A new cross-sectional nationwide study of 206 health care organizations suggests there are record high levels of burnout, intent to leave the profession, and work overload across all members of the health care workforce, not just doctors and nurses. The results, which are published in Journal of General Internal Medicine, suggest that many studies in the past have focused just on physician or nurse burnout. The COVID-19 pandemic, however, has increased stress across the workforce, including support staff and health care teams who have a crucial role in patient care.
Corresponding author Lisa S. Rotenstein, MD, MBA, a primary care physician at Brigham and Women’s Hospital and Assistant Professor of Medicine at Harvard Medical School in Boston, Massachusetts, said there is an urgent need to support all roles within the health care environment to provide high-quality patient care. In the current environment with unprecedented clinical volumes due to postponed care and ongoing pandemic stresses, the authors call for systemic approaches that include ensuring sustainable compensation, adequate safeguards for mental and physical health, and readily accessible mental health resources for all members of the workforce.
Effect of COVID-19
For non-physicians, the prevalence of work overload ranged from 44.5% in non-clinical staff to 47.4% in non-nurse, non-physician clinical staff (physical therapists, respiratory therapists, social workers, and others). “The prevalence of burnout ranged from 45.6% in non-clinical staff to 56.0% in nurses,” Dr Rotenstein said. “For many health care workers, the COVID pandemic represented the first time they were worried about their personal safety. Staff shortages since the pandemic have only amplified the work overload of individuals who deliver health care and now face a pent-up demand for care.”
The sample of 43,026 respondents (mean response rate 44%) was 35.2% physicians, 25.7% nurses, 13.3% other clinical staff, and 25.8% non-clinical staff. Burnout was defined as a phenomenon characterized by emotional exhaustion, depersonalization, and a lower sense of personal accomplishment. The researchers assessed burnout using the Mini-Z single-item burnout measure.
Burnout by Health Care Role
Approximately 50% of all respondents reported burnout, with the highest levels among nurses (56%) and other clinical staff (54.1%) reporting burnout. Intent to leave the job was reported by 28.7% of health care workers, with 41% of nurses, 32.6% of non-clinical staff and 31.1% of clinical staff reporting the sentiment. The intent to leave was higher for both physicians and nurses in an in-patient setting compared to out-patient settings.
The prevalence of perceived work overload ranged from 37.1% among physicians to 47.4% in other clinical staff. This work overload was significantly associated with both burnout and intent to leave the job. “Physicians who reported work overload had 2.4 times greater risk of experiencing burnout and a 1.7 times greater risk of intending to leave the role within the next two years,” Dr Rotenstein said. “However, what was novel about this study was that we saw similar trends across role types.”
There is no clear standard for quantifying work overload in the health care setting. Approaches to workload reduction in medicine are haphazard, according to the authors. With other industries, such as the airlines, there are established rules concerning exhaustion for airline pilots and flight attendants. The workload is closely monitored. Now is the time to identify and address workload across all role types, Dr Rotenstein said. She advocates for more innovative approaches that do not simply shift responsibilities from some members of the health care workforce to others, but to automate or reimagine some of these responsibilities.
“This is a multifaceted problem, so it will take multifaceted solutions to address,” Dr Rotenstein said. “Some of the key principles include paying all healthcare role types a living wage, ensuring the safety of working in health care across all role types, regular workload monitoring and modulation, and good leadership and management training for healthcare leaders from the local work unit to executive level.”
Proactively addressing work overload across multiple role types may help with concerning trends across the health care workforce. This will require a more granular understanding of sources of work overload across different role types, and a commitment to matching work demands to capacity for all health care workers. “There are staffing shortages in health care facilities across the country and it’s not just physicians,” she said. “It is nurses, medical assistants, and more. We need to take care of all types of health care workers.”
Phillip L. Coule, MD, MBA, Vice President and Chief Medical Officer at AU Health System and Associate Dean of Clinical Affairs at the Medical College of Georgia in Augusta, said the problem of burnout is worse than ever. “The entire health care industry is seeing burnout across every discipline and specialty, but it appears to be worse in internal medicine, emergency medicine, and nurses across the board,” Dr Coule said. “We have seen improvement in the burnout numbers with resolution of the COVID pandemic, but it is not all being driven by COVID. Much of this was building prior to COVID. If you look at why they are burned out, it is the electronic medical record and bureaucratic tasks.”
Practitioners are spending more time entering data into the computer and less time face to face with their patients. The average physician spends 1.5 to 2 hours a day just working on the electronic medical record, Dr Coule said. That 9 to 10 hours per week that is not compensated time. “As an industry, we need to re-evaluate what data is being collected and why, and how we might make documentation more efficient to reduce the administrative burden on our doctors and nurses.”
Rotenstein LS, Brown R, Sinsky C, Linzer M. The association of work overload with burnout and intent to leave the job across the healthcare workforce during COVID-19. J Gen Intern Med. Published March 23, 2023. doi:10.1007/s11606-023-081