Leaders of health care institutions may want to pay closer attention to burnout, as more environmental, social, and governance frameworks take shape.
Although virtually all physicians have experienced a sense of exhaustion in the context of unceasing demands from work, burnout is often ignored by health care leaders. Even if its presence is acknowledged, burnout tends to be misunderstood. Prior to the pandemic, lack of understanding on the part of health care organizations exacerbated the problem, as this left physicians and other health care workers feeling resentful and, in some cases, even betrayed. The onset of the pandemic amplified the problem, as the moral authority and guiding purposes of physicians were relentlessly attacked by “anti-vaxxers” and other propagandists who were intent on spreading misinformation and disinformation.
At least that is what we suspected. In order to determine whether or not this was the case, we conducted a literature review and harvested some of the more exasperated voices in social media.1 We found that there was a significant rise in burnout across health care providers. There were differences around gender, age, race, and other factors including specialty, which is known. Therefore, a need already exists to engage leaders in this challenge.
Unfortunately, there are common inadequate responses to burnout data and engagement studies by leaders that are making it worse.
“Not one more mandatory lecture on mindfulness!”
“We do not need more pizzas sent to the lounge!”
Does it matter that burnout exists? Yes. Its consequences are broad and deep. These include medical errors and premature departure from the profession. Interpersonally, burnout manifests as irritability and lack of full personal engagement at work, which harms teams and affects work quality. And, has COVID-19 had an impact? Also, an emphatic yes.2 Many worry about erosion in the quality of care because of the disengagement from the work (divided attention, fatigue from poor sleep, etc) and fears of harm both to the patients and to the profession itself, given the loss of so many skilled and experienced practitioners.
What Should be Done?
For those who have influence over physicians and within health care systems, we offer 3 recommendations:
1) It is important to recognize that the governance of organizations is on the threshold of significant change. The general theme relates to “sustainability”—ie, changing our way of working so that it aligns with values beyond profit such as diversity, equity, and inclusion (DEI) and preservation of the biosphere—humanity’s life-support system. Our future survival demands that we pay attention to things beyond “the bottom line,” and leaders in the world of accounting are taking notice.3 We need to attend not only to the biosphere that physically sustains us but to fairness and functionality. These problems relate directly to burnout because physicians and other health care workers need to feel that their work and work organizations contribute to the creation of a kind of world in which they would like to live4 (Table1).
Table. Magnitude of ESG's Impact1
2) The investment dollars and momentum for environmental, social, and governance (ESG) frameworks and sustainability are impressive. But that is not the whole story. We must pay attention to things that are both financially and psychologically material. Physicians and other health care workers should be encouraged to advocate for changes—and leaders should listen to them when they do so.
3) The third challenge entails recalling that the need to derive meaning is at the core of human psychology. Each situation is different, and each situation has its own meaning. As psychiatrist Viktor Frankl, MD, PhD, observed, “Between stimulus and response, there is a space. In that space is the power to choose our response. In our response lies our growth and our freedom.”5 Working toward a goal that has a value outside of oneself is psychologically material and alleviates the individual’s sense of insignificance. This challenge is particularly salient in light of the increasingly fractious and normless culture within which we find ourselves.
Dr Morrison is a clinical assistant professor of psychiatry at Rosalind Franklin University’s Chicago School of Medicine, and past president of the Academy of Organizational and Occupational Psychiatry. He is also a member of the Group for the Advancement of Psychiatry (GAP) Committee on Work & Organizations; the Institute for Fraud Prevention (IFP); and the Tomkins Institute of Applied Studies of Motivation, Emotion, and Cognition. He is a co-author of A.B.C.’s of Behavioral Forensics and Psychiatry of Workplace Dysfunction and a regular contributor to the B4G™ blog, bringingfreudtofraud.com. Dr Brown is a department psychiatrist at the Boston Police Department and immediate past president of the Academy of Organizational & Occupational Psychiatry. He is a co-author of Psychiatry of Workplace Dysfunction.
1. Couser GP, Morrison DE, Brown AO. Getting serious about people over profit: addressing burnout by establishing meaning and connection. Physician Leadersh J. 2022;9(4):29-35.
2. Galanis P, Vraka I, Fragkou D, et al. Nurses' burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis. J Adv Nurs. 2021;77(8):3286-3302.
3. Preber B. ESG investing needs standards to prevent fraud and greenwashing. Fortune. November 22, 2021. Accessed September 1, 2022. https://fortune.com/2021/11/22/esg-investing-needs-standards-to-prevent-fraud-and-greenwashing/
4. Brown AO. What makes work feel meaningful? Workosophy. May 21, 2022. Accessed September 1, 2022. https://workosophy.org/2022/05/21/what-makes-work-feel-meaningful/
5. Frankl VE. The Will to Meaning: Foundations and Applications of Logotherapy. World Pub. Co; 1969.