BURNOUT: Significance for healthcare and society

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

There has been much in the news about healthcare worker burnout. Burnout has resulted in crisis-level losses of staff and expertise since before COVID-19, which the pandemic exacerbated. Addressing burnout is as important as training more workers. Lost seasoned professionals take years of experience and wisdom, gleaned from time in the field, when they leave.  This cannot be quickly replicated in the newly trained.

 I suggest you read this column from a personal – as well as societal and healthcare impact – perspective.  How are you, your loved ones, and your friends doing in your jobs?

I experience burnout in transactional (vs interactional) healthcare visits and poor customer service in commercial interactions. Burnout affects and is a problem in all aspects of society.

Definition

The World Health Organization (WHO) classifies burnout as a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”  Its three main symptoms are:

1. Feelings of energy depletion or exhaustion
2. Increased mental distance from one’s job or feelings of negativism or cynicism to one’s job
3. Reduced professional efficacy as well as a low sense of personal accomplishment

The WHO describes burnout as an occupational phenomenon, not a medical condition. That said, burnout is a kind of depression of the ‘work soul’ and can lead to medical conditions including depression, anxiety, substance abuse, and overeating.  It can result in wanting to quit (and leaving) one’s job.

Causes of Burnout

(from the Harvard Business Review):

6 Causes of Burnout, and How to Avoid Them (hbr.org)

1. Workload overload
2. Perceived Lack of Control, autonomy, and having a say in decisions that affect your job
3. Reward both intrinsic (feeling appreciated) and extrinsic (being paid in a way that reflects your skills and contribution)
4. Community relationships that are supportive and trustworthy
5. Fairness of treatment
6. Values Mismatch between your motivation to work and your organization’s values

Burnout is not just being tired. It is a condition that requires interventions: prevention and treatment interventions by employers and self-care by employees.

The current data on healthcare workers corroborate this list of the causes of burnout from business research. In addition, healthcare workers deal with unique stresses that include taxing work (long and non-traditional shifts that need to be filled 25/7/365) as well as significant safety risks. Safety risks entail exposure to infectious diseases, long and often unpredictable hours, as well as stressful interactions with patients and families who have become increasingly threatening and at times violent.

Operating room full of tired doctors

Healthcare worker safety and harassment make things worse

No longer working on the front lines of healthcare, I was shocked to hear from an ER RN colleague from Milwaukie, WI, that he experiences at least three threats to his life on EVERY ER shift!  Reading Edwin Leap M.D.’s column (www.edwinleap.com) confirms this and I have no doubt these risks exist locally. An RN friend from Bremerton shared that during the pandemic, she and staff were incessantly harassed and blamed for causing patients to be ill with COVID-19 (despite their attending a party to get exposed) rather than being thanked for caring for them.

The Data on Burnout is NOT GOOD

Medscape publishes online updates on medicine and performs studies on physicians’ work lives. A review on burnout in internists showed up this week and caught my attention.

Internal Medicine physicians, like me, are also called internists (different from interns who are first-year doctor trainees). Yup, confusing. Internists now mostly work as hospitalists. They are primary care physicians for those who are hospitalized. Sadly, internists rarely practice outpatient primary care these days.

The news about internist burnout is grim.

Half of US internists experienced burnout last year. The main causes? Lack of autonomy over their practices, plus the burden of bureaucratic tasks and paperwork over which they feel no control.  As a result, half of them have considered leaving medicine. Amid a critical primary care physician shortage, this is very bad news.

The news is not better for other healthcare professionals.

In November 2023, the CDC published a paper in the MMWR (Morbidity and Mortality Report, a weekly update on what is happening in healthcare) called  

Vital Signs: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022 (cdc.gov)

In 2022, nearly half of healthcare workers reported feeling burnt out often. 44% reported they were likely to look for a new job, called ‘turnover intention.’ This compares to 14% in fields other than healthcare. It also showed that US healthcare workers experienced greater declines in mental health, job, and life satisfaction than other workers.

In this time of severe healthcare workforce shortages, this too is very bad news.  

A male doctor with the cutting marks of goggles pressed into his face, looking exhausted and burnt out.

Why Does the Problem of Burnout Matter?

Because preventing burnout is good for all of us and our society to prosper.

The Surgeon General’s report states that distressing work environments contributed to a record-high number of healthcare workers quitting their jobs.  “These data support an imperative call to action to create a system where healthcare workers can thrive.”

The report also called out the importance of ‘decent work’ in our society (safe work that provides a fair income and opportunities for growth and productivity) as a public health goal…that is, for everyone.

What is Being Done?

Optimistically, the Surgeon General’s report notes that modifiable working conditions can make all the difference, and much more quickly than training new healthcare professionals. Preventing burnout is a potent solution for maintaining staff.

The National Institute for Occupational Safety and Health (NIOSH) has responded to this problem with a robust tool called Impact Wellbeing. In this 100+ page document are buckets of strategies for organizations to use to prioritize professional well-being.

The introduction states, “Positive and safe working conditions, including trust in management and supervisor help, were associated with lower odds of burnout in staff. “This tool offers evidence-based solutions to hospitals to reduce burnout, sustain staff well-being, and build a system where healthcare workers thrive.”

A group of professionals at a table discussing in a collaborative manner.

Key points that help with burnout and apply to all work environments include:

• COMMUNICATION – clear, consistent, and transparent with staff.
• COLLABORATION with staff by offering supportive leadership and supervision is key to establishing a positive workplace CULTURE that reduces burnout.
• Promoting a culture of SAFETY: where workers feel safe to seek mental health services, trust leadership to be honest, and take steps to address violence and harassment in the workplace.

*See column A caring difference you can feel, Dec 26, 2023, on how one Washington community hospital’s leadership is well on its way to incorporating these tools.

The complexity of corporatized hospital organizations has slowed their implementation of such burnout prevention strategies. It is hoped that they will buy in as soon as possible as these entities control a majority of healthcare in our state.

I believe that what is good for patient- care and healthcare professionals is important for healthcare organizations’ success in providing care to their communities. Burnout, loss of expertise, staff turnover, and re-training are time-consuming, expensive, and impair quality of care, morale, and trust.

Keeping current staff working is a powerful way to reduce staff shortages and brain drain.

What Can You Do?

If you are experiencing burnout, here’s what you can do:

• Become Aware, Accept, and Admit it – you are not just tired and discouraged
• Talk to someone. Seek help from a coach or therapist. Burnout can lead to depression, anxiety, and even suicide. Pam Wible, M.D. pamelawible.com has made it her goal to support physicians and prevent physician suicides.
• Practice healthy self-care: figure out what restores you and do it. Struggling internist studies show that they maintain their happiness and mental health most often with exercise, spending time with family and friends, doing activities and hobbies they enjoy such as cooking, reading, gardening, etc., getting enough sleep, and eating healthy.
• Talk to your employer and share your experience. HOPEFULLY, that employer will be working on cultural change where employees' experience and needs are both heard and responded to. Importantly, after speaking up, it will become clearer what you can and cannot do to influence your work environment.

6 Causes of Burnout, and How to Avoid Them (hbr.org) This short article has excellent and practical suggestions on what to do if you are experiencing burnout.

Reducing worker burnout is a foundational solution to the healthcare worker shortage. Let’s keep our doctors and nurses and all their support staff on the job!

P.S. I am interested to hear from readers, our local healthcare workers, and leaders in response to these columns using your input for more columns on these important topics!

Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com