Q&A: Surgeon general warns of ‘crisis’ level health care burnout

ATLANTA — During a visit to Grady Memorial Hospital Thursday, U.S. Surgeon General Dr. Vivek Murthy sounded the alarm over burnout among health care workers reeling after more than two years of caring for patients suffering from an ever-changing and often mystifying virus.

The physical and emotional toll has been immense, and many health care workers are quitting their jobs.

Murthy said the strain brought by COVID also explains why 1 in 5 doctors and 2 in 5 nurses say they plan to leave the profession. Murthy said he hears the word “trauma” used, again and again, to describe the past two years for health workers.

“I think this is not just about supporting the health workforce to make health care more available. It’s a question of living up to our moral responsibility to take care of people who have been there to take care of us,” said Murthy during an interview with The Atlanta Journal-Constitution. “They are telling us in conversation after conversation, survey after survey, that they are in crisis, and the question is, what are we going to do about it?”

His visit to Grady and Morehouse School of Medicine on Thursday was part of several stops he’s making around the nation this week to bring more attention to the loss of essential health workers ranging from doctors and nurses to lower-wage nursing home employees and nursing assistants.

The administration is calling on hospitals and medical schools to take steps to protect the mental wellbeing of health care workers; that includes offering counseling, reducing administrative burdens and promoting worker safety on the job.

Unless changes are made, Murthy said, the country will be less prepared for future public health emergencies and “we will send a message to millions of health care workers that their suffering does not matter.”

Already, Americans are feeling the impact of staffing shortages across the health system in hospitals, primary care clinics, and public health departments. Murthy released a report Monday titled “Addressing Health Worker Burnout,” which warns of the extent of projected shortages. With over half-a-million registered nurses anticipated to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the urgent need for 1.1 million new registered nurses across the U.S.

Murthy also warned of a coming shortage of 3 million “essential low-wage workers,” which includes nursing assistants, home health aides, and housekeepers, in the next five years and a shortage of doctors that could reach 139,000 by 2033.

A spokesperson for Grady said they have a shortage of more than 200 nurses along with other critical shortfalls in other essential jobs like housekeeping and public safety officers.

“Wave after wave of COVID has increased the demands on health workers, but also, and this stat surprised and shocked me, was eight out of 10 healthcare workers have experienced physical or verbal abuse during the pandemic, and these are people coming to work to help people and they’re getting literally physically or verbally attacked at work,” Murthy said.

Grady resident surgeons, Dr. Goeto Dantes and Dr. Dirir Abdullahi, both of whom had a chance to meet with Murthy, praised his work to bring attention to the intense emotional and physical toll of the pandemic.

Abdullahi, 28, started his residency during the early days of the pandemic. He said it was “insurmountably difficult” to be forced to keep family members apart from their dying loved ones. “This (was) my first year of residency in the surgical intensive care unit. And I couldn’t let a single family member come in when I was pronouncing someone for their time of death. And that takes a toll....”

Dantes said for stressed workers, little things like a coffee card or the administrative staff making rounds and handing out candy can make a difference.

But it’s not enough. He acknowledged expanded mental health services at Grady and strong program support, but said more resources are needed for healthcare workers to help them manage the highs and lows of medical care so they can “recover and continue on.”

In southwest Georgia, the site of some of the state’s earliest and worst pandemic waves, Phoebe Putney Health System last week publicized a Mental Health Awareness Week for its own staff. Workers were invited to relax with service dogs and take part in a meditation session, in addition to other techniques the hospital system has begun offering regularly to boost staff mental wellness.

The pandemic “is unlike anything any of us in nursing or healthcare have ever experienced,” said Evelyn Olenick, Chief Nursing Officer at the system’s flagship Phoebe Putney Memorial Hospital.

“There was a shortage (of health workers) before the pandemic, but what the pandemic did … it just widened and exacerbated that gap,” Olenick said.

During the long periods of time when hospitals restricted visitors for critically ill patients, nurses stood in for friends and family members. “The nurse became everything — everything — to the patient. It almost looked like they were surrogate family members,” Olenick said. “I know there were nurses that have probably experienced more deaths in that period of time than over their careers. And that is a significant burden.”

Olenick has been a registered nurse for 46 years, and at Phoebe for seven. She is glad to see the resources Phoebe is putting towards the mental health of its workers.

“If they’re feeling so overwhelmed, so anxious, if they have ongoing degrees of compassion fatigue and (it’s) leading to burnout, they’re not going to want to stay in the profession.”

And visits with the service dogs last week were a hit. “The people that came down to see the dogs…you could tell the staff were joyful, they were happy.”

Q&A with U.S. Surgeon General Dr. Vivek Murthy

Murthy’s responses are edited for clarity and length.

Q: You talked about the need to address health misinformation which is draining health care workers.

A: I remember one nurse telling me that she was caring for a patient who had severe COVID and had to get intubated. And when she tried to have a conversation with the patient, the patient got very angry at her and said, ‘Don’t tell me that. COVID isn’t real. Why are you intubating me? Are you trying to hurt me?’ The patient has absorbed the misinformation from someone else. So heartbreaking. The nurse recognizes the patient’s life is on the line and needs lifesaving care and it turns into a verbal altercation.

Healthcare workers are some of the most resilient, thoughtful people but everyone has their limits.

Q: Where do you think we are in the pandemic?

A: I think the good news is that we have gotten to a place where we are still seeing this decoupling between cases and deaths (when case numbers shoot up more steeply than hospitalizations and deaths). It doesn’t mean that people aren’t still dying from COVID — they are, and too many people each day — but during past waves when we saw cases increase to this level, we would have seen a much greater increase in deaths. Why is this decoupling happening? I think it’s two things. I think it’s it is vaccines and I think it’s also treatments. We know Paxlovid as a treatment can be very helpful in reducing your risk of hospitalization and death. And so, we want people, especially those who are at higher risk, to talk to their doctor, go to covid.gov and we have a list of places where test-to-treat options are available.

I mean, I think that I can certainly sympathize who people who over the last two years have had to I’ve had to contend with the fact that we’ve been learning about this virus along the way and as we learn, guidance shifts and changes and well from a scientific process, that’s understandable. And that’s how things go. I recognize that can be challenging, right? If you’re out there in the public trying to figure out the simple question of what do we do?

Q: How important is tracking COVID cases today when so many people take home tests?

A: Cases matter for at least two reasons. One is because we know that even people who are healthy and at low risk could transmit infection to somebody who is high risk. And because of long COVID.

What measures work to reduce the likelihood of getting long COVID? We do have some data that shows that getting vaccinated could help reduce your risk of getting long COVID. Does it eliminate it? No. But the other question we want to answer also is what effect treatments have on your risk of long COVID. There are a lot of questions we still have to answer which is why I think it still bears being cautious when it comes to preventing yourself and others from getting COVID, because we don’t know who is ultimately going to end up with a condition like long COVID.And finally, this is why I think it’s also important for people, and for us as a country to keep the tools that we have to reduce spread readily available for people and those include high-quality masks and we need to make sure rapid home COVID tests are available too.

Q: Can you talk about your visit to Morehouse School of Medicine?

A: An important reason that I wanted to go to Morehouse is that we know that the brunt of the pandemic has been disproportionately borne by communities of color, that has been clear. We also know that to best serve the community, we also need diversity in our workforce. And it turns out that diversity in the workforce also is a way of helping to support those who are racial ethnic minorities in our workforce. ... But what I hear from students as I often do is that they are the only Black person in their medical school or that there are no other people of Latino background like they are....and so they don’t necessarily feel like people may understand their experience during training. It’s heartbreaking, right? Because training is hard enough in of itself, whether it’s in nursing or medicine.

And it’s important to have people who share your experiences, your background, who can understand what you’re going through, in order to be optimally supported. So, Morehouse stands out as an institution that has recognized this for years before the pandemic. They have worked hard to increase diversity in the workforce.