Highlights from the U.S. Surgeon General’s warning on health worker burnout

For years there has been an increase in health workforce burnout. The COVID-19 pandemic exacerbated the effects of exhaustion and moral distress across the health community. Earlier this year, U.S. Surgeon General Vivek H. Murthy, MD, addressed health worker burnout and provided solutions in his advisory on building a thriving health workforce titled, “Addressing health worker burnout.”

The advisory raises the American people’s awareness of an urgent public health issue and provides recommendations on how to address the issue. Dr. Murthy dedicates this advisory to the health workers who lost their lives during the pandemic while healing and comforting others. Below are key points from his advisory.

Health worker burnout and its consequences

Dr. Murthy defines burnout as “an occupational syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.” While burnout can occur in any profession, health worker burnout in particular is worrisome because of its impact on patient care and safety. These effects manifest in ways such as increased medical errors, decreased time spent with patients, staffing shortages and increased costs as the health care system must replace staff more frequently.

Not only will staffing shortages inhibit our ability to be prepared for the next public health emergency, but they will also make it harder for Americans to get routine preventive care, emergency care and medical procedures. These obstacles will further worsen health disparities as marginalized groups will suffer more when medical care is limited.

Disproportionate impact of burnout on groups of health workers

Dr. Murthy highlights how groups of health workers of color, immigrant health workers, female, low-wage workers and health workers in rural and tribal communities have been disproportionately impacted before and during the pandemic.

For example, health care workers of color were less likely to have adequate PPE but had more than double the likelihood than their white colleagues to test positive for COVID-19. Female health workers reported higher rates of burnout before and during the pandemic. They are more likely than men to be responsible for childcare at home and consequently experienced more disruption to their careers and professional advancement. Health workers in rural and tribal communities had access challenges even before the pandemic – staffing shortages, resource limitations and an insufficient number of physicians – and these situations were further exacerbated during the pandemic.

Surgeon General’s call to action: ‘We must shift burnout from a ‘me’ problem to a ‘we’ problem‘

Dr. Murthy calls for a collaboration of public and private stakeholders and community partners to amend the root cause of health worker burnout from a systems-level approach. The following summarizes the action items directed to a few of the stakeholders addressed in the advisory.

Health care organizations: By implementing evidence-based policies, programs and solutions to address and prevent burnout, health care organizations can strengthen and establish safer organizational environments. Dr. Murthy encourages organizations to empower health workers by being responsive to their voices and needs and to have policies to ensure health workers are not deterred from seeking appropriate care for both their physical and mental health.

Health care organizations should promote diversity, equity, inclusion and accessibility by combatting bias, racism and discrimination in the workplace. Dr. Murthy cites Massachusetts General Hospital as an example. Mass General implemented a code of conduct that defines their zero-tolerance policy for discriminatory behavior toward staff, and patients can be removed if they break this code multiple times.

Health insurers and payers: Health insurance companies and payers can help improve the quality of health care by supporting the quality and quantity of time that health workers spend with patients. Allowing health workers to determine optimal visit length standards will help improve efficiency and quality of care. Further, reducing the administrative burden imposed by authorization requests and other reporting needs can be done by using technology to streamline these requirements. Ideally, health workers can save up to 12 minutes per transaction if prior authorization processes become fully electronic.

Academic institutions and clinical training programs: Learners in the health care field are also vulnerable to burnout. Dr. Murthy encourages educators to build resilience and mindfulness into their curriculums and promote a culture that supports the success of their learners. Such a learning environment would discuss the harms of sleep deprivation and provide shift schedules to minimize it. Additionally, faculty and senior health leaders should model empathy and encourage discussion of behaviors that promote wellness.

Much like how health care organizations should advocate for diversity, equity and inclusion, so too should training programs. Dr. Murthy advises training programs to address systemic barriers that prevent students from diverse backgrounds from entering and remaining in health professions. Moreover, learning environments should institute inclusive policies that reduce, if not eliminate, stigma and discrimination and provide safe spaces for mentorship and comradery by discussing shared experiences for minority students and faculty.

Health workers: Learning how to recognize signs of burnout and reaching out for help are the first steps health workers can take to prevent burnout and improve their wellbeing. Dr. Murthy reminds workers to prioritize what is important to them, whether it be hobbies or spending time with loved ones. Ensuring one has all their basic needs met and incorporating good health habits – regular exercise, sufficient sleep, healthy meals, etc.— will provide a foundation for wellness.

Finally, health workers should use their voice to advocate for positive changes and promote a healthy work environment. Participating in workplace problem solving or even reporting changes that need to be made can empower the health worker.

More research needed

Dr. Murthy ends his advisory by recognizing that more research is needed to develop a national tool to assess, measure and respond to health worker burnout as needed. He also notes that further research on the many factors at play when it comes to health care worker burnout are needed to improve our understanding of the causes and consequences of burnout.

Read the U.S. Surgeon General’s advisory here.

Related reading:

Is burnout the correct term to use?

Physician burnout and the transition to nonclinical careers