Viewpoint: Dr. Ahmed Kutty – Burnout in the health care workforce

By DR. AHMED KUTTY

For the Ledger-Transcript

Published: 07-09-2024 11:58 AM

A recent paper in the Journal of the American Medical Association (JAMA) dated June 25, reporting on a study in 2020, says one in five physicians in the United States intended to quit practice in the next two years, and a follow-up survey in 2021 showed a grimmer picture, with 40% voicing similar intentions.

Dr. Mark Lenzer, a coauthor and director of the Institute For Professional Worklife at Hennepin Healthcare in Minneapolis, is quoted as saying, “With the way medicine is practiced today it is just barely sustainable.”

The title of the JAMA report under is “To Fix Burnout, New Initiatives Go Beyond Worker Resilience and Put Onus on Health Systems.” It accurately reports the impact COVID-19 pandemic had on physicians, nurses and other professionals comprising the health care workforce. However, Dr John Howard, Director of the National Institute for Occupational Safety and Health (NIOSH) says, “These problems did not arise overnight.”

Stigma associated with mental health and institutional barriers impede clinicians from seeking help when they need it most. The electronic health record (EHR) is cited as the biggest driving force. In March 2022, Congress passed the Dr Lorna Breen Healthcare Protection Act, named after an emergency medicine doctor who died of suicide during the pandemic.

The NIOSH released a National Plan for Health Workforce, added on to the Change Maker Campaign by the National Academy of Medicine (NAM). The Lorna Breen Heroes Foundation published their “Impact Wellbeing Guide.” These collaborative efforts are funded from the American Rescue Plan Act of 2021.

A report by Definitive Healthcare, a health care tech company, last September found 145,213 health care workers to have left practice from 2021 through 2022. Nearly half of them were doctors; 35,000 nurse practitioners walked away, and thousands of physician-assistants, physical therapists and medical social workers have joined the exodus.

While a critical shift from an individual-based efforts at self care to a an institutional and system-wide approach for the well-being of these precious resources is recommended to stem the tide, the guide’s coauthors, Drs. Stefanie Simmons and John Howard recommend decreasing excessive workload as one of the seven actionable measures.

Conspicuously absent  is naming, let alone attempting to address issues at the core of the rot – loss of professional autonomy, a deep fountain of pride in the work, mostly joyful acceptance of the long hours and disrupted work-life balance by the folks entering careers in health care dating back to more than a century and a deserved compensation level. All have upended by the advent of the world ruled by humongous and powerful commercial enterprises, decimating a once-revered profession, beginning in the late 1970s.

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Once the doctors, nurses, pharmacists and other health care professionals can stop feeling like a cog in the giant wheel of the profit-making machine, it is still not too late to expect resiliency towards healing and capacity to bounce back as proud, dedicated and competent caregivers individually and within a team at the institutional level.

Policy-makers, private institutional leaders, professional societies and publicly funded research organizations like the National Institutes of Health will be well-served if the corrosive effects of putting profits over patients is firmly grasped and tackled vigorously, head-on..

Otherwise the current situation is unsustainable, indeed.

Engaged and well-informed citizenry, confronting the formidable forces of profit-driven conglomerates like Big Insurance, Big Hospitals and Big Pharma, will find them intimidating. Margaret Mead said, “Never doubt that a small group of thoughtful committed citizens can change the world; indeed it is the only thing that ever has.”

Small yet impactful steps could start with joining a campaign to protect traditional Medicare from the ravages of the pervasive and pernicious consequences of Medicare Advantage, a profiteering empire which now has enrolled 51% of our eligible seniors, enabled by the Medicare Modernization Act of 2003 that opened the floodgates for the privateers. Unless stopped, Medicare as we have known since its inception in 1965 will cease to exist by the end of the decade or will barely survive as a skeleton of the once-popular and widely-acclaimed program of public funding of health care for seniors and the disabled in our country.

Educating seniors nearing Medicare age on the pitfalls of Medicare Advantage is a baby step on this journey.

To agitate for extending the benefits of price regulation of essential drugs like insulin, lately capped at $35 for Medicare beneficiaries, to all Americans is a doable intermediate-term task. Fighting for expanding Medicaid coverage in all states and for adequate insurance coverage for opioid and other substance-use disorders are areas of struggle eminently worthy of joining the battle for.

There is evidence that efforts by large swaths of the public striving to secure health care justice will be conducive toward mitigating the scourge of despair-induced burnout among our world-class health care professionals. As Frederick Douglass said, “Power concedes nothing without a demand. It never has and it never will.”

Dr. Ahmed Kutty of Peterborough is a former health care professional with 50 years of experience.