James' World 2

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Last year, a 28-year-old E.R. nurse named Tristin Smith took her own life. Her father found a note among her effects, titled Letter to My Abuser. “Ever since I was young, I expressed interest in healthcare,” she wrote. “I gave my heart, my body, and my mind to you.” But as “unnecessary” support staff was cut, the quality of care plummeted. Requests for more resources were met with online training sessions telling nurses “to just smile more and be friendlier to patients.” Instead of receiving the “support we deserve, we get a pizza party and free pens for the ‘healthcare heroes.’” Her disillusionment deepened: “You use and exploit us to line your pockets, using the common citizen’s money for overpriced healthcare.” For me, as an emergency physician, Tristin’s words ring with startling clarity. I know firsthand the challenges of constantly doing more with less. I recognize the surreal disorientation of having real needs met with empty gestures, like free pens or a hospital potato. I have felt that the systems in which I work no longer value me, or the patients whom I treat. But the most astute aspect of Tristin’s letter is the culprit she points to for these problems: an obscenely expensive health care system that values profit above all else, to the detriment of patients and providers alike.

We in the medical profession are all, to varying degrees, like Tristin. A survey of over 12,000 physicians released last month by the American Medical Association found that 48 percent of them had at least one symptom of burnout. Another survey last month found that nearly two-thirds of physicians would not recommend a career in medicine to their children. It’s not just physicians, of course: Health care providers of all kinds are burned out and considering leaving their jobs. “That’s a disaster for a system that is already struggling to fill critical roles,” said L. Casey Chosewood, an official at the National Institute for Occupational Safety and Health, NIOSH.

This is a massive problem not only for our health care system but for every single person in America who depends on it. Burnout is associated with medical errors and malpractice litigation; hospital-acquired infections; and anxiety, depression, and suicidality among providers. Physicians with burnout are twice as likely to leave their jobs and five times more likely to quit medicine entirely, at an annual cost as high as $6 billion. For nurses, the annual cost of turnover related to burnout is estimated at $9 billion.

The pandemic clearly made burnout worse, for obvious reasons. But things aren’t improving, even though the acute crisis of Covid has passed. Why not?

There was a time when remedies for burnout in health care emphasized resilience and individual action. In 2021, at the height of the delta variant of Covid, I assessed my own level of burnout using a standard metric, the Maslach Burnout Inventory. No surprise: I was suffering from significant burnout. The MBI offered unhelpful suggestions like “step up self-care practices” and “attend presentations, meetings, and workshops on burnout.”

Fortunately, this attitude seems to be evolving. Last year, the U.S. surgeon general published a report that called for “systems-oriented, organizational-level solutions” over “individual-level support.” In November, NIOSH launched a new campaign to address burnout called Impact Wellbeing. Chosewood, whose office will coordinate the effort, acknowledged that resilience training was like a “Band-Aid on a gaping wound.” Instead, the campaign promises to help hospital leaders “address the systemic factors at the root of staff burnout.”

Directing attention toward the health care system itself is progress. But what are the systemic factors at the root of burnout? According to the National Academy of Medicine, they include excessive workload, longer working hours, inadequate staffing, insufficient time with patients, and high administrative task burden. I can attest that all of these contribute to burnout. However, these factors are only symptoms of a larger, more central problem.

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Gabrielle Lurie/The San Francisco Chronicle/Getty Images

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