US Surgeon General Report on Healthcare Burnout

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Recently, the United States Surgeon General, Dr. Vivek Murthy, published an advisory report entitled “Addressing Health Worker Burnout” (LINK).  The extensive document outlines the increasing problem with healthcare professional burnout and proposes recommendations to address the situation.  It is an important and significant step forward to have such a report from high levels of the US Government.  At the same time, in my opinion, there are substantial opportunities remaining to address the issue in a more holistic and comprehensive fashion than were outlined in the report.

An increased emphasis on individual factors is, in my opinion, crucial to not only addressing healthcare professional burnout, but improving the health and wellbeing of healthcare professionals and promoting their ability to pursue sustainable high performance in all aspects of life.  Focusing on individual level factors is not synonymous with placing ‘blame’ on healthcare professionals who become burnt out.  Without a doubt, it is not the individual’s ‘fault’ if they develop burnout.  At the same time, it is incumbent upon us as individuals to address the factors within our control to improve our situation.  This applies equally for those who have developed burnout and those who have not.  This emphasis on what we control promotes our agency and self-efficacy and is foundational to self-actualization and transcendence as described in the field of humanistic psychology.

The emphasis on burnout leaves open the question- what about those who have not developed burnout?  While many healthcare professionals have become burnt out, by no means are all providers experiencing burnout.  By focusing on improving ‘heatlh worker burnout’ we must be cautious not to exclude those who are not burnt out.  Furthermore, there is more to be gained than solely addressing burnout.  We can also pursue health, wellbeing, and sustainable high performance.  This pursuit extends far beyond burnout.  When the time comes that we have addressed burnout, this work must not end, we must continue to promote health and wellbeing.  Additionally, the development of health, wellbeing and sustainable high performance has a positive impact on all areas of life allowing for healthcare professionals to be the best version of themselves in all domains of life for themselves and those around them.  In essence, this allows healthcare professionals to become better humans not solely better healthcare professionals.

An overemphasis on the role of the healthcare system and its culture has drawbacks.  While the system and culture are in desperate need of significant change, by prioritizing the individual, we as healthcare professionals potentiate our self-efficacy and agency allowing for self-actualization and transcendence.  These are core components of humanistic psychology and allow for development of mastery of self.  Such a pursuit is not prioritized when we over index on the system and culture.  From a practical perspective, change to the healthcare system and its culture will be a slow process and is less likely to be lasting if it comes from a top-down approach.  Rather, by effecting change amongst individual healthcare professionals we can create a bottom-up, grassroot style of culture shift which will likely be more enduring.

Within the typical paradigm of healthcare professional burnout, the individual aspects that are discussed tend to focus on resilience and grit.  Given the nature of pre-medical education and, in particular, medical training it is preposterous to contemplate that healthcare professionals are in need of more grit and resilience.  The truth is that each and every healthcare professional has a greater than average level of grit and resilience, otherwise they would not have reached this point in their career.  Additionally, there is an overemphasis on meditation as a cure all for burnout.  While meditation is an essential skill and is undoubtedly necessary in the development of the individual skills of health, wellbeing and sustainable high performance, it is not sufficient in and of itself to remedy burnout.  Related to the over index on resilience, grit, and meditation there is a lack of emphasis on body-based skills and habits that are highly effective and equally essential in the development of health, wellbeing, and sustainable high performance.

In my opinion, a better and more complete paradigm to address the issue, not only of burnout, but of development of health, wellbeing and sustainable high performance is a comprehensive approach in which mind-based and body-based skills and habits are developed amongst individual healthcare professionals.  There are numerous advantages to this approach.  It is comprehensive and allows the healthcare professional to develop skills of being a better provider and a better human in all areas of life.  It is inclusive of all healthcare professionals, whether or not they are burnt out.  It promotes agency and self-efficacy and will create a groundswell of change amongst individual professionals which will inevitably lead to a seismic shift in the healthcare system and its culture.  Essentially, this approach allows each and every healthcare professional to work with and optimize their biology rather than trying to overcome it, an attempt that inevitably will not be successful. 

This approach, termed The Practices of the Healthcare Athlete, will empower all healthcare professionals to be at their best in all areas of life for themselves and those around them in a sustainable and comprehensive fashion.  This provides the ultimate solution for the challenges we are currently facing in the healthcare system.

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