Last week, President Biden signed into law the Dr. Lorna Breen Healthcare Provider Protection Act. Breen’s death by suicide was a sentinel moment in the early phase of the pandemic, a stark indication that our health care workforce was bearing a great burden of the pandemic’s onslaught.
The new law requires the Department of Health and Human Services (HHS) to award grants to hospitals, medical professional associations, and other health care entities for programs to promote mental health and resiliency among health care providers. In addition, HHS may direct resources toward relevant mental and behavioral health training for health care students, residents or professionals.
The statistics are alarming: 78 percent of physicians surveyed have experienced some signs of burnout. Physicians are more than twice as likely to die by suicide than the general population and are almost twice as likely (40.2 percent to 23.2 percent) to be dissatisfied with their work-life balance than the average working American adult. Each year, roughly 400 U.S. physicians took their own life. And worse, dissatisfaction is affecting our trainees even before they get their careers off the ground.
Among medical residents, 25 percent said that if they were to begin their education again, they would choose a field other than medicine. Medical students rate of depression is 15 to 30 percent higher than that of the general public.
But now that the Breen Act is law, it’s time to consider an important question: Is what health care workers are experiencing solely, or even mostly, a mental health problem?
The components of the Lorna Breen Act would leave some with the impression that, for most, it is.
I would argue that most health care worker dissatisfaction is actually driven by external forces, such as the profit over purpose culture of modern medicine, as well as the tyranny of the electronic medical record which has done more to disassociate the provider from her mission than anything that has come along in medicine. Perhaps most importantly driving dissatisfaction is the moral injury that comes when it becomes clear that the values and ethics of colleagues, leaders and health care institutions do not align with those interested in doing what is best for patients.
That’s not burnout — it’s an appropriate expression of one’s humanity. The most overwhelming feature of health care provider unhappiness (let’s call it that for now) is disillusionment. Sadly, health care workers, generally an idealistic group of people (in the best possible way), are being let down by the very system and hospital culture in which they are asked to perform their life-saving work, and they are asked to do so even in the most trying circumstances. Like a global pandemic, for instance.
The term physician or nurse “burnout” to me conjures up images of emotional wreckage, a person huddled in the corner of a room, a shell of his or her former self. With regard specifically to health care workers, emotional wreckage is often a feature of what has been commonly called “burnout” and being a shell of one’s former self is common in these instances (I should know: as a physician, I experienced the syndrome and was in fact a shell of my former self). But there is so much more in play, as hard as we try to aptly describe what is happening with a catch-all phrase like burnout.
The health care “system” — not much of a system at all but rather a vast, fragmented for-profit enterprise — is failing our nation’s clinicians and is no longer defensible. So, when we call what’s happening “burnout,” the solutions put forth will tend to focus only on repairing the individual and not the system, a strategy that I believe is doomed to fail.
The script should be flipped — focus on the external causes of dissatisfaction and the provider will be fine, at least in the vast majority of the cases, shifting the burden away from an individual’s responsibility to find and implement solutions for a problem that he or she likely didn’t create and can’t control. Based on what I have seen and experienced, our health care workers are less “burned out” than “burning mad” at a work environment that is untenable.
“Burnout,” properly termed disillusionment, does not take a pre-existing mental issue to develop, but it surely can lead to one when one considers what our health care force is asked to do, whether it’s the nurse who is asked to care for too many patients at one time, the doctor who has to spend her time fighting with insurance companies to render the care that she knows her patients need. Or the constant need to tend to the electronic health record, often leading to an exhausted medical workforce interacting with the computer during the day far more than they do with their patients, and at night when they get home far more than they do with their family. If that doesn’t necessarily lead to mental health issues, I don’t know what will.
So, where do we go from here? First, let’s applaud the passage of the Breen Act and Dr. Breen’s family’s courageous advocacy after her death.
But second — and this is important — let’s call the syndrome what it is for most workers, because if we can’t label it accurately, we can’t fix it. A first step would be to stop calling it burnout.
Third, we need to address the external problems in medicine that are causing health care workers to leave the hospital in droves and those that remain to be actively looking for an exit ramp.
All of us will be patients sooner or later, and, trust me, we want — no, need — the health care environment to change. With the renewed effort to address physician and nurse wellness brought on by the pandemic, we can make the work environment better for our frontline workers, not just to get us through the current crisis, but to sustain us afterward.
If that doesn’t happen, there won’t be anyone left to take care of us.
David Weill, M.D., is the former director of the heart and lung transplant program at Stanford University. He’s also the author of “Exhale: Hope, Healing, and a Life in Transplant.”