• Matthew A Pappas, James K Stoller, Victoria Shaker, James Houser, Anita D Misra-Hebert, and Michael B Rothberg.
• Center for Value-based Care Research, Cleveland Clinic, Cleveland, Ohio, USA.
• J Hosp Med. 2022 Oct 1; 17 (10): 803808803-808.

Background And ObjectiveCosts of physician turnover are lacking for specialties organized around a site of care. We sought to estimate the cost of physician turnover in adult hospital medicine (HM).Design, Setting, ParticipantsA retrospective cohort study within a large integrated health system between July 2017 and June 2020. To understand likely variation across the country, we also simulated costs using national wage data and a range of assumptions.Main Outcome And MeasuresDirect costs of turnover borne by our department and institution and indirect costs from reduced hospital billing. In our simulation, we measured costs per hired hospitalist.ResultsBetween July 2017 and June 2020, 34 hospitalists left the practice, 97 hospitalists were hired, and a total of 234 hospitalists provided adult care at six hospitals. Direct costs of turnover totaled $6166 per incoming physician. Additional clinical coverage required at times of transition was the largest expense, followed by physician time recruiting and interviewing prospective candidates. The salary difference between outgoing and incoming hospitalists was cost-saving, while reduced billing would add to indirect costs per hire. In our simulation using national wage data, programs hiring one hospitalist would spend a mean of $56,943 (95% CI: $27,228-$86,659), programs hiring five hospitalists would spend a mean of $33,333 per hospitalist (95% CI: $9375-$57,292), and programs hiring 10 hospitalists would spend a mean of $30,382 per hospitalist (95% CI: $6877-$53,887).ConclusionsThe financial cost of turnover in HM appears to be substantially lower than earlier estimates of the cost of turnover from non-hospitalist specialties.© 2022 The Authors. Journal of Hospital Medicine published by Wiley Periodicals LLC on behalf of Society of Hospital Medicine.

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