Can organizing fix health care’s burnout problem for clinicians?

A series of high-profile nursing strikes and a recent call by Dr. Eric Topol for physicians to organize both touch on one of the clinical workforce’s most pressing issues: burnout. 

Roughly 8,200 nurses in four states went on strike last month, citing patient-to-nurse staffing ratios, wages and health benefits, and employee medical debt. The strikes, along with recent threats to strike at Kaiser Permanente and St. Luke’s Hospital, highlight the growing professional clout of nurses and other health care workers. 

“Executive pay is high, the role of private equity is growing and patient care seems to be at the bottom of the priority list,” Rebecca Givan, associate professor of labor studies and employment relations at Rutgers University, told me. “All those changes have led to massive frustration among nurses.”

Some nurses say they are so worried about inadequate staffing levels that they have considered quitting nursing. “Nursing isn't what it used to be,” Tiffany Mustapich, a registered nurse in Apache Junction, Ariz., wrote on LinkedIn this week. “Staffing is so poor that [the] safety of our patients becomes a real threat. I am so close to tears most days after racing around for nine miles daily that I am considering a career change altogether.”

When it comes to physicians, rising burnout rates are tied to the time-consuming documentation that comes from electronic health records and the ensuing lack of time spent directly with patients. 

A 2017 study found that family medicine doctors spend roughly six hours typing during an 11-hour workday. And to no surprise, most physicians resist their growing roles as data clerks. “Burnout has reached rampant levels among United States health care professionals, with over one-half of physicians and one-third of nurses experiencing symptoms,” Thomas Reith, a medical student in Milwaukee, Wis., wrote in a 2018 review on burnout. 

In his recent essay for The New Yorker, Topol argues for the creation of a new type of physician organization that would instead take on big issues like drug pricing and false health claims touted by celebrities rather than advocate for better reimbursement.  

“I feel strongly that physicians should organize,” Dr. Leroy Ounanian, medical director at the Beaver Medical Group in Redlands, Calif., wrote. “The myriad of government regulations have burdened the physician with up to three hours a day of burdensome administrative tasks to the detriment of face-to-face doctor-patient time. Busy doctors have stood by and let this happen. It is time to change.” 

Clinicians, what’s your take on this idea? What role should organizing have in today’s health care system? Is it an effective solution to solving burnout?

News I’m Watching

PHYSICIANS | Rural America’s medical crisis. The federal government now defines almost 80% of rural areas as “medically underserved,” reported The Washington Post. These regions account for 20% of the nation’s population and less than 10% of its medical professionals. Some doctors in these “medical deserts” provide care to residents spanning areas as large as 11,000 square miles. Experts fear the gap will worsen in coming years and exacerbate health issues, notably because doctors currently working in rural areas skew older than those based in cities. [By Andrew Murfett]

Editor's Pick: “This is why we need not only telehealth and digital tools to expand care delivery, but a systematic investment in the health care workforce of the future. Health and care are human rights, worthy of supporting as essential infrastructure.” - Dr. Amy Compton-Phillips, Providence St. Joseph Health

TECH | Verily hires former FDA commissioner Robert Califf. His appointment, as head of strategy and policy for Google Health and Verily Life Sciences, underscores the company’s rising health care ambitions, according to CNBC. It has hired a handful of notable physicians in recent years, including former Geisinger CEO Dr. David Feinberg and Dr. Jessica Mega. As tech giants like Amazon, Apple, Google, and Microsoft (LinkedIn’s parent company) push further into health care, they are increasingly snapping up senior-level talent to run their health operations. 

Editor's Pick: “It’s becoming increasingly more interesting to follow how the tech giants will influence the health care ecosystem.” - Dr. Christian Born Djurhuus, Novo Nordisk 

ECONOMICS | To cut costs for high-cost patients, hospitals as landlords. Denver Health is working with the local housing authority to turn an unused hospital building into apartments for seniors and homeless patients recently discharged from the hospital, according to Kaiser Health News. It can cost $200,000 to keep patients who are likely housing candidates in the hospital, compared to the $10,000 they estimate it will cost to house a patient for a year. Other hospitals are considering similar initiatives. 

Editor's Pick: “The health care environment continues to evolve — and there is no shortage of perspective on how to address access, costs, and industry economics. As Washington continues to debate solutions, industry players are increasingly innovative, forward-thinking, and action-oriented.” - Bryan Paull, senior health care banker

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Clinicians, what’s your take on this idea? What role should organizing have in today’s health care system? Is it an effective solution to solving burnout? Share your thoughts in the comments, using #TheCheckup.