Healthcare workforce burnout is a crisis that's so widespread and serious that in 2019, the World Health Organization (WHO) added it to the International Classification of Diseases as an “occupational phenomenon.” And that was before the ongoing COVID-19 pandemic threw gasoline on an already raging fire deeply affecting our physicians, nurses, and other caregivers and staff.
Burnout prevention tactics can help thwart it, and there is progress in treating those suffering from its many negative effects—but first we must understand what drives it. Burnout and its ripple effects are harmful to clinicians, patients, and support staff, which is why hospitals and professional organizations have been so dedicated to studying and addressing it in recent years. And in doing so, researchers and advocates have increasingly turned their attention to how people of different ages experience and cope with burnout.
Read on as we explore burnout’s high costs for everyone, and examine how it affects people of different generations.
What is burnout?
Burnout, as defined by the WHO, is directly related to a person's occupation, rather than being a medical condition in and of itself. That means, according to the American Medical Association, that solutions for burnout should focus on improving the workplace, instead of trying to "fix" individuals. It’s about much more than just job satisfaction and work hours.
The WHO describes burnout as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed." It has three "dimensions," per WHO:
- Feelings of energy depletion or exhaustion
- Increased mental distance from one's job, or feelings of negativism or cynicism related to one's job
- Reduced professional efficacy
Although people in any occupation can experience burnout, research shows that it's more prevalent among healthcare workers in hospitals, health systems, and medical practices than the general population. The consequences of healthcare provider burnout, therefore, can be especially hazardous for all who utilize healthcare services, since nurses and doctors work long hours in highly stressful, often life-or-death situations. Several studies have linked high levels of burnout with worsening patient safety, such as increased medical errors and even a diminished overall patient safety culture.
That's not all. An investigation in the July 2021 International Journal of Nursing Studies concluded that "nurse burnout is associated with worsening safety and quality of care, decreased patient satisfaction, and nurses' organizational commitment and productivity." On the flip side, research also shows that reduced physician burnout is linked with improved patient satisfaction.
Burnout in action
The costs of burnout are incredibly high for healthcare providers and their organizations, and of course for patient care. However, burnout's prevalence among healthcare workers can be hard to accurately gauge. For instance, the 2020 Medscape National Physician Burnout and Suicide Report reported a burnout rate of about 43% among physicians, while the National Institute for Health Care Management (NIHCM) Foundation reports that 76% of healthcare workers reported exhaustion and burnout in September 2020.
Although burnout is caused by external workplace factors, it manifests in people with very real feelings of stress and anxiety and even physical symptoms, from depression to poor sleep, to appetite problems, and even physical pain. Some cases are even more severe. In fact, 13% of healthcare workers said “yes” when asked if they have ever felt suicidal, and the physician suicide rate is two times higher than that of the general public, according to the NIHCM Foundation.
Such symptoms undoubtedly have a negative effect on physician-patient relationships, too. When asked how their depression affected relationships with patients, doctors said it made them easily exasperated with patients (36%), less motivated to carefully take patient notes (24%), and more likely to make errors they wouldn’t usually make (15%), the Medscape National Physician Burnout & Suicide Report 2021 found.
The pandemic has only made it worse. A Mental Health America Survey, which captured responses from 1,119 healthcare workers during the COVID-19 pandemic in 2020, found that 76% reported exhaustion and burnout and 63% experienced "work-related dread."
Many also reported changes in appetite (57%) and physical symptoms like headache or stomach ache (56%) during the pandemic.
It's important to remember, though, that burnout has been a problem among healthcare workers for a long time. And while no one disputes the fact that the recent pandemic exacerbated the burnout crisis, research also shows it wasn't the main cause: The 2021 Medscape National Physician Burnout & Suicide Report shows that 79% physicians said their burnout started before the pandemic. This WHO’s 2019 classification of burnout as an “occupational phenomenon” also supports this research and finding.
Burnout by generation
Although burnout can affect healthcare providers of any age, the way clinicians of different generations experience the symptoms of burnout and how they deal with them can differ.
Baby boomers, who were born between the years 1946 to 1964 and are currently 57-75 years old, make up a huge portion of the physician population. According to the Federation of State Medical Boards’ most recent census of 985,000 licensed physicians in the U.S. in 2018, the number of licensed physicians between 60 and 69 years old grew to 19.5% and the number licensed physicians 70 and older grew to more than 10.8%.
According to market research, Baby Boomers are competitive, optimistic, self-sufficient, equate authority with experience, are confident, and often define themselves by their professions. They also aren't retiring, a finding that's echoed in the Federation of State Medical Boards census.
A Medscape survey shows that 39% of Boomer physicians report burnout, which is less than their Gen X counterparts (48%) but slightly more than Millennials (38%). Boomer doctors also seem to have more trouble with technology than their younger counterparts and are more likely to say that dealing with it in their practice is a major contributor to their burnout, Medscape found. While all three generations agree that too many bureaucratic tasks, like charting and paperwork, is the number-one contributor to burnout, only Baby boomers—41% of them, in fact—said that an increasingly computerized practice, including the use of electronic health records, was among their top three contributors to burnout. Boomers named it as their number-two contributor, while Gen Xers and Millennials didn't name it in their top three at all.
Although Boomer physicians reported roughly the same levels of burnout as their younger colleagues in the Medscape survey, they were more likely to say that it has had an impact on their life, with half saying it has had a strong/severe impact on their life, compared with 46% of Gen X and 36% of Millennials.
Despite more Boomers saying burnout has had a strong impact on their lives, they're less likely to say it's had an impact on their relationships (69%, versus 77% of Millennials and 73% of Gen X), the Medscape survey shows.
Although that's seemingly a paradox, when considered against Boomer characteristics of confidence and self-sufficiency, it perhaps makes more sense. We'll also see more of this self-sufficiency when we look at the ways Boomers deal with their feelings of burnout (see below).
Loosely grouped by people born between the years 1965 and 1980, Gen Xers are currently between the ages of 41 and 56, making the average aged U.S. physician—at 51.5 years old—a Gen Xer, according to the most recent data from the Federation of State Medical Boards.
Gen Xers are the original "latchkey kids" who cared for themselves while their parents worked, and as a result, tend to be self-sufficient, resourceful, and individualistic, as well as independent and technologically savvy, market research shows.
Medscape research shows that Generation X physicians report experiencing more burnout than other generations (48%, compared with 39% of Boomers and 38% of Millennials, as noted above). This makes sense because of their age. As a Medscape expert noted, mid-career is when professionals experience the most burnout.
Their age and life experiences likely also play into the 73% of Gen Xers who say that burnout has an impact on their relationships. That's because many people in this age group fall into what's become known as the "sandwich generation" of people who are simultaneously caring for children under 18 and aging parents.
Millennials (Generation Y)
Born from 1981 to 1996, Millennials (also referred to as Gen Y) are between 25 and 40 years old. They are rising in their careers, grew up with new technology in a way other generations did not, and came of age during the September 11 terrorist attacks.
Often challenging the status quo of experience and organizational hierarchy, Millennials value meaningful motivation, learning, creativity, and social interactions at work. They're more likely to be task-based than time based, are open to change, and crave feedback from their colleagues, market research finds.
These characteristics are evident in the ways Millennial healthcare workers experience burnout. They're the least-burnt-out generation and are also the least likely to say that burnout has had a severe impact on their lives. However, they're the most likely to say that burnout has affected their relationships (77%, versus 73% of Gen X and 69% of Boomers), and that makes sense for a generation that values communication and social connections, Medscape research shows.
Millennials were also most likely to say that spending too many hours at work (38%) was a top-three contributor to burnout and that they'd take a salary reduction to achieve a better work-life balance.
Unlike their Boomer counterparts, Millennials didn’t cite technology as a burnout contributor. In fact, their comfort with and reliance on technology throughout their everyday lives might actually make them less at risk of burnout than Boomers, according to UC Davis research. Those authors wrote, "The next generation of physicians will use technology to support their work and lifestyle preferences, making them more resilient to burnout than previous generations."
Gen Z is the newest generation, born between 1997 and 2012, making them 6 to 24 years old. Some individuals in this group are old enough to be in medical training. Those in medical school, residency training, fellowships, and other medical internships are vulnerable to pressures associated with the demands of medical education and training, and can also experience burnout.
While there is little research about burnout and work-life balance in Gen Zers pursuing medicine, experts say dispelling the notion that all medical students are “super resilient” and capable of handling the pressure of balancing medical school studies and daily life alone is a start to helping prevent burnout before their careers in the medical field even begin.
Burnout remedies by generation
Because burnout is a result of chronic workplace stress, the best solutions and remedies tackle the workplaces themselves. “The most powerful interventions to reduce burnout are to improve workflow efficiency, teamwork, and leadership,” Christine Sinsky, MD, the American Medical Association's vice president of professional satisfaction, said in an AMA article.
For instance, the Mental Health America survey shows that 39% of healthcare workers did not feel like they had adequate emotional support, especially nurses (45%), yet having an emotionally supportive workplace is a key factor in combating burnout.
However, it's still incredibly important to consider interventions and workforce management tools from a generational standpoint, because people of different age groups cope with the effects of burnout differently.
For example, although Millennial doctors were the least likely of all the age groups to report being depressed, this socially minded generation is more likely to talk about it with a friend or get professional help for it than older generations, the Medscape survey found. Similarly, they're the generation most likely to say that their workplace offers a program to help reduce stress and/or burnout, perhaps suggesting that they have been more likely to either pay attention to the availability of such programs or seek them out.
Conversely, Boomers and Gen Xers said that even if their workplaces offered such programs, they wouldn’t use them: That was true for 45% of Boomers, 39% of Gen Xers, and 38% of Millennials. Likewise, self-sufficient Boomers and Gen Xers are more likely to say they cope with burnout by isolating themselves from others (45% each) and exercising (44% and 46%, respectively), whereas Millennials would rather sleep (56%) or talk with family and friends (53%).
While burnout isn’t limited to one age group, healthcare professionals of different generations experience and cope with burnout differently. Understanding how each generation views and deals with burnout can help organizations develop strategies to effectively help their employees when feelings of burnout occur.
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