I’ve been hearing more and more stories about dropped balls in healthcare. One friend told me his father was discharged from the hospital with an oxygen saturation of 70% and given no explanation for why he had suddenly developed shortness of breath. Another patient had to call seven times for a lab result before finally getting a call back, at which point she was informed the result was abnormal and that she needed to make an appointment to come in and discuss. Another hospitalized patient asked a cardiologist for a copy of his echocardiogram before discharge. He said he’d go get him a copy and come right back, but never did.
What’s going on?
Here were some concerning descriptions that I had also been hearing from people about other providers who work day-to-day on the frontlines. “She looked like a robot,” reported one person about a nurse she had just interacted with in the ER. “They are like walking pulses,” said someone else about the doctors and nurses she had interfaced with during a brief hospital stay.
Patients and families are having to fight more and more every day to get even the most basic medical needs met. But as a friend of and treating psychiatrist for many healthcare providers on the frontlines today, I also have a hunch that it’s not the laziness or pure negligence of doctors and nurses that’s to blame. Rather, I’m guessing the root cause is provider burnout.
What is burnout?
Burnout is a state of emotional and physical exhaustion often seen in overworked healthcare workers. It’s associated with compassion fatigue, mental distress, cynicism, erosion of passion for the job, and feelings of incompetence. I knew the burnout problem had been ballooning. And many providers I’ve talked to and heard from and read about are aware of and deeply pained by the fact that their exhaustion and overwhelm has been impacting their ability to provide the quality of treatment they expect from themselves.
Burnout before the pandemic
Even before the pandemic, burnout was a concern. There were rising levels of mismatch between the goals of the healthcare organizations and the workers, a culture of “suffering in silence,” and career dissatisfaction. And psychiatric symptoms were high: suicide rates in doctors were double that of their patients, and at the same time doctors were notorious avoiders of mental health care, in part because they feared recrimination from the hospitals and licensing boards.
Burnout during the first year of the pandemic
And when the pandemic hit, things got worse. Already exhausted providers were suddenly being asked to make difficult ethical decisions about provision of care and repeatedly experience the pain of loss of patients and colleagues. They had to cope with working long hours while fearing the consequences of contracting infection for themselves and their families. And those that were providing direct care to COVID-19 patients, especially people of color and women, were at higher risks of depression, anxiety, and mental distress.
Today, things continue to spiral downward. While patient care loads continue to be high, salaries are being cut. And there’s been a rapid exodus from the healthcare field of late. Staff shortages are a growing problem, with 20% of hospitals reporting critically low staff numbers. As a stop-gap, temporary workers are being recruited, in the form of military medical personnel or travelling nurses, which increases the training burden on existing staff, and increases the risk for medical errors by those unfamiliar with a new clinical environment. Not only that, but travelling nurses are now making up to $5,000 per week, fueling resentment for permanent employees, who make a quarter to a third less per hour.
Effects on patient care
The worse burnout gets, the more patient care deteriorates. Studies show that burnout and provider fatigue lead to more medical errors, lower levels of patient satisfaction, reduced patient safety, and healthcare system inefficiency. It also makes providers numb: nearly 40% of nurses experience an extreme lack of empathy from burnout. No wonder patients are having these experiences.
What’s to be done?
On the bright side, the White House recently released over $100 million to address healthcare worker burnout. The health and human services plan to use this money to train individuals who work in health care and related settings about wellness, and to help 10 healthcare organizations to expand their wellness programming and promote mental health.
But will it be enough? And will it be spent in the right way? I am worried it won’t. Sure, wellness promotion by training providers on how to meditate more, eat right, exercise regularly and build community can’t hurt. But let’s be honest: Who really has time to engage in self-care when working in a war zone? Reducing burnout needs to be something that the healthcare systems take primary responsibility for. A major top-down transformation needs to take place, and it needs to happen in more than just 10 organizations who happen to apply for and win grants.
Three major shifts need to occur, and now. First, hospitals need to think about rationing care and pulling in ethics professionals much earlier than they are. This could take the burden of decision-making out of the hands of providers so they can concentrate on providing excellent care to the patients they serve, and reduce their patient loads. Second, the culture of medicine needs to change, and managers need to create blame-free environments and put a stop to the overvaluing of stoicism, so people can talk about stressful experiences and mental health needs openly. Providers should be applauded, not punished, for asking for help with substance use or depressed mood. Finally, our healthcare workers need to be honored for their sacrifices in the same way we honor our veterans, and they need to be compensated adequately, not have salaries cut. Perhaps if change happens fast, providers can find meaning again in the work that they do, and people like my friend’s dad will, again, get the attention and care that they deserve.