The Doctor Shortage Crisis

Maybe you've felt it: getting an appointment with our healthcare providers is increasingly difficult. When we finally do get in, the visits feel rushed and incomplete. The care we receive is sometimes even substandard. The cause? We just don’t have enough providers.

Burnout, a reaction to prolonged stress including emotional exhaustion, cynicism, and a lack of work satisfaction, was a problem before 2020, but the pandemic made things much worse.

By late 2021, burnout reached the highest recorded levels: 60 percent of physicians and advanced practice clinicians reported burnout, and over 40 percent planned to leave their professions. Now people are dropping out of healthcare all over the country in droves.

In my home state of New Mexico, a third of the doctors left between 2017 and 2021.

The more people leave the healthcare profession, the less support the remaining providers have. The remaining workers are burdened with higher and higher productivity requirements and long hours. It’s a downward spiral from there.

“You can’t take the canary, teach it to be more resilient, and stick it back in the same coal mine and expect it to survive,” she said. “You need to focus on the coal mine,” wrote Brigit Kuehn, quoting Heather Farley, MD.

Anti-burnout measures need to be implemented at the systems level–meaning our hospitals and other healthcare workplaces need to change and fast.

How do we fix it? There are already great blueprints to guide us.

An excellent recent news article in JAMA argued the path to recovery is already known. The National Plan for Health Workforce Well-Being, published by the National Academy of Medicine (NAM), presents guidelines–based on almost a decade of research–on how systems should be changing.

This plan lays out seven key priority areas that healthcare systems should be focusing efforts on to reduce burnout and retain staff:

1. Creating positive work and learning environments

2. Investing in assessment and research

3. Supporting mental health

4. Addressing regulatory and policy barriers

5. Using effective technology

6. Adopting well-being as an institutional value

7. Maintaining a diverse, inclusive healthcare workforce

Each area is broken down into action items and goals within the meat of the plan.

According to the document and experts interviewed in the aforementioned news article, creating positive work and learning environments can be accomplished by setting reasonable productivity expectations, keeping workers safe, providing adequate support, reducing administrative burdens, and providing mechanisms for reporting and responding to discriminatory behavior.

To support worker mental health, there need to be systemic efforts to eliminate barriers–including punitive responses for seeking help—to those who desire mental health or substance use care. Finally, the environments must empower workers to speak out about and address problems, giving them a voice in their work schedules and job-related decision-making.

The plan even guides who should be responsible for implementing these goals, and systems are encouraged to create appropriate wellness officer positions.

Other important documents, such as the Surgeon General’s Advisory on Building a Thriving Health Workforce, have similar suggestions. According to the news article, some healthcare systems have even started to make these changes. But institutions that have undergone the necessary massive cultural shifts are few and far between.

What’s going to motivate our healthcare systems to implement them?

If institutions do not address staffing crises, the lack of supportive leadership, long work hours, excessive demands, inflexibility, and the need to redesign health care occupations, society will pay the price,

Briget Kuehn wrote, again, summarizing L. Casey Chosewood’s conclusions during the interview.

Burnout Essential Reads

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Research shows that preventing burnout is essential for society’s health, and we already have guidelines on how to do so. So how do we get our institutions to put this first? The majority of our institutions are already strapped and struggling to stay afloat. So how can we motivate leaders to prioritize these efforts in the face of the hundreds of other crises landing on their desks each week?

Implementing these well-being plans promise long-term financial benefit to the institutions. Healthier work environments will make retaining and recruiting higher-quality staff easier and will provide a competitive advantage. Administrators can “tap internal health systems“ existing resources such as safety management offices, wellness teams, human resources, patient safety, and worker’s compensation teams to minimize cost. But, although sustaining a healthy work environment may prove financial benefits long-term, implementing these changes could be costly, and finances may be a real barrier for some institutions.

Regulation to hold healthcare systems accountable will be essential. Unfortunately, no current mechanism exists for the NAM to enforce its recommendations. But we can start working legislatively to write and pass laws to support regulation. Such legislation could require that institutions follow through with key components of the NAM’s plan and regularly track worker wellness (using a variety of excellent, already developed measures), for example. Also, tax money could be allotted to support necessary transformation within systems, such as temporarily funding wellness officer positions or other necessary components to incentivize change.

Finally, legislation protecting healthcare workers from being reported to the licensing board if they access mental health care, as passed in Delaware, is desperately needed in the rest of our country, too. The national Dr. Lorna Breen Health Care Provider Protection Act also supports clinician mental health and could be added to and adapted as needed.

Conclusion

Burnout is a problem for everyone. It’s not just providers that are affected. We all are. It will only worsen if we don’t act fast, and changing our work environments will be the cornerstone. Thanks to NAM, we’ve got excellent evidence-based guidelines showing us the way. Legislation to facilitate the implementation of anti-burnout changes within institutions could be the important next step to keeping our healthcare systems afloat. We should push for it.