Concerns Grow About Burnout and Stress in Health Care Workers
Faced with rising pressures to produce better outcomes at lower costs, the US health care system is making big changes in how it delivers care. The shift may be good for patients, but behind the scenes, health workers are burning out at alarming rates.
As the US health system continues to change, the prevalence of burnout is growing among physicians.
Photo by Sturti, courtesy iStockphoto.
“This is a significant public health problem, because it affects the functioning of all of our health systems,” Bryan Bohman, MD, senior advisor to the WellMD Center at Stanford Medicine, told The Nation’s Health. “Imagine a problem that affects quality of care, results in high turnover, reduces productivity, destroys people’s personal lives and increases the risk of suicide. That’s what burnout is, except it tends to work undercover.”
Health care is an inherently high-stress field, and its workers are reporting worsening rates of burnout, which is often characterized by emotional exhaustion, a low sense of personal fulfillment from work, and depersonalization, which makes it harder to connect with patients in meaningful ways.
In 2012, a landmark study in the Archives of Internal Medicine surveyed more than 7200 US physicians, finding that nearly half reported at least 1 symptom of burnout, putting doctors at higher risk than other US workers. In 2015, a study published in Mayo Clinic Proceedings found that burnout prevalence went up by 9% among US physicians between 2011 and 2014 and remained stable among other worker groups. In a 2018 report from Medscape that surveyed more than 15 000 physicians across 29 specialties, 42% reported burnout.
Beyond burnout, 39% of physicians report depression and about 400 physicians die by suicide each year, which is twice the rate of the general population. The suicide rate among women doctors is about 130% higher than among the general population, whereas men doctors experience a 40% higher rate. Nurses also report high rates of burnout and depression as well as high rates of posttraumatic stress disorder symptoms.
Advocates and researchers say that the data suggest there are systemic problems that demand health systems and policymakers more carefully consider how a rapidly changing work environment is driving providers out of the field and into mental distress.
—Kim Krisberg
To read the full story, visit http://thenationshealth.aphapublications.org/content/48/8/1.3.
Home Visits Helping to Reduce Asthma Disparities
As is the case for many big-city residents, New York City residents are regularly exposed to both indoor and outdoor allergens that can result in an asthma flare-up. A closer look at where asthma is most prevalent and symptoms are most severe reveals disparities rooted in socioeconomic inequity.
“We are all more or less breathing the same particulate matter, and the differential in terms of impact . . . really comes down much more to poverty,” Shoshanah Brown, MBA, MS, CEO of At-Home Integrated Relief for NYC, told The Nation’s Health.
Disparities in asthma are particularly notable when comparing potential asthma triggers in affluent and low-income households. The National Institutes of Health in November published findings in the Journal of Allergy and Clinical Immunology that showed widespread allergens in US homes, with significant differences in exposure levels by age, race, ethnicity, gender, and socioeconomic status. Furthermore, the study found higher rates of multiple exposures in homes that were older, mobile, rented, or located in rural areas.
Public health is tackling disparities in asthma severity and management by going to the source. Home visits, in which community health workers come to people’s homes to assess potential asthma triggers and offer holistic solutions to illness, can be especially beneficial to low-income families, who may lack the resources and support to make their homes conducive to easy breathing.
“A lot of research has been done showing that home-based education and interventions work,” Michelle Eakin, PhD, MA, associate professor of medicine in the Pulmonary and Critical Care Medicine Department at Johns Hopkins Medicine, told The Nation’s Health. Because “asthma has such an environmental component, it’s just one of those diseases that really lends itself nicely to home visits.”
—Julia Haskins
To read the full story, visit http://thenationshealth.aphapublications.org/content/48/8/1.1.