Fighting burnout

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

U.S. Surgeon General Vivek H. Murthy, MD, addressed health worker burnout and provided solutions in his advisory on building a thriving health workforce.


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.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

Is burnout the correct term to use?

Physician burnout and the transition to nonclinical careers


  1. Donna DeFilippo

    How about less administration and more time with patients?? How about not tying our pay to production?? How about not threatening us with our job loss if we don’t measure up to projected and impossible goals set by administrators who are not doctors and have no clue?? How about backing up the physicians when patient are very abusive verbally and physically??

    1. Jane Datinguinoo

      Hello Dr. DeFilippo! Yes absolutely agree. My apologies for not including these key points in this summary. In the full advisory, Dr Murthy does discuss that inefficient work processes including burdensome administrative requirements contribute to health worker burnout. To your point, he suggests optimizing technology to increase time between health workers and patients by simplifying EMR work flows and providing work schedule flexibility and autonomy. Interestingly, Dr. Murthy shares how Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program asked for employee feedback on their EMR system to eliminate unnecessary steps which resulted in 1,700 nursing hours saved per month. Regarding your discussion about job loss threats, setting impossible goals, and protecting physicians from abusive situations, Dr. Murthy advises health care organizations to use evidence-based policies, programs, and solutions to address these issues and provide safer working environments for all health workers. One of his action items explicitly states, “Establish a zero-tolerance policy for violence, and institute a workplace violence prevention program to address violence and abuse in the workplace (this includes physical, verbal, and/or cyber-based).” While I do recognize the systemic pressures that physicians face, I haven’t felt the weight on my shoulders just yet as a medical student. I truly appreciate learning how to navigate medicine from the attendings & residents.

  2. Dr. Heidi Levine

    Dr. DeFilippo is correct. Studies show that physicians who spend at least 20% of their time in an area of interest are more engaged. Clerical burdens and the EHR have done the opposite of what they were supposed to do, increase efficiency. Physicians need to feel valued at work and should be included in administrative decisions that effect them.

  3. JoBeth Augustyniak

    Moral injury is the better term than “burnout”. In our current system, physicians are required to meet more and more demands, from patients and administration, including increased patient panel size. Physicians feel powerless and discouraged when they cannot care for patients the way they know they should/want to because of these burdens. We have no autonomy, no say in how processes work. This is not sustainable.
    There are note enough primary care physicians, leading to increased referrals because physicians simply do not have time to address everything that they were trained to address in the very short visits. This increases patient and physician frustration.
    Increased payments and/or monetary support to encourage more medical students to choose a primary care specialty could relieve some of this burden. And, I am not referring to the difficult to get loan forgiveness programs. Simplifying all the documentation requirements and the ridiculous prior authorizations, constant changes in formularies, would benefit as well.

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