Addressing the human factors behind burnout
Clinicians offer many reasons for why they struggle in their professions, but addressing deep-seated, personal concerns may be the best place to start.
Burnout and negative emotional association with care delivery doesn’t have one root cause, but the impact of multiple trends in recent years is having devastating effects on doctors and nurses.
The emotional toll is causing attrition in the workforce, and exacting a financial toll on provider organizations, who are seeing trained caregivers leave their positions, or even the profession, because of unsustainable stress levels.
“Doctors, nurses and pharmacists are just tired,” says Eve Bloomgarden, MD, an endocrinologist and thyroid subspecialist at NorthShore University HealthSystem, and co-founder of IMPACT4HC, a coalition of physicians in Illinois. “You can’t find medical assistants, and without a good medical assistant, then it’s really hard to hire and train them. We’re kind of in this spiral.”
Systemic pressures – particularly financial shortfalls facing healthcare organizations, personnel shortages linked to demographics, and psychological stress and politically-based verbal abuse related to the pandemic – all have added fuel to the fire burning through clinicians’ ranks.
Many causes, one result
Many experts observing the trend see a trend of pressures that swirl into a circular vortex of pressure that exacerbate the situation.
With pandemic relief funding drying up, healthcare organizations are having to make difficult financial choices, often resulting in staffing reductions or other cuts that place pressure on staff.
Demands for more efficiency and higher workloads discourage clinicians even more, resulting in decisions to leave jobs, reduce workloads or “quiet quit,” observers say.
That has a negative effect on patient experience, as physicians report higher caseloads and longer delays in treating patients, Bloomgarden says. “More patients are coming in with the same story – their primary care physician has retired or they can’t get into other specialists for months.”
Patients delayed care during the pandemic, but that won’t continue, says John Erwin, CEO of Carenet Health, a consultancy specializing in patient engagement. “Hospitals and health systems can’t be caught without the adequate, refreshed staff needed to meet what will surely be colossal demand. Today’s inflation and slowing economy pose additional challenges to this preparation.”
The need to monetize care also leads to depersonalization of clinicians, with them feeling like they are cogs in a transactional system, and a long way from the altruistic motivations that led many to the profession.
“It’s so much less personal; it’s just the monetization of care,” Bloomgarden contends. “We’re the only revenue generators for organizations, and people have had enough of it. I know seven or eight full-time clinicians that have decided to leave medicine completely.”
Loss of control, lack of respect
There is a sense of loss of control over their professional environment – administrators hold sway over overall operations; payers influence care decisions through the authorization process; and patients are playing a growing role in their own care, even if they sometimes draw inferences from unreliable sources.
“A lot of the people have the control and decision-making power,” says Subha Airan-Javia, MD, associate professor at Penn Medicine and founder and CEO of CareAlign. “The reality is that health systems are struggling; it’s really tough times. (Clinicians) are in putting-the-fire-out mode.”
And because caregiving is a deeply personal, core issue for professionals, many struggle with the whipsaw of emotions experienced during and after the COVID-19 pandemic, says Josh Holzbauer, director of physician well-being for Epic, the Verona, Wis.-based health records system developer.
“One thing that’s not getting enough attention is that COVID was politicized, and clinicians were getting more abusive language from patients. There’s been a noticeable lack of civility and respect in messages and communication. It makes things worse when they don’t treat you as a human being.”
Clinicians received a reprieve from some of the stressful components of their jobs because of limitations on face-to-face encounters during the pandemic, but many report that those pressures have risen post-pandemic. And the sense that doctors and nurses were labeled as heroes at the beginning of the pandemic seems especially ironic, Holzbauer says. “It can be patronizing, particularly when it doesn’t match the way they’re treated on a day-by-day basis.”
Solving the crisis
With many causes for burnout, there won’t be any one solution that will reverse the trend.
An important first step is looking at what clinicians perceive to be the cause of their struggles. Medscape’s most recent survey on burnout and depression found that 61 percent of survey respondents cited too many bureaucratic tasks as the cause; 38 percent mentioned lack of respect from co-workers; 37 percent cited too many work hours; 34 percent noted insufficient compensation; and 31 percent reported a lack of control or autonomy. In all, physicians mentioned nine types of causes, and 12 percent listed other factors outside of those types.
Financially constrained healthcare organizations will be hard-pressed to implement some of the workplace measures that physicians most frequently mention as remediations. These include increased compensation, by 45 percent of respondents; a more manageable work schedule, by 44 percent; more support staff, by 37 percent; and lighter patient loads, by 33 percent.
But some responses to clinician needs are under the control of administrators and don’t cost too much, says Adrienne Boissy, MD, CMO at Qualtrics and a practicing neurologist at Cleveland Clinic. Some of these “soft” factors likely hold more sway with clinicians, she contends. A recent survey by Qualtrics, an experience management company, found that 38 percent of clinicians are at risk for burnout.
“Most concerning to us is that we’re getting a lot of signals that we should be listening to clinicians, considering their emotional well-being,” Boissy says. Qualtrics’ ongoing research indicates the need for sustained effort to affirm professionals’ value and address issues that are causing stress.
“We need to be creating more value for them, and they need to be feeling valued, which involves how we show up in their lives, how we can ease the burden of process inefficiencies, making sure environments are inclusive and that there is a wholistic in a listening strategy,” Boissy explains.
“Most feel pretty unknown in their systems,” she adds. “They want their values to not feel at conflict with the organization. There needs to be value alignment, and healthcare organizations need to be able to humanize at scale.”
“What it boils down to is people want to feel valued; it should be a free thing to give out,” agrees Bloomgarden. “There are some places that have done it; they will do whatever it takes to keep the workforce. Organizations have to change their question away from purely a revenue-staffing question. They need to understand why people are leaving. The answers are already out there – people want flexibility, and they want to be thanked.”