‘Burnout’ and the Healthcare Workplace

Root cause needs to be addressed instead of the symptoms.

The US Surgeon General, the AMA, ACEP and multiple other organizations have announced the need for addressing burnout in the healthcare workplace.

Physicians, nurses and other healthcare providers experiencing burnout, depression and dissatisfaction were recommended to seek counseling, therapy and work towards re-achieving ‘wellness.’

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The recommendations go on to say that healthcare workers should not fear seeking out mental health assistance for these issues, and that increased mental health and counselling resources should be made available for this support.

Such suggestions are misguided and may potentially lead to more harm than good.

Why? First, they attempt to address symptoms of the problem, not the root causes.

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Secondly, such recommendations also create a perception (incorrectly or otherwise) that those facing such symptoms have some type of individual psychological problem. That there is some type of ‘weakness’ or mental frailty that needs to be addressed.

Or that they are, somehow, not as ‘resilient’ as others in the workplace. The very fact that many advocates of this pathway voice that healthcare providers should not fear seeking out mental health counseling speaks to a generalized presence of that perception.

Physicians, nurses and other healthcare providers, especially ‘hands-on’ providers are, as a group, some of the most mentally tough – mentally stable people that I know.

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To suggest that literally hundreds of thousands of healthcare workers have some type of psychological fitness challenge or lack of resilience (as compared with others) is misguided and frankly demeaning to this group of tough professionals.

It is certainly not wrong to assist individuals who are suffering symptoms of burnout, dissatisfaction, unhappiness in the healthcare workplace.

This assistance becomes even more important as there is now some preliminary information that suggests that exposure to workplace burnout may produce biological changes in the brain, especially with ongoing or recurrent exposures.[^1]

It is also true that for decades we have been advocating for increased availability of mental health resources for our patients. These are, however, two separate issues.

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To the issue of healthcare worker counseling and therapy, such efforts might have a transient benefit in some cases. As healthcare providers already know, treating symptoms and not the root cause disease will rarely result in a long-term ‘cure.’

We also know clinically that no matter how well we address the symptomatic issues/problems of any individual, if we then return them back into same environment that produced the problems, the ‘fix’ will almost never hold and symptoms will likely worsen. The root cause environment of this now critical workplace situation evolves from the disruptive conditions present in the healthcare workplace itself (the worker-reported toxic workplace) that, in turn, leads to symptoms of dissatisfaction, depression and burnout. [^{2, 3 4, 5, 6, 7]} 

Over half a million workers left the healthcare workplace between 2020 and 2021 [^8], and the exodus continues.  Numbers of emergency physicians reporting burnout in this year’s physician ‘burnout’ survey increased to 60% of all EPs – the largest increase among all reporting physician specialties.[^9]

Are all these half million exiting healthcare workers and/or 60% of practicing EPs ‘frail’ and in need of therapy and counseling?

No!  These ‘symptoms’ are being caused by exposure to the current toxic healthcare workplace. Individual counseling and therapy will not successfully provide any long-term solution for the majority of all the healthcare workers facing these workplace conditions.

We need to address the ‘root cause’ problem before more healthcare workers continue ‘voting with their feet’ and exit healthcare for other professions (where they are not touted as weak and less resilient).  This in a time when healthcare worker shortages are already critical and accelerating!

We need to stop just treating ‘burnout’ symptoms and begin to address the root cause — we must start identifying elements contributing to the toxic healthcare workplace — and ‘fix’ them.

References:

1. Tina Shaw, Michael R Privitera, LinkedIn, July 1, 2022. https://www.linkedin.com/posts/tinashahmd_burnout-humanfactorsengineering-ehr-activity-6948072916852903936-oBfB/?utm_source=linkedin_share&utm_medium=android_app
2. Evan Wade, ‘Are You in a Toxic Healthcare Workplace? 5 Signs to Look For’. Barton Associates, February 09, 2017. https://www.bartonassociates.com/blog/are-you-in-a-toxic-healthcare-workplace
3. M, ‘Time to Face the Truth: Healthcare Workplaces are Toxic.’ Reflections of a Millennial Doctor, December 17, 2018. https://reflectionsofamillennialdoctor.com/2018/12/17/healthcare-workplaces-toxic/
4. Raven Ishak, ‘19 Signs Your Work Environment Is Toxic.’ Bustle, July 8, 2018. https://www.bustle.com/articles/170826-19-signs-your-work-environment-is-toxic-affecting-you-negatively
5. Cleveland Clinic, ‘8 Signs of a Toxic Work Environment. A hostile work environment can be harmful to your health and wellness.’ Cleveland Clinic Health Essentials, January 12, 2022. https://health.clevelandclinic.org/toxic-work-environment/
6. CDC-NIOSH, ‘Healthcare Workers: Work Stress & Mental Health.’ https://www.cdc.gov/niosh/topics/healthcare/workstress.html
7. Lawrence Donaldson, ‘TOXIC WORKPLACE CULTURES IN HEALTH.’ PHN Channel.blog, February 7, 2021. https://phnchannel.blog/2021/02/07/toxic-workplace-cultures-in-health/
8. Asher Wildman, ‘More than 500,000 have left the health care industry since early 2020, data shows’. Spectrum News, Oct 8, 2021. https://www.mynews13.com/fl/orlando/news/2021/10/09/more-than-500-000-people-have-quit-the-health-care-industry-since-the-start-of-the-pandemic–data-shows
9. Roxanne Nelson, ‘Are Docs Getting Fed Up With Hearing About Burnout?’ Medscape, June 18, 2022. https://www.medscape.com/viewarticle/974638