Burnout: The Scourge of Healthcare Workers and the Health System

Healthcare worker burnout worldwide became impossible to keep ignoring during the Covid-19 pandemic. Although this article concerns the US healthcare system, we share it because similar problems in Turkey make it worth highlighting. The New England Journal of Medicine published this article by Dr. Vivek Murthy on August 18, 2022. It discusses how the pandemic made longstanding physician burnout impossible to postpone addressing. It also examines violence in healthcare, laws that harm doctor–patient relationships and what we should consider when training future doctors.

Early in the Covid-19 pandemic, as much of US society shut down, healthcare workers risked their own safety and continued caring for patients. Americans initially tried to boost their morale by banging pots, cheering from balconies and displaying thank-you signs, but those pots have long since fallen silent. An explosion of health misinformation and eroding trust in science and public health experts have replaced gratitude with hostility, anger and even death threats against healthcare workers. Yet doctors, nurses, pharmacists, social workers, hospital security staff and employees of healthcare and public health organizations continue showing up to fight the pandemic and its wounds (long Covid, mental health problems and widening health disparities).

The warning bells for our healthcare workers are alarming. Thousands have died from Covid. More than half report burnout symptoms, and many struggle with insomnia, depression, anxiety, post-traumatic stress disorder or other mental health problems. An intensive care nurse in Miami said, “There came a point when I could no longer contain the heartbreak of everyone I had lost.” She stopped counting after her 135th patient died of Covid in the pandemic’s first year. Patient care has always been emotionally and physically demanding, but as a Missouri doctor put it, “We have lost so much too. We are human too.”

Burnout manifests in individuals but is fundamentally rooted in systems. It was a crisis long before Covid-19. Causes include insufficient support, growing workloads and administrative burdens, chronic underinvestment in public health infrastructure, and moral injury from being unable to provide the care patients need. Burnout is not just about long hours but a fundamental disconnect between healthcare workers and the service mission that motivates them.

These systemic failures have pushed millions to the brink. Approximately 52% of nurses (American Nurses Foundation) and 20% of physicians (Mayo Clinic Proceedings) say they plan to leave their work. More than 1 million nursing vacancies are projected by year’s end (US Bureau of Labor Statistics), and a shortage of 3 million low-wage healthcare workers is expected over the next 3 years (Mercer). Public health also faces major staffing shortages just as defenses against future threats need strengthening. Healthcare worker burnout seriously threatens the country’s health and economic security.

The time for slow, incremental change has passed. We need bold, fundamental change addressing the roots of this crisis. We Must Stand by Healthcare Workers and the Next Generation.

On May 23, 2022, I issued a Surgeon General’s Advisory on healthcare worker burnout and wellbeing, declaring the crisis a national priority and calling for action with specific directions for health systems, insurers, government, educational institutions and other stakeholders. The advisory also aims to raise awareness of burnout’s threat to national health. Public awareness and support are essential for sustained action.

Addressing wellbeing begins with valuing and protecting healthcare workers: ensuring a living wage, health insurance and adequate sick leave. They must never again go to work without sufficient personal protective equipment (PPE), such as masks, as they did during the pandemic. The Biden administration’s efforts to expand domestic PPE production and maintain adequate Strategic National Stockpile supplies remain essential. We also need strong policies protecting healthcare workers from violence: according to National Nurses United, 8 in 10 report physical or verbal abuse during the pandemic.

Second, we must reduce the administrative burdens between healthcare workers and patients. One study found that outpatient physicians spent approximately 2 daytime hours on electronic records and desk work for every 1 hour with patients, plus 1-2 hours on administrative tasks each evening—a trend widely lamented by doctors and patients. The 25×5 initiative, a symposium addressing US physician documentation burdens, aims to reduce those burdens by 75% by 2025, an important goal. Insurers should reduce prior authorization requirements, streamline paperwork and develop simple common billing forms. Electronic health records need human-centered design optimizing usability, workflow and communication across systems. Health systems should regularly review internal processes to reduce duplication and inefficiency. Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program saved 1700 nursing hours monthly.

Third, we need to improve healthcare workers’ access to mental health services . Lack of insurance, narrow mental health provider networks and inflexible appointment schedules make care difficult to obtain. Expanding the mental health workforce, strengthening insurance parity laws and using virtual technology to deliver care where workers are and when they are available are essential steps.

Fourth, public investment in the workforce and public health can be strengthened. Expanding public funding to train more doctors and public health workers is crucial. Greater funding for community infrastructure—from sustained support for local public health departments to addressing social determinants such as housing and food insecurity—advances health equity and reduces demands on the healthcare system. The CDC’s recent announcement of 3 billion dollars in grants for public health infrastructure, data systems and workforce is the investment needed.

Fifth, we need to build a culture supporting wellbeing . It is time to break the traditional silence surrounding healthcare workers’ suffering. Our work can be deeply isolating as well as rewarding, especially when we feel unable to tell colleagues we are struggling. Millions of workers, including me, have experienced this during our careers. Change should begin in educational institutions, where wellbeing can be nurtured early. Health systems and public health departments also need exemplary leadership. Licensing bodies should adopt approaches that do not punish workers for reporting mental health concerns or seeking help, and protect privacy. Many workers still face severe racial, gender or disability discrimination. Inclusion, equity and respect are essential for morale.

These changes will not be easy, but they are urgent and necessary. Key stakeholders must do their part. Government can ensure sustained focus and accountability by supporting a National Healthcare Workforce Commission to coordinate federal action and collaborating with state/local authorities and the private sector on a national wellbeing agenda. The Joint Commission can add worker wellbeing measures to accreditation standards. Health system leaders should make wellbeing a measurable priority, accountable at the highest organizational level, and involve workers in designing and implementing comprehensive strategies.

Despite years of inaction, signs suggest this time may be different. The Dr. Lorna Breen Health Care Provider Protection Act of 2022 and billions from the 2021 American Rescue Plan will provide infrastructure and resources for wellbeing programs. These support expanded mental health services, workforce growth, healthcare professional loan forgiveness, stronger public health infrastructure and wellbeing training. President Biden has called for billions more to sustain these investments.

Outside government, the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience has increased engagement and commitment through its National Plan for Health Workforce Well-Being. Health systems are creating executive positions with the responsibility, resources and authority to institutionalize comprehensive wellbeing agendas. A rising generation of workers is also using its collective voice in workplaces, schools, professional associations and public debate to advocate policy change. They understand that silence is not an option when their wellbeing and communities’ health security are at stake.

As a nation, we cannot allow ourselves to fail healthcare workers and their communities. We must advance these steps by boldly confronting vested interests, bureaucratic inertia and the status quo. Workers across the country say they are at breaking point and “something must change.” They are right. May the United States never forget its moral obligation to care for those who sacrifice so much to care for us.

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