I Quit!

Even before the Covid 19 pandemic, surveys of over 20,000 physicians reported in Medscape have consistently found that about 45% of physicians have one or more symptoms of burnout and about one in 10 were considering leaving their job.

A recent study from the Mayo Clinic has confirmed the devastating effect of the pandemic on healthcare workers. They devised a survey tool, “The Coping with the Covid Survey,” which was administered to physicians, nurses and advanced practitioners. It measured the effects of overall stress (Covid stress), fear, burnout, anxiety, work overload, sense of meaning and purpose and feeling valued by one’s organization.

Then they asked the questions, “What is the likelihood that you would leave your practice within two years?” and “What is the likelihood that you would reduce your clinical work hours over the next 12 months?” They surveyed over 20,000 healthcare providers. Among physicians, about 24% indicated they plan to leave the practice within two years and 31% said they intended to reduce clinical hours the next 12 months, which is more than double the normal rate.

If I were a cynical healthcare administrator I might think, “No problem. We’ll just replace those expensive physicians with PAs, NPs and other less expensive advanced care practitioners.” Other than the quality of care issues involved, the Mayo Clinic survey should not only sound a warning, but there should be a flashing red light! Among nurses surveyed, a whopping 40% said they plan to leave practice within two years and 34% said they intended to reduce clinical work hours. Typically under normal circumstances about 1/3 of physicians and nurses who intend to leave practice actually do. Under these highly unusual and stressful circumstances, the percentage is anyone’s guess.

So what is a healthcare administrator or executive to do? You can’t deliver healthcare without healthcare providers. Unfortunately, the response of many healthcare executives in the face of decreased revenues due to decreased elective procedures during the pandemic has been to cut staffing or cut pay. The consequence of those decisions is a further increase in stress and work overload for physicians, nurses and other healthcare practitioners. Clearly, this shortsighted strategy is not going to work.

Since burnout has been shown in multiple studies to be associated with reducing work hours or intention to leave practice, reducing burnout needs to be a high priority. Although making mental health care, coaching and stress reduction programs available may help individual practitioners, it is the systemic causes of burnout which are the largest factor and most urgently need addressing. The systemic factors have long been known to include lack of support for clinical staff, lack of flexibility in work hours, work overload and lack of practice efficiency. There needs to be significant investment of attention, time and money to address these systemic factors.

Loss of satisfaction, meaning and purpose in one’s healthcare career also contributes significantly to burnout. In addition, this survey specifically measured feeling valued by one’s organization and found that feeling valued decreased the likelihood of intent to reduce hours or leave the job. Organizations can use tangible measures such as providing childcare or eldercare or improving the quality of training, but it is the intangible qualities of leadership that can make practitioners feel valued.

There needs to be strengthening of physician leadership, nursing leadership and executive leadership, with an emphasis on emotional intelligence and team building. Organizational culture needs to shift from a profit centered to a people centered approach. There are a variety of measures which have proven successful including team coaching and implementation of Lean management. Regardless of the approach taken, it is clear that the commitment to a more people centered culture has to start at the top.

Sinsky C, et. al., Mayo Clin Proc Inn Qual Out 2021;5(6):1165-1173