Burnout in healthcare workers has been prevalent for many years, but the Covid-19 pandemic has brought the seriousness of this issue to the forefront and in the public eye. Burnout within healthcare workers is now so pronounced that it prompted the U.S. Surgeon General, Dr. Vivek Murthy to write a strong opinion piece calling governments to confront the issue.

According to Dr. Murthy, the causes for healthcare worker burnout include “inadequate support, escalating workloads and administrative burdens, chronic underinvestment in public health infrastructure, and moral injury from being unable to provide the care patients need.”

Burnout in healthcare workers is a real phenomenon and we have seen it replicate itself in India, at private and government-owned facilities, in equal measure.

Burnout is defined as a state of physical, emotional, and mental exhaustion that results from long-term involvement in work situations that are emotionally demanding

While burnout can occur amongst people of all industries, healthcare workers are more susceptible to it. The phenomenon is widespread enough that the World Health Organisation (W.H.O.) recognizes it as a serious risk that can cause psychological distress.

According to doctors and nurses who deal with patients every day, the onset of the pandemic heightened the levels of burnout. “It’s not like we didn’t have burnout before Covid” says Dr. Rachna K. “But the conditions that healthcare workers were exposed to, combined with limited resources, and no end in sight made the burnout a lot worse.”

Covid or not, burnout amongst healthcare workers remains real and present; and since mental health issues need to be addressed with due consideration, it’s worth the effort to understand why they happen and what they look like.

“Educating people and opening the pathways for dialogues is extremely important, especially about mental health awareness” says Dr. Rachna. “People everywhere must understand that human beings are susceptible to all kinds of illnesses and the way out is support, not isolation”.

So what factors cause burnout amongst healthcare workers?

According to Dr. Vivek Murthy, while burnout is visible in individuals, it it “fundamentally rooted in systems” and these systemic shortfalls have “pushed millions of health workers to the brink.”

We discuss some of these shortfalls below :

One of the more well-known causes behind burnout in healthcare workers is the long hours they are required to put in at work.

“When the pandemic was raging, 48-hour shifts were becoming the ‘new normal’ for us” says Dr. Rachna. “We even heard stories of healthcare staff who didn’t have the opportunity to go home for a week or 10 days at a time.”

Even without the pressures of the pandemic, it’s quite common for doctors, nurses, and administrative staff to be working 10-12 hour shifts. Intense work schedules and long hours spent at work translate to less time spent with family, friends, or doing things that people love to do.

When compounded across a long period of time, or years spent not taking a vacation, long working hours can turn into feelings of exhaustion and burnout because people have not had enough time to de-stress.

We are all aware of the extreme demands placed on healthcare workers during the beginning and the height of the pandemic. They were expected to care for Covid-infected patients with inadequate resources and incredible danger to their own lives.

Dr. Rachna offered a sobering reminder of that time. “Our healthcare workers have shown up to work inadequate resources to ensure their safety. Many chose to stay back at work to avoid endangering their families and loved ones. And in the face of these challenges, many of them were also expected to go without pay for 3 months or more at a stretch. Imagine the toll on them and their families.”

Other factors of compensation include a glaring lack of additional work benefits such as equitably distributed workloads, family or sick leave, breaks and other workplace policies that assure holistic support.

According to multiple studies, approximately 50% of healthcare workers report burnout. While that is an overwhelmingly high number, there are chances it’s not the most clear estimation because mental health issues are often kept under wraps.

“For many years, there’s been an unspoken rule amongst healthcare workers that we can’t speak publicly about our mental health issues” says Dr. Meenakshi Kumar, a Delhi-based General Physician. “Many of us feel like we can’t talk about things like feeling tired or needing support because it might be seen as a weakness.”

However, research indicates that another picture might be the reality. According to an excerpt from this study, “Within the dimension of emotional exhaustion, nearly 50% of the HCWs (health care workers) reported that they most often kept thinking about work-related issues even during off duty hours, which prevented them from enjoying [time] with their families. Nearly 35% of the HCWs felt sleepless and had loss of appetite, felt frustrated and constantly worried about their work.”

So the question then becomes, why are so many of them unable to get the help they need. “Without a doubt, the pressure we feel to keep our struggles to ourselves contributes to our exhaustion.”

The occupational hazard towards burnout is particularly high in healthcare.

“As it stands, healthcare is an industry that is already defined by long working hours” reminds Dr. Meenakshi. “When we add factors such as frequently changing work schedules, limited available resources for mental health support – or any other kind of support, really – then the recipe for burnout becomes much more potent.”

Very often, when healthcare workers develop stronger relationships with their patients, they are unable to de-personalize their interactions with them, a phenomenon we saw occur frequently during Covid.

When compounded alongside other factors, burnout seems like the most obvious outcome. “If left to its own devices, there’s no other way for burnout to go but in a downward spiral” says Dr. Meenakshi. “We really need systems in place that encourage healthcare workers to get the support we need. Because the most frightening adverse effect can spill over to our patients.”