The Healthcare System’s Impact on the Mental Health of Healthcare Workers
In the medical field, it is well known that the patient’s health always comes first. However, the onset of the COVID-19 pandemic brought another crucial component of the healthcare setting to the forefront: healthcare professional’s wellbeing. It is important to recognize the important role healthcare professionals play within a patient’s treatment plan, and patient care and the greater community health would not exist without the dedication and tireless effort from our medical workers. This article seeks to shed more light onto the healthcare environment during and post-pandemic, its effects on physicians and healthcare workers, and the various measures that we can take to help ease their burdens.
The strain of the pandemic pushed the healthcare system to its limits and revealed deep flaws within its structure, one being professional burnout. Burnout is defined as “a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment” or purpose. (Source 1) This phenomenon has devastating effects on patient quality care - delay in care to patients, less attention with patients, etc - and is one of the many reasons why the healthcare system is observing a shortage in physicians and clinicians within the field. The CDC found that approximately 46% of health workers reported burnout by 2022 - towards the end of the pandemic - and that approximately 44% were planning on leaving healthcare in search for a new job. (Source 2) Healthcare workers who experienced harassment reported higher levels of anxiety (85%), depression (60%), and burnout (81%) compared to those who did not experience harassment. (Source 2) In addition, a closer look at burnout surveys have demonstrated gender differences in the appearance and prevalence of burnout symptoms - 51% female vs 43% male in 2015 and 48% female vs 37% in 2020. (Source 3)
In recent years, the greater attention towards healthcare professional health has spurred numerous investigations into the sources of burnout. In 2022, the U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce revealed that the increase in burnout observed in healthcare professionals is a result of multiple factors, a major one being administration. With the sudden shock of the pandemic, it forced the healthcare system to rapidly adapt to this new danger, and the existing system struggled to keep up with such drastic changes. The sudden influx of health information brought along with it “burdensome administrative tasks, requirements, and a complex array of information to synthesize,” drastically impacting the amount of time healthcare professionals could dedicate to patient care: a 2022 survey of over 1,500 physicians found that 61% felt they had little to no time or ability to “effectively address their patients’ social determinants”, a component of patient care physicians believe contribute to burnout rates. (Source 4)
Furthermore, the U.S. surgeon’s advisory outlined that the healthcare system’s lack of support or foundation to deal with a sudden influx of patients also greatly contributed to professional burnout. Healthcare workers became the frontline force against COVID-19, with hospitals saturated to the maximum with COVID-19 patients. As a result of the increased work demand, healthcare workers were forced to take on more and longer shifts with little to no rest time. As accessibility to proper PPE (personal protective equipment) quickly dwindled, healthcare workers were forced to put their own health - and the health of their families - at risk, and more and more professionals found themselves isolated at the hospital. Healthcare workers had to cope with the effects of misinformation, politicization of pandemic information, which resulted in workforce violence and unrealistic expectations of healthcare workers, not to mention a lack of acknowledgement or recognition of their sacrifices. (Source 4)
Although the COVID pandemic revealed and increased healthcare burnout rates, healthcare professional mental health has always been an issue within the system even before the pandemic. This begs the question, if such burnout and mental health rates have always been so high, why has this not been addressed sooner, and why are healthcare workers not seeking help? A study published in 2021 by the Association of American Medical Colleges seems to believe medical school education and physicians themselves are part of the problem. Mental health stigma among professionals has long been identified as part of medical school’s hidden curriculum, in which the medical field considers having a mental illness as a shame or weakness to keep hidden. The study found that primary reluctance to seek mental health treatment in physicians stemmed from this very stigma. (Source 5) Healthcare professionals, particularly physicians, are seen as godlike figures, both within the community and amongst themselves, and to admit to having a flaw would be akin to admitting imperfection.
One of the greatest fears healthcare professionals report is that having a mental illness and seeking help might put their careers in jeopardy, particularly with licensing boards and licensing renewals. As of 2017, studies have found that “only one-third of states have licensing and renewal questions that either inquire only about current impairment from mental health conditions or did not ask about mental health conditions altogether.” Furthermore, a study in 2007 reported that state licensing board executives believe that “a mental health diagnosis alone was sufficient to impose sanctions on health care providers.” Physicians with such sanctions would be scrutinized for their fitness to provide adequate patient care, and might even find their practices subjected to restrictions and limitations, despite the fact that there is no evidence currently that ties a physician’s mental health diagnosis to “impairment or increased risk of harm” to patient care. (Source 6) This threat of lack of autonomy and flexibility contributes in part to physicians’ habit of avoiding their own mental health.
To effectively tackle this crisis, there needs to be systematic change within our healthcare system, as well as in medical school education. However, in the meantime, there are several options that can be pursued to help alleviate the burden on healthcare professionals. The US Surgeon Advisory isolated key steps each population - healthcare workers, hospitals, community members, etc – could take to support healthcare mental health. From an administrative and systematic standpoint, there needs to be 1) a general programming in place that prioritizes physicians’ and other workers’ mental health and that provides them with the necessary resources to cope with their profession; 2) a reduction of administrative work for each healthcare worker; and 3) the elimination of punitive consequences for previous mental health problems. From a healthcare professional’s standpoint, members should create a welcoming community in which mental health is no longer viewed stigmatically; being comfortable enough to share stories with each other, feeling safe enough to seek help, and creating a pattern of healthy habits - eating right, exercising, socialising, etc. From a medical school standpoint, administrators, educators, and peers can help by revising a medical curriculum that recognizes the importance of mental health and that provides students with the tools and awareness to combat mental health early on within their careers.
From a community standpoint, the general community member can help contribute to the solution by prioritizing their own health, and following up with family members to do the same. For example, creating and maintaining consistent, close relationships with primary care physicians, as well as staying on top of their own health needs, e.g. exercise, nutrition, medication, etc. Taking these small steps help reduce medical workers’ workload and redistribute the patient care responsibility. Finally, community members can greatly help by recognizing and respecting their medical team’s attention and effort: be patient and be kind to a healthcare worker. A smile or even a few words of gratitude goes a long way, and helps healthcare professionals feel valued.
Sources:
1) Physician Burnout. Content last reviewed November 2023. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html
2) Centers for Disease Control and Prevention. (2023a, October 24). Health Workers Face A Mental Health Crisis. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/health-worker-mental-health/index.html#:~:text=Nearly%20half%20of%20health%20workers,up%20from%2032%25%20in%202018.&text=Nearly%20half%20of%20health%20workers%20intended%20to%20look%20for%20a,up%20from%2033%25%20in%202018.
3) Prevalence of Burnout in Healthcare workers and how to cope with burnout: De Hert S. (2020). Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local and regional anesthesia, 13, 171–183. https://doi.org/10.2147/LRA.S240564
4) US Surgeon General. (2022). Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce. Washington D.C.; U.S. Department of Health and Human Services. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
5) Brower, Kirk J. MD. Professional Stigma of Mental Health Issues: Physicians Are Both the Cause and Solution. Academic Medicine 96(5):p 635-640, May 2021. | DOI: 10.1097/ACM.0000000000003998
6) Mehta, S. S., & Edwards, M. L. (2018). Suffering in silence: Mental health stigma and physicians’ licensing fears. American Journal of Psychiatry Residents’ Journal, 13(11), 2–4. https://doi.org/10.1176/appi.ajp-rj.2018.131101
