Quiet Quitting: Why Is It Worse in Healthcare and What Do We Do About It?

Walking around the hospital at 4:00 PM on any given workday (other than in the ED, which is standing room only) most resembles a ghost town. Empty waiting rooms, the odd surgeon in their office, and support staff not at their desks are common. Has anyone been going to department meetings or conferences lately? Probably 50% attendance. This was not the case prepandemic. What's going on? Not only is our healthcare system crumbling as it relates to accessibility due to supply: demand mismatch, but the joie de vivre, esprit de corps, and overall culture within the healthcare workforce is waning too. Herein we describe why we’ve arrived at the quiet quitting stage of healthcare human resources and why we should be concerned about the future (and start recruiting, in earnest).

Some definitions and scope of the problem to start. Quiet quitting can be defined as “opting out of tasks beyond one's assigned duties and/or becoming less psychologically invested in work.” ¹ The bare minimum is completed, but the willingness to “engage in activities known as citizenship behaviours … staying late, showing up early, or attending non-mandatory meetings” ¹ has dropped off. Some have suggested it to be a generational problem, a work ethic problem, or a management problem.^1,2 How big a problem is it? Interestingly, a Gallup study found two-thirds of Canadian workers were quiet quitting. ³ Perhaps the low levels of unemployment in Canada enable this since employers are struggling to find labor? ⁴ In academics, some additional sequelae include less attendance at conferences, less participation in peer review, less committee membership, lack of mentoring, and reduced teaching. ⁵ Among others, reasons for introducing boundaries in one's work included burnout, the absence of financial incentives, no recognition, insufficient time, and lack of support. ⁵

Extrapolating this discussion to healthcare writ large, the phenomenon of quiet quitting can be considered a symptom of what was trending prepandemic, healthcare worker burnout. The endgame of the triad of depersonalization, exhaustion, and a reduced sense of professional efficacy is quiet quitting. This survival mechanism is the de facto result of a multitude of factors compounded by the pandemic. Prepandemic our hospitals/health systems were increasingly moving towards less physician autonomy via direct physician employment models of compensation. Although the perception of “quality” may have been the selling point for electronic health records, via their implementation physicians now laboriously spend more time screen-facing as opposed to patient-facing. The death knell came with the pandemic; physicians were essential front-line staff who may have been deployed to various parts of the hospital, and unlike many of their professional colleagues (accountants, lawyers, etc) who were able to work from home and where some semblance of work–life balance was possible, physicians could not. Perhaps quiet quitting is indeed worse in healthcare?

So how does this relate to us? Plastic surgeons may be in the < 1% of physicians who can choose to work on the private side of healthcare and perhaps control their practice (through the maintenance of practice autonomy, case mix selection, scheduling, hiring, etc) enough to avoid many aspects of health authority and/or academic medicine that contribute to burnout and quiet quitting. However, this practice type does not benefit the entirety of “Plastic and Reconstructive Surgery.” If all plastic surgeons retreated to this style of practice, our specialty as we know it would cease to exist over time as other disciplines would assume care of clinical problems (and this encroachment has begun) currently under our domain. Quiet quitting indeed!

So what do we do about it? Carrots are always better than sticks, so some increased engagement at the margin may be possible via financial incentivization and recognition opportunities. Nonetheless, ultimately the leadership in Canadian healthcare and government (many who also are in the two-thirds of quiet quitters) are going to have to find ways of recruiting more-and-more physicians into our system since a fractional full-time equivalent workforce of part-timers may be the only way forward. The future of healthcare as we know it (and that of our specialty) depends on it.