Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study
Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden: a case study
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DOI：
10.1186/s12913-018-3663-z
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发表时间：
2018-11-27
影响因子：
2.8
通讯作者：
Trockel, Mickey T.
中科院分区：
文献类型：
--
作者：
Hamidi, Maryam S.;Bohman, Bryan;Trockel, Mickey T.
认识到学术医疗中心因职业倦怠导致的医生流失的经济成本，可能有助于激励组织层面的努力，以改善医生的福利和减少人员流失率。我们的目标是：1)使用最近的纵向数据作为案例来检查医生自我报告的职业倦怠，离职意图（ITL）和两年内实际离职之间的关系，以及2)估计医生因职业倦怠而离职的成本。方法：我们使用了472名医生的去识别数据，这些医生完成了2013年在斯坦福大学两家附属医院进行的质量改进调查，以评估医生的健康状况。为了保持调查应答者的机密性，本分析中未使用潜在可识别的人口统计学变量。数据的第三方保管人利用医务人员名册编制了2015年的离职数据。我们使用逻辑回归来调整潜在的混杂因素。结果在基线上，26%的医生报告在接下来的2年内经历过倦怠，28%的医生报告有ITL。两年后，13%的受访医生真的离开了。那些报告ITL的人离开的可能性是其他人的三倍多。报告经历过职业倦怠的医生在两年内离开机构的可能性是其他医生的两倍多(相对风险(RR)=2.1；95% CI = 1.3 - -3.3)。在逻辑回归模型中调整了外科专业、工作时间类别、睡眠相关障碍、焦虑和抑郁等因素后，2013年经历过倦怠的医生与没有经历过倦怠的医生相比，在2015年离开斯坦福大学的几率高出168%（优势比=2.68,95% CI: 1.34-5.38）。因职业倦怠而离职的两年征聘费用估计在15 544 000美元至55 506 000美元之间。职业倦怠导致的离职风险是职业倦怠导致实际离职风险的3.7倍。对职业倦怠导致的离职经济成本感兴趣的机构可以很容易地使用与离职指标相关的调查数据来计算该参数。横断面研究中的ITL数据也可以与调整因子一起使用，以纠正因倦怠而导致的离职意图风险的高估。
BackgroundAwareness 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.MethodsWe 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.ResultsAt baseline, 26% of physicians reported experiencing burnout and 28% reported ITL within the next 2years. 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.ConclusionsInstitutions 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.