Ellen MacInnis, 63, worked for 20 years as a registered nurse in St. Elizabeth’s Medical Center’s emergency room. A few months ago, she transferred to an inpatient detoxification unit.
MacInnis couldn’t take the constant stress in the emergency department of being short-staffed with too many patients. She worried about increasingly threatening patients.
“I can tell you how many shifts I have until I retire,” MacInnis said. “I’m just counting the days.”
Burnout is a major problem among workers in health care, leading to retirements and quitting. The problem feeds off itself since the more workers leave, the more work falls on remaining employees, as employers struggle to fill vacant positions. While burnout was a problem pre-COVID-19, pandemic-related factors exacerbated it.
In a spring 2022 Massachusetts Medical Society survey of physicians, 55 percent of respondents reported burnout symptoms. Half had already reduced their clinical hours or were likely to reduce clinical hours over the next year, and around 1 in 4 planned to leave medicine within two years. A March 2023 Beacon Research survey of nurses found that 18 percent planned to leave the field within two years, half to retirement and one-third to a job outside health care. The top reasons given were age, overwork, and exhaustion. An April 2023 1199SEIU survey of unionized personal care attendants and facility-based health care workers found that 23 percent planned to leave health care or home care within two years, and 68 percent said during the past year they felt exhausted or burnt out.
“We’re in crisis currently, but we’re on the brink of a collapsing workforce,” 1199SEIU executive vice president Tim Foley said.
Raises and better benefits for the lowest-paid health care workers could incentivize some to stay. A Massachusetts Health Policy Commission report found that the lowest-wage segments of the industry — home health and nursing homes — saw the biggest workforce drops in 2022. But many health care jobs, including physicians and nurses, are well-paying. According to the Massachusetts Health Policy Commission, nurses had a median annual income of $96,630 in 2021. This is not an issue money alone can solve. It will take a sustained focus on addressing conditions that cause clinician burnout.
“What people want is time and quality of work-life,” said Dr. Andrew Artenstein, chief physician executive and chief academic officer at Baystate Health. “They want to have some joy in their professional lives.”
One response is to enhance employee wellness programs. Lahey Hospital and Medical Center, with over 6,000 employees, created a four-person health and wellness office. It offers “serenity suites” with massage chairs, therapy dog visits, peer support, and organized walks and Reiki to give employees breaks. But to address the core of the problem, employers must reexamine the jobs themselves.
One area ripe for exploration is using technology to alleviate administrative burdens.
The most efficient health care systems let everyone focus on what they are trained for — and for doctors and nurses, that’s patient care. Some of the biggest stresses reported by doctors are tasks ancillary to medical care, like documentation and insurance processing. Electronic health records, while necessary, are not user friendly.
More hiring of and better pay for administrative support staff could help fill positions that would answer phones, transport patients, handle insurance, or do documentation as medical scribes.
Equally necessary is advanced technology. Hospitals can work with tech companies on apps to improve electronic health records.
Mass General Brigham is starting two innovative pilot programs this summer using artificial intelligence. In one, the doctor uses an app to record a patient visit, and the app produces a medical note detailing the interaction, similar to what the doctor would have written. The doctor reviews and can edit the note. The second pilot uses artificial intelligence to draft responses to patient emails, which a clinician reviews. The machine cannot draft medical advice but can answer administrative requests, like for medication refills.
“The technology is exciting not because it’s new and shiny, but because I see real pragmatic benefits to it in terms of alleviating burden and burnout and using it to improve the patient experience,” said Dr. Rebecca Mishuris, chief medical information officer at Mass General Brigham.
In the future, data analysis software could help with things like predicting when units will be busy so hospitals can staff accordingly.
One key to retaining staff in any field is giving workers a path to advance their careers through initiatives like apprenticeships or leadership training programs. For example, health care workers’ union 1199SEIU recently used its employer-funded training fund to pay trainees’ tuition for a certified nursing assistant training program at Cape Cod Hospital, where entry-level nurses apprenticed on the floors. Baystate Health offers programs for physicians who want to become educators or administrators.
One lesson learned from medical trainees’ recent pushes to unionize is that workers want a voice. In the Massachusetts Medical Society survey, about one-fifth of younger physicians felt they did not matter to their organization. Creating spaces for employees to be heard is vital to identifying problems and finding reasonable solutions, particularly on difficult issues like staffing or scheduling.
Massachusetts Nurses Association President Katie Murphy said perpetual understaffing is one of the biggest factors that leads to quitting, since nurses feel “exploited” and unable to properly care for patients. The union has long pushed for mandatory staffing ratios, but hospital executives say ratios are inflexible and expensive, and voters rejected a 2018 ballot question imposing mandatory ratios. The best solution would be if hospitals and unions could work together to develop realistic staffing ratios appropriate to each hospital and unit.
On scheduling, medical professionals often complain about a lack of work-life balance, given medicine’s grueling hours. A desire for flexible scheduling leads nurses to leave inpatient work for gig work.
While more staff is the ultimate solution, hospital administrators can do things like drafting work schedules in advance, offering flexible scheduling where employees choose shifts, offering part-time work, or letting some work be done remotely. Hospitals should consider benefits like on-site child care and off-hours access to mental health care.
Longer term, policy makers should examine challenging issues related to workplace satisfaction like how to simplify insurance requirements or reimburse for care in a way that lets physicians spend more time with each patient.
Finally, everyone deserves a safe workplace, and violence against medical professionals is a problem. Hospitals need trained security guards and strong policies in place to defuse tense situations.
Programs to train new health care workers are important in the long-term. But for now, keeping the health care system afloat will mean doing a better job retaining the doctors, nurses, and other professionals already caring for patients today.
Editorials represent the views of the Boston Globe Editorial Board. Follow us @GlobeOpinion.