For health care workers in the United States, the COVID pandemic significantly ramped up feelings of burnout and anguish, according to a federal survey released this week. The crisis didn’t start with COVID, but the last three years have exacerbated persistent mental unwellness and trauma among those workers. These conditions threaten the sustainability of the nation’s health care workforce, the Centers for Disease Control and Prevention says, especially if systems do not take steps now to improve conditions for these essential workers.
Nearly half of U.S. health care workers – 46 percent of those surveyed – said they often felt burned out in 2022, the CDC report found, marking an increase of 14 percentage points since 2018. During that same time period, workers faced rising incidents of harassment, while trust in management sank. About four in 10 health care workers said they were likely to change jobs in 2022, up from three in 10 shortly before the pandemic began.
Health workers have invested years of their lives to become physicians, nurses and specialists, said Dr. Christine Sinsky, vice president for physician well-being for the American Medical Association. If they are willing to abandon those jobs, she added, “That’s a red flag.”
“Exposure to human suffering takes an immense toll on this vital workforce,” Dr. Debra Houry, the CDC’s chief medical officer who co-authored the report, told reporters on Tuesday.
That exposure was often unavoidable during the pandemic, said Dr. Mysheika Roberts, public health commissioner for Columbus, Ohio. In trying to protect their community from an evolving virus while the medical science raced to catch up, Roberts said she and her staff worked long days for more than three years, enduring “lots of pushback from the community about some of the public health recommendations.”
Health and safety measures like masking, social distancing and vaccine distribution summoned the greatest resistance, she said. To further complicate a difficult situation, Roberts added that the politicization of COVID also created the perception of health care workers as “the bad guys.”
“People were really brutal,” Roberts said. “My staff got that abuse.”
Deteriorating work conditions are still pushing some in the health care industry to a breaking point. In early October, 75,000 workers went on strike against health care system Kaiser Permanente, calling attention to burnout, harassment, low pay, as well as insufficient staffing levels, and demanding executive action for improvement, ultimately reaching an agreement.
Concerns about the sector’s workforce sustainability existed well before the pandemic, Sinsky said. Research has shown that physicians are spending nearly twice as much time doing administrative work, such as updating electronic health records, talking to insurance companies or responding to emails, as they spend face-to-face with patients. That glut of work has become a burden that a growing number of physicians and health workers feel is untenable, Sinsky said. For years, “physicians [have recognized] we are spending our days doing the wrong work for our patients.”
Burnout is only part of the health worker pipeline problem. Nearly half of all practicing physicians are over age 55, said Dr. Jesse Ehrenfeld, president of the American Medical Association, in a speech before the National Press Club Wednesday. At the same time, medical schools are not able to fill vacancies quickly enough, and the American Association of Medical Colleges estimates that nationwide, communities may see a shortage of roughly 100,000 physicians over the next decade.
Improving mental wellness among health workers and preventing burnout and further industry attrition will require more than a single solution, said CDC Director Dr. Mandy Cohen Wednesday, but it is critical for provider and patient safety going forward.
“We need to make sure we’re thinking about the health of our workforce so that we have those caregivers – whether doctors, nurses or others – there to care for this country,” she said.
What experts suggest
Changing the way employers operate and how supervisors manage health workers at a systemic level could boost morale, even when funds run short to raise staffing levels, according to the CDC.
Research suggests supportive managers and systems that welcome worker input, prevent harassment and provide enough time to complete tasks help improve mental health. In fact, changes that are implemented system-wide appear to go further in relieving stress and ultimately retaining staff than screening employees for signs of stress or placing the burden on individuals to seek help and manage their own stress, the report authors wrote.
Leaders also must do a better job of taking accountability and responsibility for workers’ needs, said Dr. Casey Chosewood, who directs the CDC’s Office of Total Worker Health. He stressed the need for manager flexibility, training to identify mental distress and encouraging workers to take time off, in order to move beyond resilience and toward systemic change.
Stigma still forms a significant obstacle between health workers and the mental or behavioral health care they may need, Houry said. This barrier surfaces in the form of stigmatizing language when people apply for medical licensure or certification and are asked about their mental health or substance use. Employers can reduce that stigma by “eliminating intrusive questions for credentialing,” the CDC report recommends.
“Seeking care for burnout, mental illness, or a substance use disorder is a sign of strength — an act that takes courage and deserves our health system’s unconditional support,” Ehrenfeld said. “The health of our patients, and our nation, depends on more physicians seeking help for their mental health and well-being before they abandon medicine altogether.”