United States Surgeon General Dr. Vivek Murthy has issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis.
Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout. The pandemic further exacerbated burnout for health workers, with many risking and sacrificing their own lives in the service of others while responding to a public health crisis.
The Surgeon General’s Advisory Addressing Health Worker Burnout lays out recommendations that the whole of society can take to address the factors underpinning burnout, improve health worker well-being, and strengthen the nation’s public health infrastructure.
Even before the COVID-19 pandemic, health workers were experiencing alarming levels of burnout – broadly defined as a state of emotional exhaustion, depersonalization, and low sense of personal accomplishment at work. Burnout can also be associated with mental health challenges such as anxiety and depression. In 2019, the National Academies of Medicine (NAM) reported that burnout had reached “crisis” levels – PDF, with up to 54% of nurses and physicians, and up to 60% of medical students and residents, suffering from burnout. The pandemic has since affected the mental health of health workers nationwide, with more than 50% of public health workers reporting symptoms of at least one mental health condition, such as anxiety, depression, and increased levels of post-traumatic stress disorder (PTSD).
Health worker burnout not only harms individual workers, but also threatens the nation’s public health infrastructure. Already, Americans are feeling the impact of staffing shortages across the health system in hospitals, primary care clinics, and public health departments. With over half a million registered nurses anticipated to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses across the U.S. Further, within the next five years, the country faces a projected national shortage of more than 3 million low-wage health workers – PDF. The Association of American Medical Colleges (AAMC) projects that physician demand will continue to grow faster than supply, leading to a shortage of up to 139,000 physicians – PDF by 2033, with the most alarming gaps occurring in primary care. Health worker burnout affects the public’s ability to get routine preventive and emergency care, and our country’s ability to respond to public health emergencies.
The Surgeon General’s Advisory Addressing Health Worker Burnout lays out recommendations for health care organizations, health insurers, health technology companies, policymakers, academic institutions, researchers, and communities to address health worker burnout and ensure their well-being – so that health workers can thrive and better answer their call as healers.
Topline recommendations to address burnout in the Surgeon General’s Advisory include:
Transform workplace culture to empower health workers and be responsive to their voices and needs.
We can begin by listening to health workers and seek their involvement to improve processes, workflows, and organizational culture.
Eliminate punitive policies for seeking mental health and substance use disorder care.
Ensure on-demand counseling and after work hours care are more accessible to health workers to promote and preserve their well-being.
Protect the health, safety, and well-being of all health workers.
Provide living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults for all health workers.
Ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve. This is critical to protect and sustain health workers and communities.
Organizations, communities, and policies must prioritize protecting health workers from workplace violence and ensure that they have sufficient personal protective equipment.
In a national survey – PDF among health workers in mid-2021, eight out of 10 experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.
Among 26,174 state, tribal, local, and territorial public health workers surveyed across the country during March-April 2021, nearly a quarter (23.4%) reported feeling bullied, threatened, or harassed at work.
Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.
One study showed that on average, for every 1 hour of direct patient care, a primary care provider will spend 2 hours a day on administrative tasks.That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and patients.
Prioritize social connection and community as a core value of the healthcare system.
This enhances job fulfillment, protects against loneliness and isolation, and ultimately improves the quality of patient care.
This includes peer and team-based models of care to strengthen collaboration and create opportunities for social support and community.
Invest in public health and our public health workforce.
Diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.
Surgeon General’s Advisories are public statements that call the American people’s attention to a public health issue and provide recommendations for how it should be addressed. Advisories are reserved for significant public health challenges that need the American people’s immediate attention.
Read Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory for Building a Thriving Health Workforce at www.surgeongeneral.gov/burnout.
The Department of Health and Human Services (HHS) has awarded the largest field strength in history for its health workforce loan repayment and scholarship programs thanks to a new $1.5 billion investment, including $1 billion in supplemental American Rescue Plan (ARP) funding and other mandatory and annual appropriations. More than 22,700 primary care clinicians now serve in the nation’s underserved tribal, rural and urban communities, including nearly 20,000 National Health Service Corps (NHSC) members, more than 2,500 Nurse Corps nurses, and approximately 250 awardees under a new program, the Substance Use Disorder Treatment and Recovery Loan Repayment Program. The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) oversees these critical programs.
“Thanks to the American Rescue Plan, we now have a record number of doctors, dentists, nurses and behavioral health providers treating more than 23.6 million patients in underserved communities,” said Health and Human Services Secretary Xavier Becerra. This demonstrates the Biden-Harris Administration’s commitment to advance health equity and ensure access to critical care across the country. We will continue to invest in our health workforce to make life-saving support within everyone’s reach.”
During the pandemic, thousands of NHSC and Nurse Corps health care providers have served in community health centers and hospitals across the country, caring for COVID-19 patients, supporting the mental health of their communities, administering COVID-19 tests and lifesaving treatments, and putting shots in arms.
Connecting Skilled Providers with Communities in Need
HRSA’s workforce programs directly improve the nation’s health equity by connecting skilled, committed providers with communities in need of care. National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery Loan Repayment Program members work in disciplines urgently needed in underserved tribal, rural and urban communities.
“Today’s awards, which represent a more than 27 percent increase in scholarship and loan repayment awards, support current and future providers who are committed to working in vulnerable communities,” said HRSA Acting Administrator Diana Espinosa. “These awards also provide critical support for health care sites that need to recruit and retain clinicians to meet increasing demand.”
Today’s field strength includes more than 11,900 members working in behavioral health disciplines, including psychiatrists, substance use disorder (SUD) counselors and psychiatric nurse practitioners.
Nurses represent the largest proportion of the field strength, numbering more than 8,000 across all scholarship and loan repayment programs. National Health Service Corps nurse practitioners make up its largest discipline at approximately 5,400 and fill a critical need for primary care where shortages exist throughout the country.
Currently, one-third of HRSA’s health workforce serves in a rural community where health care access may be especially limited or require patients to travel long distances to receive treatment.
More than half of all National Health Service Corps members serve in a community health center where patients are seen regardless of their ability to pay.
Providing Treatment and Care to Patients with Substance Use Disorders
Through dedicated funding for substance use disorder (SUD) professionals, HRSA is now supporting more than 4,500 providers treating opioid and other substance use disorder (SUD) issues in hard-hit communities. The Substance Use Disorder Treatment and Recovery Loan Repayment Program was launched in FY 2021 to create loan repayment opportunities for several new disciplines that support HHS’ comprehensive response to the opioid crisis, including clinical support staff and allied health professionals. In addition, this year’s NHSC awards include 1,500 substance use disorder (SUD) clinicians at approved treatment sites through the NHSC’s Substance Use Disorder and Rural Community loan repayment programs.
Investing in the Future Health Workforce
Through scholarship programs, HRSA is investing in the next generation of providers committed to working in communities most in need. The American Rescue Plan supplemental funding announced today allowed HRSA to award almost 1,200 scholarships — a four-fold increase — in the National Health Service Corps and nearly doubled the number of Nurse Corps scholarship awards to 544. In addition, new awards to 136 nurse faculty are supporting training for the future nursing workforce. This year’s scholarship recipients join 2,500 current National Health Service Corps medical, dental, and health professions students and residents and approximately 900 current Nurse Corps scholars preparing to serve in high-need communities across the country.
HRSA also recently awarded approximately $28.4 million in ARP funding to create new accredited teaching health center primary care residency programs in rural and underserved communities. To further support the expansion of primary care, the Administration plans to continue awarding the full $330 million in ARP funding for Teaching Health Center Graduate Medical Education in the coming months. This additional funding will support the expansion of the primary care physician and dental workforce in underserved communities through community-based primary care residency programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, or geriatrics. They are based in the communities they serve, with 80 percent located in community-based health centers, such as Health Center Program-funded health centers, Health Center Program look-alikes, rural health clinics, community mental health centers and tribal health centers.
Opportunities Now Open for Loan Repayment Programs
American Rescue Plan funding has made it possible for the National Health Service Corps to make a historic number of awards to all eligible applicants. Additional American Rescue Plan-funded awards are planned, with the next application cycles for the National Health Service Corps and Nurse Corpsloan repayment programs now accepting applications.
The National Health Service Corps helps medical, dental, and behavioral health clinicians pay off their student loan debt through scholarship and loan repayment programs in exchange for working in a Health Professional Shortage Area (HPSA). Nurse Corps participants commit to providing care in facilities with a critical shortage of nurses or as nurse faculty and help reduce the nursing shortage issues experienced across the nation. The Substance Use Disorder Treatment and Recovery Loan Repayment Program makes awards to clinicians, allied health professionals, and support staff who provide substance use disorder (SUD) treatment and recovery services to patients at treatment facilities located in a Mental Health Professional Shortage Area or in a county (or a municipality, if not contained within any county) with a threshold drug overdose death rate defined in statute.
Today’s funding announcement is directly responsive to the recommendations in the final report – PDFof the Presidential COVID-19 Health Equity Task Force.
, with up to 54% of nurses and physicians, and up to 60% of medical students and residents, suffering from burnout. The pandemic has since affected the mental health of health workers nationwide, with more than 50% of public health workers reporting symptoms of at least one mental health condition, such as anxiety, depression, and increased levels of post-traumatic stress disorder (PTSD).
among health workers in mid-2021, eight out of 10 experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.