U.S. Surgeon General Issues Advisory on Health Worker Burnout

John Whyte, MD; Vivek Murthy, MD

Disclosures

May 24, 2022

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JOHN WHYTE: Hi, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD.

Burnout is a problem. Many of us are experiencing it.

And what's really concerning is the burnout in health care workers because we want people to be around to help us when we're not feeling well. And the surgeon general has issued an advisory addressing health worker burnout.

Joining me to discuss why he issued this advisory, and what's in it, is the United States surgeon general, Dr. Vivek Murthy. Dr. Murthy, thanks for joining me.

VIVEK MURTHY: Of course. Glad to be with you today, John.

WHYTE: Well, let's start off with – you talk about there's an urgent need. What's different now? Because we know there have been issues of burnout. Medscape's actually has been doing reports for years. What's different?

MURTHY: Well, John, some things are different and some things are familiar, as you know. What is different, in part, now is that the pandemic has made burnout rates and mental health struggles among health workers worse. And it's done so in part because it's significantly increased the burdens on health workers. So many health workers have just faced wave after wave of COVID-19, on top of the other challenges that they routinely faced prior to the pandemic.

But we also know that the other challenges – of health misinformation, for example – have taken a toll on health workers as well. So many doctors and nurses I've talked to across the country tell me stories of how they've had to contend with misinformation out there that tells patients that COVID is not real, or that vaccines don't work, or that they're not based in science. All of these are not true, but this is what health workers feel like they're battling: COVID on the one hand, and misinformation on the other.

So those have certainly added to an already very, very difficult circumstance for health workers. But it's important that we recognize that this has been going on for a long time. You at Medscape know that. Many of our colleagues in the profession of medicine and nursing and the other health professions know that as well.

But one of the reasons I'm issuing this surgeon general's advisory on health worker burnout is because I want the entire country to know that. And it's important that the whole country know this, that health worker burnout is a crisis, because it affects their health as well. I just don't think enough people recognize that.

When we look at statistics that tell us that one in five doctors and two in five nurses are considering leaving their practice. When we look at the fact that we are going to need more than 1 million nurses by the end of 2022. More than 3 million lower-wage health workers over the next 5 years. More than 100,000 doctors over the next 10 years.

All of these numbers tell us that we had a shortage, and burnout is going to make that crisis worse. So if you're somebody out there who's not necessarily in the health professions but who needs a primary care doctor, who wants to be sure that there is somebody to take care of you when you get sick, you should care about health worker burnout.

WHYTE: And many people have left over the last 2 years for a variety of reasons.

But I also want to address the issue – we have all these new priorities. We're talking about the need to address social determinants of health, address food insecurity. You and I have talked about in the past clinical trial diversity, getting more people involved. We need to have more primary care physicians who ask patients to participate.

I still see patients – and I will tell you, my colleagues will say don't ask me to do one more thing. So, how do we address? We want to meet the need that clinicians, health workers have in addressing burnout. But then we also have a lot of other priorities that we want them to take on to help address. Are they mutually exclusive?

MURTHY: So, not necessarily. And I think it requires us to think about a couple things. One is that part of what's driving this burnout crisis is that we have increased the demands on health workers without increasing the supports. Supports in the form of an expanded workforce. A team that can help take on some of these challenges so that primary care doctors, for example, don't feel like everything that has to be done is added to their plate and their plate alone.

We also haven't provided enough of the supports in terms of flexibility, mental health services, and the other tools that anybody who is working in a high-stress, high-paced profession needs in order to function well. So that's one thing that we have to recognize. This is not about health workers not being able to cut it. This is about the system not serving them well.

But the other piece that we have to realize is some of these broader issues that we have identified that contribute to health, like housing, like food insecurity, like neighborhood safety, education – yes, these are important for the health system to be engaged and aware of. But I want to draw a distinction between that and saying that now it is the job of, let's say, doctors or nurses to entirely address social determinants on their own. We can't say that that's the case, and it's not the case.

What I think we have to do is give more thought to how we design team-based approaches to care more broadly, but to addressing some of these social determinants as well. When I think about health workers, they have a unique perspective to add. They have a voice that should be welcomed in the room when it comes to policy being made in their institutions, but also for the broader community. That means that we've got to figure out how to better support them with teams.

And if we do this, I think not only can we achieve better care, but we've seen in the VA model – the PACT model, for example – and in other models, that team-based approaches lead to better outcomes, better satisfaction for patients, and more fulfillment and less burnout among health workers themselves.

WHYTE: I want to talk about some of the strategies that you suggest in the advisory. And two of the top ones are to transform the workplace culture to empower health workers and be responsive to their voices and needs, and eliminate punitive policies for seeking mental health and substance use care. I want to start with the second one first because, as you know, many of our colleagues are concerned that if they ask for help, that will impact their job, it'll impact licensure.

MURTHY: Yes.

WHYTE: So how do we address that? Because that's also part of the first one in terms of the culture, as well.

MURTHY: So, you're exactly right. And I said yes because I've heard this concern from many, many clinicians across the country who say, “How can I really be honest if they might take my license away?” And that should never be the case, that a clinician who's struggling, who needs help, feels that they can't ask for help for fear of retribution.

So part of what we need to do there is we need states, and state medical boards in particular, to take a clear look at their criteria, at their licensing standards, and make sure that they are not penalizing clinicians for coming forth and asking for help or admitting that they may be struggling.

Now, if they are genuine issues around safety, that's a conversation that needs to be had. And that's where a state medical board may have license and reason to take some action. But the vast majority of cases, while clinicians are struggling, what they actually need is help. And they need the ability to get mental health care, potentially to work with their employer to see how they can perhaps get greater flexibility or get, perhaps, a break from what may be just an incredible onslaught and burden of clinical work that so many of our colleagues take on.

And so that's what they need, not fear and retribution. So this is part of both policy and culture change that has to take place. And it's not just with licensing boards. Even within institutions, there are health workers who worry that if they speak up that they're going to be seen as – and say, “Hey, I'm struggling. I need some help. I need to take a bit of a break. I need to focus on my mental health” – that they will be seen as weak.

That somehow people will think they're not reliable, that they may be penalized in terms of promotions in the workplace, or at their academic institution in terms of tenure. These are all the worries I hear about every day from clinicians. And this is where institutions, I think, have a responsibility to develop a culture that doesn't penalize people, but also where leaders are leading by example.

It's one thing I remember, John, when I started my residency training. It was in the early days of the work hour restrictions. We had the right, in some ways, policy in place to try to limit work hours for trainees. But the culture hadn't changed yet. And so trainees didn't feel that they could be honest on their forms when they reported their hours.

And that's what we have to guard against here, too. We have a culture in too many institutions that tells people if you're struggling, you're weak. We've got to change that, and that's going to require, in part, our leaders in those institutions leading by example, talking about perhaps their own challenges. Taking the breaks that they need to seek out support and care, and supporting others when they do the same.

WHYTE: A lot of these solutions are long-term strategies. What can we do short-term? What can we do right now to address health worker burnout?

MURTHY: Well, John, actually, there's a lot we can do right now. I think number one, acknowledging the problem, talking openly with our health workers, gathering their ideas and inputs in our health care systems and institutions is an important first step. Many health workers don't feel like they're heard, or that anyone cares or notices, frankly, in their health systems or in society more broadly. So that's an important first step.

I think the second thing that we can do is we can look internally at some of the barriers that stand between health workers and the people they are trying to serve. And there's often low-hanging fruit that we can address to try to either get people more support for some of those tests that interfere or to reduce administrative burden. So, we can take that on within our institutions today.

But the other thing that we can do also is to ensure that we are starting today to create an environment, like in our health systems, where it is OK to talk about our mental health struggles. And that can start today from the top with leaders who lead by example, share their own stories, and talk about the kind of changes that institutions are going to make to make it easier for people to access health care.

I think about one nurse in particular who was talking to me about this struggle she had during the pandemic. And she said, “I'm blessed to have insurance coverage. But I have no time to actually go get care during daytime hours because I'm on the night shift. I'm working time and a half most of the time, be given the demands in the hospital system. When am I supposed to go there?” Bringing some of those services in-house through telemedicine and other tools is an important strategy as well.

And finally, institutions can, on their own today, start to develop workplace policies that protect workers from violence. Eight out of 10 health workers were the victims of verbal or physical abuse during the pandemic. That is extraordinary: 80% of health workers. We should not be allowing people to be abused who are coming to work each and every day to help other people.

So, there are a lot of things we've got to do to address health worker burnout, but we can start today. And, more broadly, what I would love to see is increased access to mental health care and services. I'd like to see us focus on reducing the administrative barriers to people providing the care that they came to the profession to provide. That means looking at our EHRs [electronic health records], which are often built more for billing than for patient care. It means reducing prior authorizations if you are payers, public or private payers, to, again, reduce the amount of work that clinicians have to do outside of direct patient care.

And it also means that we've got to take a closer look at the culture within our health care systems. Too often we define strength in health care as how many hours you can stay up, and how many patients you can see before you go home at night, and how many days you can work in a row without taking a break. That is not strength. That is a recipe for burnout and exhaustion. And history, in fact, has proven that to us.

But we don't often value enough the compassion, the kindness, the empathy that someone brings to the bedside. Can you tell me the last time you heard of a faculty member who was promoted and got tenure because of their compassionate care? More often, we hear about the papers people publish, the funding that they brought in, the clinical volume that they took on.

So, we got to make some major changes, not only in policy and practice, but in our culture, in health institutions, and in the health care system more broadly. That's why I issued this advisory. It's a call for both the short- and long-term change that we need. But it starts with acknowledging that this is a problem and laying out a clear set of actions that we're going to take as institutions to finally have health workers' backs.

WHYTE: Where can people learn more about your advisory?

MURTHY: So, people can go to surgeongeneral.gov/burnout, and that will take you to the advisory that we issued. We've all got to step up and do our part to address the burnout crisis.

WHYTE: Absolutely. We all have to do our part. At Medscape, we've been issuing reports on burnout for quite some time. And this advisory will help advance those discussions and think of strategies that we need to address this burnout in health workers.

Thank you, Dr. Murthy.

MURTHY: Thanks so much. Appreciate it, John.

WHYTE: If you have questions about burnout and you want to learn more on how to address it, drop me a line. You can email me at drjohn@webmd.net. Thanks for watching.

This interview originally appeared on WebMD on May 24, 2022

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