Letters to the Editor
To the Editor: Epstein and Krasner1 offer a compelling account of the importance of physician resilience and how we can promote it. Their commentary is both evidence based and practical; however, these very qualities make this reader wonder why progress in the adoption of the concept of resilience has been so slow. I propose that, instead of basing the argument for teaching resilience in the need for physicians “to augment their well-being,”1 we would have more success making an economic case for investment in resilience.
First, health care professionals who look after their physical health are less likely to commit errors. The cost of medical errors to the United States in 2008 was $19.5 billion.2 Teaching resilience can reduce the likelihood of errors and therefore alleviate some of this enormous cost. Second, the costs of remediation for poor performance are also likely substantial, though few studies that define such costs have been done. In 2003, Finucane and colleagues3 found that the General Medical Council in the United Kingdom spent $34,500 per case assessing doctors whose performance had caused concern. This figure is just the cost of assessment—It does not include the cost of remediation itself. As with medical errors, physician resilience can reduce performance concerns and help eliminate the costs of assessment and remediation. Finally, the cost of attrition (i.e., losing physicians from the health care workforce) is also high. The cost of producing a newly graduated doctor in the United States is estimated at $497,0004; the cost of producing a fully qualified specialist would be far more. Each time a physician leaves the workforce, this investment is lost.
Almost any intervention to increase resilience would likely be a fraction of the costs of medical error, remediation, or attrition. According to Ellaway,5 “medical education is increasingly driven by economic models looking to maximise return on investment and other metrics of accountability.” Interventions to improve resilience that have convincing economic benefits will likely gain the support of all stakeholders in the health care system.
Kieran Walsh, FRCPI
Editor of BMJ Learning, the Medical Education Service of the BMJ Group, London, United Kingdom; firstname.lastname@example.org.
1. Epstein RM, Krasner MS. Physician resilience: What it means, why it matters, and how to promote it. Acad Med. 2013;88:301–303
2. Andel C, Davidow SL, Hollander M, Moreno DA. The economics of health care quality and medical errors. J Health Care Finance. 2012;39:39–50
3. Finucane PM, Bourgeois-Law GA, Ineson SL, Kaigas TMInternational Performance Assessment Coalition. . A comparison of performance assessment programs for medical practitioners in Canada, Australia, New Zealand, and the United kingdom. Acad Med. 2003;78:837–843
4. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376:1923–1958
5. Ellaway R. eMedical Teacher. Med Teach. 2008;30:342–343