We know that recruiting and replacing a physician costs somewhere in the range of a million dollars per physician, depending on the specialty. We know the effects of physician burnout and attrition directly affect key performance indicators, like patient access, quality metrics, and Net Promoter Scores. They also affect care continuity, organizational culture, and the pool of potential leaders.
And yet, return on investment (ROI) calculations have not persuaded health care organizations to invest sufficiently in reducing the drivers of physician burnout and attrition. On a long car ride recently, I came up with this idea. Radical or embarrassingly simple or somewhere in between, I don’t know. See what you think.
In health care, we use quality-adjusted life years (QALY) to calculate the cost of a treatment per year of life saved, taking into account the quality of those additional years. I’m envisioning a new indicator. The sustainability-adjusted practice years (SAPY) would calculate the number of years a physician remains in practice, while taking into account whether the physician has a satisfying, thriving career.
Here’s a possible calculation: SAPY = [practice years] X [career sustainability index]. The career sustainability index ranges from 0 to 1 based on validated measures such as:
- Professional fulfillment
- Emotional exhaustion (inverted)
- Work control
- Meaning in work
- Intention to leave within two years (inverted)
Here’s how it would work:
- An anesthesiologist who practices for 10 years at an average sustainability score of 0.9 = 9 SAPY
- A primary care physician who practices for 10 years with severe burnout with an average sustainability score of 0.4 = 4 SAPY
An intervention that raises the score from 0.5 to 0.8 over 10 years yields 3 additional SAPYs, even if the physician never leaves. The SAPY would make a key truth more visible on organizational dashboards: Simply remaining employed is not the same as sustaining a productive, fulfilling career. And that really matters (to physicians who start out LOVING their work, but also to health care organizations and, most importantly, to patients).
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Does the SAPY hold up? Would it help you advocate for practice efficiencies, additional well-trained staff, and help with your inbox? Would it make a difference in how decision-makers at your health care organization parse out resources?
Diane W. Shannon is a physician, professional coach, author, and health care writer who helps women physicians build influential, sustainable careers without sacrificing their well-being. She can be found at dianeshannon.com.
She brings more than 20 years of expertise in physician burnout, women physician leadership, and building sustainable physician workplaces. After experiencing burnout early in her own primary care career, she dedicated her work to understanding why talented physicians struggle and what it takes for both individuals and organizations to thrive. Drawing on her experience as both a physician and award-winning health care writer, she helps women physicians expand their leadership, navigate career transitions, and avoid burnout, while partnering with health care organizations to retain physicians, develop women leaders, and strengthen workplace culture.
Dr. Shannon is coauthor of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, a TEDx speaker, and cofounder of Lead Your Way Academy. Her writing on burnout, cognitive load, and physician well-being has appeared in Massachusetts Medical Society publications, the American Medical Association’s STEPS Forward toolkit series, and on WBUR. She shares updates on LinkedIn and Instagram.
