'Great Resignation' could be coming for healthcare as clinicians face mounting burnout and stress, study finds

As the lingering COVID-19 pandemic places unprecedented stress on U.S. healthcare workers, data suggest that the country is on the brink of a turnover wave in the healthcare workforce.

One in 5 physicians and 2 in 5 nurses intend to leave their current practice within two years, a new study by the American Medical Association (AMA) suggests.

The study, published in the December issue of Mayo Clinic Proceedings: Innovations, Quality & Outcomes, also found that about one-third of physicians and nurses expect to work fewer hours in the next 12 months.

“If these clinicians follow through on these intentions, this has significant implications for the future healthcare workforce,” the study’s authors cautioned, while adding that “reducing burnout and improving a sense of feeling valued may allow healthcare organizations to better maintain their workforces post-pandemic.”

Christine Sinsky, M.D., the lead author and AMA vice president of professional satisfaction, told Fierce Healthcare that “in the study, we discovered the healthcare workforce is in peril. I believe that the 'Great Resignation' we are seeing across all sectors of the economy hasn’t yet fully hit us in healthcare.”

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Factors associated with a greater intention to decrease hours or depart a work environment include higher levels of burnout, stress, workload, fear of infection, anxiety or depression due to COVID-19, and the number of years in practice, the AMA study noted.

Among physicians, the intent to leave often correlates with actual departures. “We know from other studies that approximately one-third of physicians who indicate a moderate or higher likelihood of leaving actually do leave in two years,” Sinsky said. “If that continues to hold for physicians and if it holds for nurses, we will be facing a serious shortage of nurses and physicians. It is not likely that the number of new trainees will make up the deficit.”

There are considerable costs associated with replacing healthcare workers. For instance, the expenses related to replacing just one physician could reach $250,000 and may even exceed $1 million. The cumulative cost of turnover and reduced clinical hours due to physician burnout in the U.S. is estimated at $4.6 billion annually, according to the AMA study.

Meanwhile, the study revealed that feeling valued was strongly linked to lower odds of reducing hours or leaving. In conclusion, it recommended that organizations implement strategies to enhance healthcare workers’ sense of value, establish nurturing environments and decrease work overload through better teamwork that aims to limit stress and avert turnover.

“There are many ways that an organization can help workers feel valued,” Sinsky told Fierce Healthcare, citing the importance of providing adequate personal protective equipment and proper training for new responsibilities due to COVID-19. It also helps to lighten some requirements that traditionally add burden to the workforce.

“Prior to the pandemic, some institutions required that only the physician could do tasks such as medication reconciliation or order entry,” she said. However, “during the pandemic, some organizations have modified their policies to allow team members to share in those tasks.”

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Healthcare workers in both clinical and nonclinical roles—including clerical staff, housekeepers and administrators—completed the AMA survey, which gathered data from more than 20,000 individuals at 124 hospitals and health systems between July 1, 2020, and Dec. 31, 2020. Multiple healthcare organizations across 30 states in both rural and urban settings administered the survey at no cost beginning April 2020.

This analysis excluded resident physicians because their clinical hours and likelihood of leaving their current practice are largely determined by progression through their training program. It included advanced practice providers, such as nurse practitioners and physician assistants, who practice alongside physicians, with more limited training and oftentimes with a more restricted scope of care.

“Future research should investigate whether addressing predictors of burnout and emphasizing mitigators such as positive organizational cultures and making workers feel valued could avert a potential healthcare workforce crisis in the wake of COVID-19,” the authors noted.