“As a follow-up to the conversation, try not to be aggressive and not get emotionally attached to your opinion. Try not to be judgmental. Is there anything we can help you do to hone your leadership skills?”
In the spring of 2023, I stared at an email from my boss, shaking with rage. I was pretty much at rock bottom. And I wasn’t the only one who felt that way. By any standards, it had been a tough three years for the American healthcare workforce. Burnout was skyrocketing. A quarter of American healthcare workers experienced anxiety or depression, and one in five were considering the ultimate option: leaving healthcare altogether. The emergency department where I work had so much physician turnover that I gave up counting the doctors who were replaced (even now, if I don’t see a doctor for a few weeks, I assume they’ve quit). Healthcare as a whole was pretty much at rock bottom.
Of course, none of this started during the pandemic. With hindsight, it’s clear that the healthcare industry was due for reckoning by 2020. The psychological stress, secondary trauma, workplace violence, irregular circadian rhythms, physically demanding work, and unrealistic expectations of perfection that healthcare workers had long carried and considered part of the job were taking their toll.
A 2022 survey found a whopping 40% prevalence of mental fatigue (short for burnout) among American healthcare workers, while 32% reported mental fatigue already in 2019. When researchers retrospectively examined healthcare workers’ responses in national surveys conducted between 2017 and 2019, they found that the prevalence of poor sleep and depression was 41% and 19%, respectively, significantly higher than non-healthcare workers in the same survey. Pre-pandemic data consistently showed rising moral injury and turnover rates across all areas of healthcare, reflecting the high costs of being a caregiver.
The seeds of clinician burnout and turnover were sown decades ago, but the pandemic has only turned them into a bountiful harvest. This is the nature of disasters in general and pandemics in particular.
Aftermath of the disaster
But major public health crises are almost always followed by major chaos. Disasters act as amplifiers and accelerators, exposing long-standing cracks and weaknesses in social infrastructure, causing anything that cannot withstand the pressure to collapse. They disrupt traditions and livelihoods alike, making the impossible possible and the unthinkable real. Cultural norms are suddenly turned upside down. Entire communities are trapped in poverty, and the initial damage and subsequent displacement exceed their ability to rebuild.
All of this makes intuitive sense as a notion that disasters cause havoc. What’s less intuitive is that disasters often foster growth, precisely because of the havoc they cause and the assumptions they shatter. The vacuum that emerges after a disaster or pandemic opens up opportunities and avenues for previously ignored ideas to flourish.
In the late 1990s, two psychologists at the University of North Carolina at Charlotte coined the term “post-traumatic growth” to describe the notion that adversity leads to significant growth. Disasters and other traumatic events trigger in most people varying degrees of anxiety, distrust, intrusive memories, and a desire to return to the way things were before. Ultimately, however, the extraordinary nature of these experiences and the window into a different perspective they create act as a catalyst for growth. This growth occurs at the individual and organizational levels and goes beyond resilience (the ability to cope with adversity). It involves adaptation, a cognitive restructuring that takes into account lessons learned from the new reality and the disruption of the old reality.
A changing field
Ask any clinician today, post-pandemic, how it feels to be a healthcare professional and you’ll probably hear the same answers: exhausting. The pace of change is dizzying. There aren’t enough clinicians in a country with a rapidly aging population of chronically ill patients. Many of us are still processing the trauma of the pandemic while also adapting to a new normal.
But this turmoil is a reason to remain hopeful. American health care is in the midst of a period of post-traumatic growth. This growth is uncertain, uncomfortable, and at times, frankly, disconcerting and contradictory. And it’s evidence that health care, an industry steeped in tradition and historically slow to evolve, is capable of both cultural change and adaptation.
First, we are witnessing a new and refreshing intellectual humility. After all, what could be more humbling than the advent of generative artificial intelligence (AI) that can combine the knowledge base of past, present, and future clinicians with a decidedly more empathetic email? What could be more humbling than the revelation that, after decades of reverence for specialty medicine, we are lost without primary care? Or, in the wake of a pandemic and a tsunami of COVID-19 patients, what could be more humbling than being reminded that it is always better to keep people healthy than to treat the disease?
More importantly, we are seeing a new appreciation for frontline clinical work, including the recognition that the heart of medicine is the doctor-patient relationship, even if it takes place on a screen and with the support of AI, and the long-overdue realization that improving the bedside situation is the best way to improve patient retention, rather than weaponizing sympathy or encouraging clinicians to work more.
At the same time, the early post-pandemic years have seen a new emphasis on clinician wellness and work-life balance, as evidenced by the unionization drives in facilities across the country. As someone who trained 25 years ago, when the Libby-Zion Act was considered an affront, this seems nothing short of miraculous. I never expected to be told to put on my own oxygen mask first.
A battle worth fighting
Clearly, we still have work to do to balance the books. Too many executives and middle managers don’t spend enough time at the bedside, and too many front-line clinicians work unsustainable schedules. We also need to mentor the next generation of clinicians in ways that encourage them to pursue both clinical medicine and their nonclinical interests. But I’m confident that we’re making small strides toward a more resilient health care workforce.
For me, rock bottom came a few weeks after the email from my boss. Eventually I found my way out and returned to the profession I love. There are still plenty of days when I want to quit mid-shift, but they are becoming less frequent, and even the hardest shifts have more moments of joy. It still feels like a constant battle, but it’s a battle worth fighting.
To all other clinicians who are wondering if it’s still worth staying in medicine, hang in there. Please don’t quit. And don’t quit in silence. Be loud and unashamed in your support of intellectual humility and clinician well-being. Be harsh, if necessary. I believe things will get better. The history of disaster teaches us that adversity sows seeds that are often unnoticed at the time but bear fruit much later.
The views expressed are the authors’ own and do not necessarily reflect the views of any institution or company with which the authors are affiliated.
