Burden of Budgets, Deterioration of Morale

January 11, 2019

Our Doctors and Nurses are Tired: What Does That Mean for the State of U.S. Health Care?

While burnout is a problem in nearly every profession, it is especially concerning in health care because of the impact it can have on patient care. No patient wants to be treated by a burned out doctor or nurse.

It has become ever clear that morale is low among health care providers in the United States. A recent global survey of doctors, nurses, and care providers conducted by APCO Insight found that more than half of doctors and one-third of nurses report experiencing burnout. To make matters worse, outlook for the future of morale in the profession is not bright. In fact, providers believe that it will worsen—especially given ongoing changes to health care delivery and budgetary pressures.

What are the causes? One in four providers pointed to factors such as interactions with patients, their clinical autonomy, daily work load, and budgetary restrictions as causes of their low morale and feelings of burnout. The results of the survey demonstrate that doctors and nurses believe things have gotten worse in the last five years. More than half feel that their level of autonomy and workload have worsened, and nearly half believe their recognition has diminished in that time.

Physicians and nurses report that budgetary pressure directly impacts the amount and quality of time they spend with patients, as well as their ability to make their own medical decisions. Adding to this strain—they are growing more frustrated with payers and reimbursement issues and government control of health care.

Nearly all health care providers surveyed are concerned that budgetary pressure will affect the quality of health care in the United States. More than two-thirds worry that these budgetary pressures have an impact on time spent with patients, and nearly all report experiencing restrictions from third-party payment organizations. In short, the business requirements associated with practicing medicine have overtaken the art and science of caring for patients.

The results are clear: the health care system is putting pressure on providers that is weakening morale, increasing burnout, and—by their account—could jeopardize the quality of health care delivery. Alternative payment models are still in their early days, which may account for the tension providers feel with payers. The system is experiencing change and that can cause uncertainty.

What is unclear is if burnout will be relieved when the wrinkles are smoothed out of value-based care delivery. If burnout relief does not improve as health care reform efforts and payment models stabilize, there are serious implications for recruiting and retaining medical professionals in the United States. This unsettling implication also comes on the heels of millions of baby boomers aging into Medicare each year and increasing the demand not only for primary care, but for robust specialty care as well.

The problem is severe enough that U.S. Surgeon General called burnout an important national priority last year; the National Academy of Medicine has launched a working group to identify best practices in addressing burnout; and the American Hospital Association is partnering with leading hospital systems, including APCO client Novant Health, to raise awareness of, and offer solutions to, the problem.

Novant Health has the most comprehensive program in the nation to address physician and nurse burnout. Three year ago, they decided to address it head on by challenging themselves to become world class at taking care of their people so they can become world class at caring for their patients. Their program is focused on provider wellness, resiliency and leadership. It fosters the ability to generate new ideas, effectively engage with peers and patients and establishes behaviors that advance the mission of providing quality care for communities and patients.

American doctors and nurses are tired, and they are frustrated. We must pay close attention to this trend and mitigate it before we are left begging the question: where have all the health care professionals gone?

Find posts based on additional global research here

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APCO Alumna Claire Grant coauthored this post. 

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