Physician burnout costs hospices — both literally and figuratively — whether it occurs among their own medical staff or with their referral partners. One of the most damaging effects is higher turnover.
Burnout causes a sizable contingent of physicians to leave their jobs, and it has only grown more prevalent during the pandemic. This not only contributes to hospices’ own labor shortages, but disrupts relationships with other providers. This can slow or reduce hospice referrals, compromise patient outcomes and drive up costs.
Trusting relationships between a hospice doctor and the referring physician take time to build, but are essential to quality care, according to Dr. Timothy Ihrig, CEO of Ihrig and Associates. Ihrig is a hospice and palliative care specialist who has been a chief medical officer for several organizations.
“It is tantamount to good care. For me, as a provider, it comes down to the relationship I have with my community partners,” Ihrig told Hospice News. “We have to sit face-to-face in that intimate space and talk about care, so that we can develop a trusting relationship. That’s what really makes a difference.”
Burnout takes a heavy toll
The number of physicians who report feelings of burnout grew to 58% by 2020, up from 40% in 2018, according to a summer 2021 study in the Journal of Medical Practice Management.
Burnout can have a devastating effect on clinicians.
The condition has been associated with fatigue, depression, social withdrawal, insomnia, increased vulnerability to illness, and increased risk of substance abuse, according to Mayo Clinic. Other potential outcomes include higher likelihood of heart disease, type 2 diabetes, interpersonal conflict and suicide.
Physicians experiencing burnout are twice as likely to leave their practices within two years, recent research published in Mayo Clinic Proceedings has found.
This can be a self-perpetuating problem. When physicians and other clinicians leave the field, it increases workload for their former colleagues — potentially fueling further burnout.
“With the stress within the health care system, the physicians are having smaller and smaller support teams, so there’s less resources around them that could go have the conversations,” P. Tad Kendall, chief growth officer for the home health and hospice provider AccentCare, told Hospice News. “More of that obligation to have the discussion is falling back on the physician. That just puts more stress in their day.”
This can also put more stress on patients.
Continuity of care between primary care physicians and their patients corresponds with better outcomes, diagnostic accuracy, fewer hospitalizations, lower costs and improved end-of-life care, according to the Mayo Clinic Proceedings study.
Each year, primary care physician turnover generates nearly $979 million in excess health care expenditures for public and private payers, the same study showed. About $260 million of that amount is attributable to burnout.
A ripple effect on hospice
When a referring physician leaves their practice, hospices come under pressure to establish a working relationship with their replacements. This includes the process of educating the incoming doctors about the nature and benefits of hospice and palliative care, which are often misunderstood by professionals in other clinical specialties.
“The physicians and their care navigators are really stretched right now. That increases our opportunity — our obligation — to engage with those physicians, understand their current hospice practices and their knowledge base around it, and then fill in the gaps and provide that education,” Kendall said.
Educating physicians about their services is a “crucial area of improvement,” a recent Trella Health post-acute care industry report indicated. The knowledge deficit among physicians contributes to lower utilization and shorter lengths of stay. In many cases, patients come to hospice too late to reap the full benefits.
Hospice physicians are not immune
The burnout issue also hits hospices closer to home. Burnout was prevalent among hospice clinicians for years prior to the pandemic and has only gotten worse.
Rising turnover during the pandemic has gut-punched many providers in an industry that can’t afford to lose more of its human resources.
Currently, the United States has 13.35 hospice and palliative care physician specialists for every 100,000 adults 65 and older, according to an April 2018 study. Researchers estimated that by 2040 the patient population will need 10,640 to 24,000 specialists, but supply is expected to range between 8,100 and 19,000.
Those numbers may sound dire, but the situation may have already worsened due to the unexpected impact of the pandemic.
“Practitioners across all hospices across all palliative care organizations are getting busier, but the infrastructure hasn’t kept up and the lengths of stay hasn’t necessarily changed,” Dr. Balu Natarajan, chief medical officer for hospice at AccentCare, told Hospice News. “The whole world is exhausted from the last couple of years, and palliative practitioners are having to navigate increased work in that environment.”