The Business Case and Evidence for Addressing #PhysicianBurnout

The rationale for tackling physician burnout encompasses multiple aspects including the resultant:

• Expenses linked to staff turnover
• Diminished productivity leading to lost revenue
• Financial risk due to the critical connection between burnout and lower quality of care, reduced patient satisfaction, and issues related to patient safety

The following evidence shows that the key steps to diminish burnout and foster engagement include knowing that:

• Improvement is achievable
• The investment is justified
• Relevant outcomes can be measured

Some of the most relevant literature is summarized below. 

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The Evidence for The Impact of Coaching on Physician Well-Being

1.  Mann A, Shah AN, Thibodeau PS, et al. Online Well-Being Group Coaching Program for Women Physician Trainees: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(10):e2335541. doi:10.1001/jamanetworkopen.2023.35541

Conclusions and Relevance: The findings of this randomized clinical trial of 1017 residents (187 surgical) suggest that web-based professional group-coaching can improve outcomes (burnout, moral injury, imposter syndrome, self compassion, and flourishing) of well-being and mitigate symptoms of burnout for women physician trainees. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2810135

2.  Fainstad T, Mann A, Suresh K, et al. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(5):e2210752. doi:10.1001/jamanetworkopen.2022.10752

Conclusions and Relevance: In this pilot randomized clinical trial of 101 female residents (6 months), professional online coaching was feasible to implement and reduced emotional exhaustion and impostor syndrome scores and increased self-compassion scores among female resident physicians. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791968?fbclid=IwAR0taY5CGpUa5eyfleNIl7RfXLT7qVt0GakKPGlT9ESIPLn0yCKWG9obrZo

3.  Makowski MS, Palomo C, de Vries P, Shanafelt TD. Employer-Provided Professional Coaching to Improve Self-compassion and Burnout in Physicians. Mayo Clin Proc. 2022 Mar;97(3):628-629. doi: 10.1016/j.mayocp.2022.01.008. PMID: 35246294.

Conclusions and Relevance: Given that all Faculty at Stanford are offered coaching – a study among the first 57 faculty, observed large and statistically significant effect size improvements (all >0.6) in burnout, sleep-related impairment, and self-valuation.

https://www.mayoclinicproceedings.org/article/S0025-6196(22)00038-6/fulltext

4.  Dyrbye LN, Shanafelt TD, Gill PR, Satele DV, West CP. Effect of a Professional Coaching Intervention on the Well-being and Distress of Physicians: A Pilot Randomized Clinical Trial. JAMA Intern Med. 2019;179(10):1406–1414. doi:10.1001/jamainternmed.2019.2425

Conclusions and Relevance: In this pilot randomized clinical trial of 88 physicians, participants who received professional coaching had a significant reduction in emotional exhaustion and overall symptoms of burnout, as well as improvements in overall quality of life and resilience. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2740206

5.  McGonagle AK, Schwab L, Yahanda N, Duskey H, Gertz N, Prior L, Roy M, Kriegel G. Coaching for primary care physician well-being: A randomized trial and follow-up analysis. J Occup Health Psychol. 2020 Oct;25(5):297-314. doi: 10.1037/ocp0000180. Epub 2020 Apr 16. PMID: 32297776.

Conclusions and Relevance: A randomized controlled trial of 59 primary care physicians who underwent coaching which improved stress and burnout, work engagement, and job satisfaction during the intervention. These findings were sustained at 6 months of follow up. 

https://pubmed.ncbi.nlm.nih.gov/32297776/

6.  Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017;177(12):1826–1832. doi:10.1001/jamainternmed.2017.4340

Conclusions and Relevance: 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.

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.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2653912