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. It also affects care continuity, organizational culture, and the pool of potential leaders. 

And yet, ROI calculations have not persuaded healthcare 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 healthcare, we use Quality-Adjusted Life Years (QALY) to calculate the cost of a treatment per year of life saved, taking into account that 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]

Where 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 healthcare organizations and, most importantly, to patients.

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 healthcare organization parse out resources?

I’d love to hear your thoughts. Ping me with comments, edits, or a big thumbs up!