to US primary care physician (PCP) turnover, both overall and specific to burnout. In this analysis, we estimate that each instance of a PCP’s leaving current practice results in $86,336 in excess health care expenditures during the following year. We estimate that PCP turnover results in $979 million in annual excess health care costs across Medicare and non-Medicare patients, of which $260 million (27%) is attributable to burnout. Physician burnout is therefore costly to public and private payers, who bear most of these excess health care costs. This analysis estimates an extra $189/medicare patient when a primary care physician leaves. Burnout is a major concern for the future of healthcare. Primary care including family medicine, internal medicine, geriatrics, pediatrics and obstetrics and gynecology are amongst the specialties with the highest rates of burnout. We call these fields primary because they provide the foundation for all healthcare and without them, patients are lost in a system of isolated specialties that don't communicate. Traditionally, these primary care specialties are also the fields that are reimbursed the least. We don't value these physicians enough. Medical students are pursuing higher-paid specialties in an attempt to repay mountains of school debt. Another article in Forbes estimates that 75% of healthcare workers will leave medicine by 2025. Healthcare professions are often referred to as a "calling" assuming this is a purpose and identity for these workers. We assume this will be a job for life. We must consider why this is happening and address it with a sense of urgency. This article surveyed clinicians and focused on three major elements of change
Enhancing health technology skills
A greater focus on the patient-provider relationship
An expanded healthcare workforce
The American Academy of Family Physicians conducted a study in 2018 that showed that physicians in small, independent primary care practices report dramatically lower levels of burnout (13.5%) when compared to the national average (54.4%). The independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout. In 2016, consolidation of healthcare practices tipped the scales, and independent, physician-owned practices became the minority. This change in culture led to less competition, choice in healthcare and now we know is heavily contributing to burnout of our nation's physicians. We need to shift back to physician-owned practices where these doctors can maintain their autonomy and focus on the patient-provider relationship. Improving our technology platforms will be helpful. Telehealth is a wonderful option to increase access to care but loses its value when the patient doesn't know the clinician. We've seen the issues it can cause in start-ups such as Cerebral, which offers psychiatric medication after a brief telehealth visit and an ongoing monthly fee. There is a rush of start-ups looking to increase access to care. I argue there is a place for these companies if partnered with a strong physician-patient relationship with a primary care physician. If not, patients are left alone, again, in a siloed healthcare system except now its online. We should focus our attention on supporting independent, physician-led practices. The COVID19 pandemic didn't cause these issues but the stress did accelerate burnout. Healthcare workers were forced to work longer and harder in a broken system that doesn't value them. For those of us that know, this crisis is not surprising.