Healthcare Provider Attrition

“Burnout” is a frequently-used term for a psychological issue that includes “emotional exhaustion, depersonalization, and a sense of reduced accomplishment in day-to-day work.”¹ Prior to 2020, healthcare worker burnout was already gaining recognition as a growing problem. For example, a 2017 Medscape report demonstrated that nearly two-thirds of physicians reported feeling burnt out, depressed, or both.² To make matters worse, the ongoing COVID-19 pandemic has only exacerbated the issues contributing to healthcare provider burnout. For over a year, healthcare workers have frequently had more demanding hours, worked in environments that are understaffed and lack adequate resources, and experienced increased exposure to death and other psychologically traumatic events. Resulting attrition as workers leave or take a break from the field can then further exacerbate stressors among remaining healthcare providers.

An article published by the Washington Post earlier this spring sought to call attention to growing healthcare provider attrition.³ According to a poll taken of 1,327 healthcare workers, roughly three in ten were considering leaving the profession – a number that is shocking given the investment of time and money required to practice in the first place. A few of the physicians and nurses who had already decided to quit their jobs were able to explain their reasoning in an interview with the journalists. Some common themes were the psychological stress and trauma of the day-to-day job, frustration toward some people’s unwillingness to cooperate in slowing the spread of COVID-19, and the constant danger of infection. Other issues, such as understaffing, demanding hours, and a sense of being underappreciated and underprepared were also mentioned. Moreover, for those physicians who experience burnout and remain practicing, their chances of becoming addicted to alcohol or other substances, experiencing relational issues, and/or having reduced patient satisfaction are increased.¹

Occasionally, physicians themselves are at high risk for COVID-19 – take, for example, Justin Meschler, a retired doctor who was interviewed by the Washington Post.³ He mentioned that he was overweight and suffered from both asthma and a heart condition, all of which are risk factors for a life-threatening COVID-19 infection. The looming anxiety of this threat coupled with the other stresses of the job led him to hang up his stethoscope at age 48, far earlier than he would have otherwise anticipated.

The growing prevalence of healthcare provider burnout and attrition has led to calls for changes to the workplace. In fact, in recent years, numerous studies have sought to establish the components of an effective burnout prevention program which could be integrated into both public and private healthcare environments. One of the most promising avenues for preventing attrition is integrating preventative practices into daily life: for example, limiting the number of hours one can work in a day to less than 16, or normalizing the practice of mindfulness exercises in the workplace.^4,5 Moreover, healthcare workers that feel appreciated by their patients and co-workers are less likely to experience burnout.⁶ Therefore, team-building exercises and other practices which encourage mutual appreciation (such as keeping a gratitude journal) might also be encouraged. Ultimately, these small habits and changes may go a long way in alleviating healthcare attrition, though there is still much to learn.

References

1. Maslach, C.; Jackson, S.E.; Leiter, M.P. Maslach Burnout Inventory Manual, 3rd ed.; Consulting Psychologists Press: Palo Alto, CA, USA, 1996.

2. Medscape National Physician Burnout & Depression Report 2018. (2018). Retrieved from https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235

3. Wan, W. (2021, April 23). Burned out by the pandemic, 3 in 10 health-care workers consider leaving the profession. Retrieved from https://www.washingtonpost.com/health/2021/04/22/health-workers-covid-quit/

4. Weaver, M.D.; Landrigan, C.P.; Sullivan, J.P. The association between resident physician work-hour regulations and physician safety and health. Am. J. Med. 2020, 133, e343–e354.

5. Amanullah, S.; McNally, K.; Zelin, J.; Cole, J.; Cernovsky, Z. Are Burnout Prevention Programs for Hospital Physicians needed? Asian J. Psychiatry 2017, 26, 66–69.

6. McMurray, J.; Linzer, M.; Konrad, T.; Douglas, J.; Shugerman, R.; Nelson, K. The Work Lives of Women Physicians. J. Gen. Intern. Med. 2000, 15, 372–380.