Clinician burnout isn’t a new trend, but the COVID-19 pandemic has exacerbated the issue, with many healthcare workers reporting that they are experiencing high levels of depression, exhaustion and burnout. Health economist Jane Sarasohn-Kahn explores why burnout is plaguing the healthcare industry and how it can be prevented or combatted.
By Jane Sarasohn-Kahn, MA, MHSA
Within the mental health epidemic spawned by the COVID-19 pandemic is one that was already hurting the U.S. health system for a long time: clinician burnout.
In the first quarter of 2021, 3 in 10 healthcare workers were considering no longer working in healthcare as a result of the pandemic, according to a study from Kaiser Family Foundation and the Washington Post’s frontline healthcare workers survey. And the younger the healthcare worker, the more likely they felt burned out about going to work.
The longer the coronavirus pandemic continues in its fourth wave and beyond, the greater the risk to that all-important fourth leg of the Quadruple Aim: care provider well-being and resilience.
To illustrate the tragic end-game scenario of burnout, turn to a group of Virginia family members of doctors who died by suicide, lobbying members of the House of Representatives in September 2021 to pass legislation supporting physicians’ mental health.
That bill is called the Dr. Lorna Breen Health Care Provider Protection Act, named after a physician who took her own life in April 2020, just weeks into the COVID-19 pandemic. Working on the front line of providers at New York-Presbyterian Allen Hospital, Dr. Breen hid her burnout and depression, unbeknownst to her family or colleagues.
Doctors, nurses and other healthcare professionals are leaving the profession in the wake of the pandemic, exacerbated by the so-called fourth wave of the coronavirus, which is blamed for causing severe burnout across medical ranks.
The data are stark and sobering: Three in five U.S. hospitals report a nurse vacancy rate greater than 7.5% and one-third of hospitals have an over 10% nurse vacancy rate.
Burnout is also hitting physicians’ assistants (PAs) hard. Nearly one-half reported work exhaustion and one-third reported burnout based on a study published in September 2021 in the Journal of the American Academy of Physician Assistants. The study examined depression, burnout and professional outcomes among PAs in the U.S., concluding that,
“Burnout may affect healthcare systems in three areas: patient care, clinician health, and systems outcomes. In terms of patient care, research has shown the negative relationship between feelings of burnout and quality of patient care, patient satisfaction, and recovery times…Clinicians may experience changes in their mental health, substance abuse, poor self-care, motor vehicle accidents, and even suicidal ideation…burnout also affects the healthcare system through reduced clinician productivity and increased turnover, which leads to reduced patient access and increased system costs.”
Dr. Pauline Chen addressed the widespread problem of physician burnout in a 2012 New York Times essay. Citing a study published in the peer-reviewed JAMA Archives of Internal Medicine, which polled the experience over 7,000 U.S. doctors, Dr. Chen noted:
“Doctors who are suffering from burnout are more prone to errors, less empathetic and more likely to treat patients like diagnoses or objects. They are also more likely to quit practicing altogether, a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.”
Burnout: Not a New Trend
That trend was identified over ten years ago. Fast-forward a decade to the Medscape National Physician Burnout Report 2021.
In its annual study into physician mental health, Medscape chose to subtitle this year’s analysis “Death By 1000 Cuts,” quoting a physician who was part of the study.
The 2020 Medscape study was conducted just before the outbreak of COVID-19, and burnout was evident across physician specialties. In the pre-pandemic environment, physician stress was due mostly to a sense of loss of autonomy (e.g., professional control).
Such was a physician’s life before COVID-19.
Enter the pandemic, especially after the availability of vaccines and vaccinations. Physicians, nurses and other clinical colleagues can feel helpless and burned out due to a sense of Groundhog Day in hotspots where patients are shunning getting the jab and mandates for masking lacking or avoided.
The physician specialties most likely to feel burnout are those on the front line of the coronavirus care, including critical care, rheumatology, infectious disease and pulmonary medicine—50% of whom feel burnout. Roughly half of physicians in urology, family medicine, internal medicine and pediatrics also feel burnout, along with 44% of emergency medicine doctors.
Even 29% of dermatologists and 31% of plastic surgeons say they are burned out.
Furthermore, 13% of doctors told Medscape they had thoughts of suicide but not attempted, and 1% admitted to attempting suicide.
Female physicians experienced more burnout than male doctors in the Medscape study, with fears of bringing the virus home and childcare responsibilities on the mind.
In addition to growing physician and other clinical worker shortages a risk due to burnout, there are the clinical and quality costs cited earlier. There is also a huge economic cost of physician burnout, calculated in a 2019 study at about $7,600 per employed physician per year. This is the enterprise-wide, organizational economic cost related to staff turnover and reduced clinical hours.
Let’s underscore the bottom line, which is every U.S. health citizen’s concern: The demand for care could exceed the supply of healthcare workers.
That’s the supply side of the healthcare human capital equation.
The demand side, looking to 2030, far outstrips the potentially eroding supply of healthcare professionals: The U.S. Bureau of Labor Statistics (BLS) projects some of the fastest-growing occupational groups will be healthcare support workers such as home health and personal care aides, nurse practitioners, physician assistants, and healthcare practitioners.
Combine this BLS forecast with AAMC’s latest calculation which expects a mounting physician shortfall in the U.S., gauged as a shortfall ranging from 37,800 to 124,000 physicians (including primary and specialty care).
Certainly, the application of evidence-based technology, from artificial intelligence to virtual care platforms, can help to scale some of the solution to burnout. In the best of all worlds, those tech-enabled solutions would be enchantingly designed for both clinicians and patients and be based on sound science and health equity.
But even the best-designed and well-intentioned technology cannot scale America’s way out of the clinician burnout challenge in this moment of truth for U.S. healthcare.
Improving Mental Health and Combating Burnout
September 17, 2021, was National Physician Suicide Awareness Day. Dozens of physician advocacy organizations aligned that day to convene a conversation that broke the culture of silence around physician mental health and suicide. Organizations including the Physicians Foundation, First Responders First, many state medical societies, healthcare systems such as New York City Health + Hospitals, and—so appropriately—the Dr. Lorna Breen Heroes Foundation participated.
The press release for #NPSADay explained that some one million Americans lose their physician to suicide every year.
To deal with this ever-worsening challenge, the project identified six ways that physicians, their loved ones, colleagues and health organizations can take action:
- Cultivate daily self-care habits.
- Realize that mental health is a dynamic part of human health.
- Look out for colleagues.
- Never assume that the most accomplished peers “have it together” and never struggle.
- Remember that with distress comes negative cognitive distortions.
- Learn how to have caring conversations.
The Medical Economics journal ran a physician survey on burnout, published in September 2021, discovering that 4 in 5 U.S. physicians felt burned out. While COVID-19 exacerbated a situation that has plagued physicians for well over a decade, the issue of autonomy and control continues to be a major driver of doctor discontent.
One doctor who participated in the study summed up the root of burnout, and its solution—supporting the doctor-patient relationship: “Practicing medicine with real connections to patients, without incentives to just do procedures and write prescriptions. Enough time to actually deal with patient problems and get them the help they need.”