As COVID-19 rates surged, health care workers continued going to jobs where they grappled with a risk of infection, losing patients, tough decisions and limited resources.
But the toll of health care work on their mental health started long before the pandemic and will continue long after, if leaders at all levels don’t take action, experts said during a National Institute for Occupational Safety and Health (NIOSH) panel discussion Thursday.
“As a nation, we have a moral obligation to address clinician burnout,” U.S. Surgeon General Vivek H. Murthy, M.D., M.B.A., said. “To do so, we need systemic and cultural changes. And changes that are going to provide our health care workers with mental health support, with reductions in administrative burden and overall workload that’s placed on them, and changes that ultimately involve building a health care culture that supports well-being.”
NIOSH Director John Howard, M.D., presented research from the National Institute for Health Care Management Foundation showing about 76% of health care workers surveyed in September 2020 reported burnout, and most physicians said it started before the pandemic. The report also found the physician suicide rate is twice as high as the rate in the general public.
The pandemic magnified the stress of health care workers. About 93% experienced stress in the early months of the pandemic. A systematic review of studies spanning 21 countries found an estimated 22% experienced depression and 22% experienced post-traumatic stress disorder during the pandemic.
“Whether you’re a doctor or a nurse, a researcher or a scientist or a public health leader, many of you bore the brunt of this pandemic in ways many people in the public may never understand,” Dr. Murthy said.
Burnout impacts not only the workers experiencing it, but also the patients they serve, according to panelist Lotte Dyrbye, M.D., M.H.P.E., co-director of the Mayo Clinic Program on Physician Well-Being. She said burnout has been linked to increases in errors, malpractice litigation, racial bias, hospital-associated infections and patient mortality.
Efforts to combat burnout
Dr. Howard stressed the importance of primary prevention in addressing burnout.
“It starts with eliminating the risk factors for burnout and stress,” he said. “Secondary and tertiary interventions are down the line. The damage has already been done.”
NIOSH has introduced a five-part plan that includes understanding the burden, gathering evidence, leveraging partnerships, identifying and adapting tools to combat the issue and generating awareness.
Dr. Murthy said it is a priority for his office as well. The American Rescue Plan included funding that will go toward research, providing mental health care, addressing systemic issues and reducing administrative burden on clinicians.
Elizabeth Royal, director of the Service Employees International Union National Nurse Alliance, provided even more specific solutions, including adequate staffing; paid leave for both physical and mental health; fair wages; affordable housing, child care and health care; removal of punitive measures for having a mental health crisis; flexible work hours; online coaching; and loan forgiveness.
Addressing burnout needs to include trainees, too. Dr. Dyrbye suggested promoting a positive learning environment, ensuring trainees have a manageable workload, giving fair evaluations and curbing educational debt.
“We’re not going to resilience our way out of this,” Dr. Dyrbye said. “We really need to move forward with system-level interventions that address the underlying reasons for why work stress is so high.”
NIOSH is asking the public to provide input on interventions to prevent work-related stress among health workers. They can do so at https://bit.ly/3cpcjSj through Jan. 25, 2022.
“Doing all this is going to take investment, advocacy and policy change,” Dr. Murthy said. “But we do have the power to make these changes.”
- National Academy of Medicine report “Taking Action Against Clinician Burnout”
- “Psychological PPE:” Promote Health Care Workforce Mental Health and Well-Being white paper from the Institute for Healthcare Improvement
- Physician Support Line, a free, confidential service, 888-409-0141
- AAP webinar on resilience in stressful times
- American Foundation for Suicide Prevention resources on mental health during COVID-19
- National Academy of Medicine COVID-19 clinician mental health resources