Physician burnout: Still a problem, and Congress could help

On Feb. 14, 2024, J. Corey Feist, JD, MBA, founder and CEO of the Dr. Lorna Breen Heroes’ Foundation, testified before the Health Subcommittee of the U.S. House of Representatives’ Energy & Commerce Committee. The House has pending House Resolution 7153, to reauthorize the “Dr. Lorna Breen Health Care Provider Protection Act," key national legislation recognizing the problem of workplace burnout among physicians and other clinicians.

Congress must continue the national fight against burnout in physicians and other clinicians, said an advocate who co-leads a movement inspired by the death of his physician sister-in-law.

On Feb. 14, J. Corey Feist, JD, MBA, founder and CEO of the Dr. Lorna Breen Heroes' Foundation, testified before the Health Subcommittee of the U.S. House of Representatives’ Energy & Commerce Committee. The House has pending House Resolution 7153 to reauthorize the “Dr. Lorna Breen Health Care Provider Protection Act.” It would direct the U.S. Department of Health and Human Services “to allocate resources to health care entities for programs that promote the utilization of mental health and substance use disorder services among health care professionals.”

“Addressing burnout necessitates a dual approach, individual support and systemic change,” Feist said. “Individual support programs act like pressure on a bleeding wound, wound of burnout, essential for immediate relief. However, true healing requires addressing the root cause of the bleeding the environment of care. Systemic efforts, such as reducing administrative burdens on health workers, are imperative to long term relief.”

The state of burnout

In previous testimony, Feist shared details about the pressures on his sister-in-law, Dr. Lorna Breen, an emergency physician in New York who worked around the clock during the early days of the COVID-19 pandemic. She feared losing her medical license if she sought mental health help, and died by suicide in April 2020.

On Feb. 14, he cited other examples – an orthopedic surgeon and a nurse in her 20s who died by suicide, another veteran nurse who spoke about positive personal and professional effects of accessible counseling. Female nurses are 8.5 times more likely to die by suicide than the general population, Feist said.

The U.S. Centers for Disease Control and Prevention’s October 2023 "Vital Signs" report stated: "Health Workers Face a Mental Health Crisis." It included alarming statistics:

• Reports of health care worker harassment more than doubled from 2018 to 2022.
• 46% of health workers reported often feeling burned out, up from 32% in 2018.
• 44% of health workers intended to look for a new job in 2022, up from 33% in 2018.

Meanwhile, the nation’s population is aging as one estimate said 900,000 registered nurses intended to leave the workforce by 2027. “Who’s going to take care of all of us?” Feist said.

The 2022 legislation had $103 million to support 44 health organizations implementing various methods to support and protect the health care workforce. However, that represents 1% of health workers and 1% of hospitals around the country, Feist said.

Lawmakers have questions

Feist fielded questions from at least six subcommittee members.

Subcommittee Ranking Member Rep. Anna Eshoo (D-California) asked about health insurance coverage for physicians and other clinicians. Health systems will cover mental health assistance, but generally offer care within their own systems. Physicians need confidentiality and should not be subject to general gossip of the hospital if they seek mental health issues, she said. Feist agreed that mental health care for physicians and other clinicians, offered outside their employer, would improve access and confidentiality.

Rep. Morgan Griffith (R-Virginia) quoted a Richmond Times-Dispatch report on health care burnout. Feist told him that in the last two years, 75% of hospitals have removed stigmatizing questions about health care workers seeking mental health assistance. They agreed the state of Virginia has become a national leader in removing stigmatizing questions and, with the Medical Society of Virginia, expanding mental health care to physicians and other clinicians through the SafeHaven program.

Rep. Debbie Dingell (D-Michigan) lessons learned about burnout in the last three years. The root cause of burnout is tied to a number of things, but the main issue is that more than 50% of a nurse’s time and more than 70% of a physician’s time is spent away from the bedside, doing administrative work, Feist said. Health care has a workforce doing the wrong thing, he said.

“They’re the only ones trained to take care of us and they’re doing administrative work,” Feist said.

Rep. Neal Dunn, MD (R-Florida), asked about solutions, and Feist noted there have been efforts to reduce administrative burdens while increasing clinical care, and measuring burnout and well-being. Health system boards of directors often look very closely at those key performance indicators over time, he said.

Rep. Kim Schrier, MD (D-Washington), noted physicians are trained to put their own feelings aside, work long hours and not admit when they are having a mental health crisis. That is the culture of medicine, she said.

In earlier comments, bill cosponsor Rep. Buddy Carter (R-Georgia) said everyone wants accessibility, affordability and quality in health care. “But we can’t have any of that unless we have a healthy workforce,” Feist said.

Rep. John Sarbanes (D-Maryland) noted the October 2023 CDC report had “really jaw-dropping statistics.” He asked about burnout as a clinically defined condition, but Feist differentiated it as a workplace condition, pre-pandemic, during the pandemic, and post-pandemic.

“It is driven by the work environment, so, a lot of the key to addressing the root cause of burnout is to make the work environment a better place,” Feist said.

Rep. Mariannette Miller-Meeks, MD (R-Iowa), asked about evidence-based solutions.

Leadership training and support cascades down to the workforce environment that drives burnout. Engaging health care workers to advance solutions, addressing work-life challenges and improving team-based care models all have been tried, Feist said, but he noted just 44 hospitals have received programming, out of more than 6,000 hospitals in the nation.

Additional testimony

Over about 3 1/2 hours, Feist was among seven experts testifying about health care, medical and patient issues, and conditions ranging from Alzheimer disease, autism spectrum disorder, Down syndrome, organ transplantation, heart disease, ambulance availability and gaps, heart health, and cancer screening. The Committee has at least 19 pending bills relating to reauthorizing research, treatment and education about those issues and more.

Additional witnesses were:

• Andy Shih, PhD, chief science officer of Autism Speaks
• Joanne Pike, DrPH, president and CEO of the Alzheimer’s Association
• Gordon Tomaselli, MD, former president of the American Heart Association
• Michelle Whitten, president, CEO and cofounder of the Global Down Syndrome Foundation
• Randy Strozyk, president of the American Ambulance Association
• Christina Annunziata, MD, PhD, senior vice president of extramural discovery science of the American Cancer Society