The Financial Impact of Burnout and Mental Health on Hospitalist Turnover and the Contribution of Work Structures and Environment

PROJECT SUMMARY/ABSTRACT
Hospitals across the United States are increasingly relying on physicians and advanced practice providers who
care for hospitalized patients (hospitalists). Hospitalists provide critical services and face a variety of stressors,
including unprecedented work conditions, exposures to highly infectious diseases, high patient volumes, and
unpredictable work demands. These factors contribute to high levels of job stress, which in turn can lead to
occupational burnout and mental health problems among hospitalists. In a recent single center study, 62% of
hospitalists reported burnout, with workload being the most commonly cited factor. This is concerning because
of the high reliance on hospitalists and the links between burnout and poor mental health and suboptimal patient
safety outcomes, and physician turnover. Burnout among US physicians has been estimated to cost the US
society $4.6 billion annually and health care organizations $7,600 per employed physician each year. However,
existing research on factors contributing to burnout and the consequences of burnout are primarily based on
physicians working in outpatient practices, leaving a critical gap in evidence-informed strategies to address
burnout among hospitalists and a lack of understanding of the cost of burnout to hospitals. Additionally, there
have been even fewer studies focused on hospitalist mental health. There is an urgent need to address the issue
burnout and poor mental health among hospitalists, as over one-third have considered leaving their current job,
threatening the sustainability of the workforce. Hospitalist turnover not only affects the long-term viability of the
field, but also has the potential to incur substantial costs for healthcare organizations; however, the costs are not
fully known. Determining the costs associated with hospitalist turnover is a crucial next step as it can inform
organizational decisions about work structure and environment and ultimately improve the well-being and
resilience of hospitalists. We will utilize a prospective multi-measure design to assess prevalence of burnout and
mental health and the relationship to hospitalist turnover using validated survey measures at 10 hospitals (Aim
1). Factors related to work structure and work environment that may contribute to burnout and poor mental health
among hospitalists will also be examined. We will gather data on the costs of hospitalist turnover by surveying
hospitalist group leaders at the 10 sites to model the probability of turnover, exploring relationships with burnout,
mental health status, and other covariates (Aim 2). A cost-consequence analysis will help leaders understand
the economic impact of turnover. The results of this study have the potential to inform policies and interventions
aimed at improving hospitalist well-being and reducing burnout and turnover in a significant portion of the
healthcare workforce. This is important because the results of this study will influence organizational decisions
about work structure and work environments that may be driving burnout and worsening mental health among
hospitalists and serve as a blueprint for other specialties.

Grant Number: 5R21OH012548-02
NIH Institute/Center: ALLCDC
Principal Investigator: Marisha Burden