How to stop losing our workforce

As Americans anticipate a return to normalcy thanks to mass vaccinations, we cannot ignore the fact that our country’s doctors, nurses and first responders are showing signs they are not close to returning to “normal.”

In fact, more healthcare workers say they are becoming disillusioned with the medical profession and there are troubling signals that many will not return. Our workforce is experiencing a decreased sense of feeling valued and losing the sense of purpose and meaning in their work.

This fact is heartbreaking, especially because it hits home.

As brother-in-law of the late Dr. Lorna Breen, my wife (her sister) and I witnessed Lorna treat COVID patients around the clock with limited personal protective equipment during New York City’s first peak. An emergency physician on the front lines, Lorna contracted the virus herself before returning to work, to a relentless number of sick patients, with insufficient supplies, not enough oxygen, not enough beds and not enough help.

Overwhelmed, concerned that seeking mental health support would affect her medical licensing, and feeling she had nowhere to turn, Lorna took her life on April 26, 2020. Her death has become the symbolic canary indicating that our health system’s coal mine is a far more dangerous environment than we ever realized.

In response to Lorna’s death, we heard a collective cry for help from clinicians across the country, which served as the catalyst for Jennifer, my wife, and me to begin the Dr. Lorna Breen Heroes’ Foundation.

As CEO of the University of Virginia Physicians Group—the medical group practice of UVA Health, which comprises 1,200-plus physicians and advanced practice providers—Lorna’s death hit home even beyond a personal level. The stark reality is that our country is losing clinicians at a rapid pace. Before the pandemic, roughly 400 physicians died by suicide each year—nearly twice the national average. Similarly, nurses die at an alarmingly high rate of twice the national average.

Let that sink in for a moment. These professions, which are focused on healing, have one of the highest rates of suicide of any other profession.

Many practitioners simply leave medicine. Before the pandemic, HHS predicted a shortage of up to 90,000 physicians by 2025. Absent immediate meaningful action, this number will surely be greater than the pre-pandemic estimate. A recent survey found that 64% of U.S. physicians reported higher burnout since the pandemic started, 46% said they felt lonelier due to stay-at-home and social-distancing guidelines, 25% planned to retire because of their experiences treating COVID-19, and 12% stated intentions to leave medicine altogether. A recent poll from the American College of Emergency Physicians found that 73% of emergency department doctors were concerned about stigma seeking mental health support, with many reporting that kept them from seeking help.

So how do healthcare leaders deal with the fact that their workforce, many of whom—like Lorna—are deeply passionate about their profession, have become despondent? What is going so horribly wrong that clinicians feel their only response is to leave their careers—or worse, take their own lives?

The average healthcare worker is burdened by high-stakes decision-making, lack of work-life balance, an increasing administrative workload, loss of independence, increasing oversight, intense patient interactions, cultural and structural barriers to self-care, and pressure to adapt to new technologies quickly.

Last summer, I co-taught a course titled “Managing in a Pandemic: The Challenge of COVID-19” at the UVA Darden School of Business, studying the root causes of clinician burnout and potential solutions. My students came from a diverse array of industries, well beyond just healthcare.

A chief culprit of burnout unearthed in their various case studies, and reinforced through extensive polling, was the burden of complex and cumbersome electronic health record systems and other administrative inefficiencies. There is simply not enough time for clinicians to input the requisite data into these systems and focus on patient care. Instead of resting after a long shift, clinicians are bringing work home. Clinicians report spending on average one to two hours a night during what is known as “pajama time” (late evening and very early morning) inputting patient data.

Our health workforce’s well-being must be addressed by analyzing both the stressors and the subsequent treatment, or lack thereof, for trauma.

Nationwide, psychiatrists say they are seeing increasing numbers of health professionals who have had long bouts of untreated work-related depression, post-traumatic stress disorder, anxiety and insomnia. Traditionally, clinicians have dealt with the trauma of their experiences away from the workplace and alone. We saw this in my sister-in-law when Lorna often talked about the importance of maintaining a stiff upper lip.

Mitigating the problem of burnout and physician suicide is an issue that will require action on many fronts.

Congress, under the leadership of Sen. Tim Kaine (D-Va.) and Rep. Susan Wild (D-Pa.), recently included $140 million in the American Rescue Plan to support programs called for in the Lorna Breen Act that address suicide, burnout, and mental and behavioral health conditions among healthcare workers. This will establish ongoing support to identify and disseminate evidence-informed best practices long after the pandemic.

Leaders play a crucial role in helping to mitigate burnout and must meet the challenge by addressing both its causes and the immediate need to help professionals through peer support.

It starts with healthcare leaders assessing the current state of their workforce. The American Medical Association is offering no-cost surveys to help healthcare systems and practices monitor the impact COVID-19 has on front-line staff during this pandemic.

Leaders should survey their workforce and discuss results to analyze causes of stress and develop targeted strategies to minimize that stress. Strategies could include efforts to improve EHR satisfaction and the sense of engagement among providers through redesigned team care. EHR vendor reports could be used to target interventions/trainings where providers are working inefficiently compared to their peers.

Most importantly, providing confidential peer support to affected healthcare workers following a distressing clinical event can make a tremendous difference. Healthcare workers often want to talk to peers rather than mental health professionals due to stigma and access issues.

On April 21, the Dr. Lorna Breen Heroes’ Foundation announced its partnership with #FirstRespondersFirst—an initiative of the Harvard T.H. Chan School of Public Health, Thrive Global and the Creative Artist Agency—in collaboration with the American Medical Association, American Hospital Association, the American Nurses Foundation and the Schwartz Center for Compassionate Care.

The All In: Wellbeing First for Healthcare initiative is a call to action for leaders to create workplace cultures that prioritize health worker well-being. It will provide a road map to institutions to invest in and cultivate environments in which their workforce feels value and supported.

Across the country, the conversation about supporting the well-being of our current and future healthcare workforces is growing. Together with funds from the Lorna Breen Act, we hope that the All In campaign and the tools it will bring to our industry will help the industry make the systemic changes needed to fully support our caregivers.

Let’s face it, healthcare is one of the most emotionally and physically demanding fields out there. The old approach of telling clinicians to maintain a stiff upper lip and download meditation apps for stress relief is not the antidote. We don’t need stronger canaries. We need to redesign the coal mine.