If we fail to pay more attention to burnout among the public health workforce, we may lose a new generation of critical workers.

During the COVID-19 pandemic, burnout among health workers  (eg, physicians, nurses, and public health workers), has increasingly been acknowledged as a major national concern. As a result, in May 2022, a new Surgeon General’s advisory addressed health worker burnout,  formally identifying burnout among health workers as a public health issue. The World Health Organization’s (WHO) International Classification of Diseases (ICD) added the term “burnout” in 2019. WHO defines burnout as a workplace syndrome that is “conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) a sense of ineffectiveness and lack of accomplishment. Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.” According to WebMD, the main causes of burnout are unmanageable workloads, unfair treatment at work, confusing work responsibilities, lack of communication or support from managers, and immense deadline pressure. Burnout accumulates over time and has detrimental effects on one’s mental and physical health such as poor physical health, anxiety, depression, and sleep disorders.¹ Health worker burnout, in addition to having negative physical and mental health effects on the individual health worker, also affects work productivity and efficiency.

Health workers have been experiencing burnout since well before the COVID-19 pandemic began. However, much of the discussion has historically focused on clinical health care provider burnout, namely among doctors and nurses. The January 2020 Medscape National Physician Burnout and Suicide Report showed that about 42% of doctors reported experiencing burnout. Similarly in 2019, the National Academy of Medicine observed that up to 54% of nurses reported experiencing burnout. Most recently, with the COVID-19 pandemic, burnout has greatly increased among clinical health care providers as 63% of physicians experienced burnout during December 2021 and January 2022, the height of the Omicron wave. ² In the clinical setting, burnout has been examined as a cause of decreased workforce efficiency³ and turnover,⁴ which have detrimental effects on the quality of care that patients receive and the ability of health workers to respond to public health emergencies.⁵

In discussions of worker burnout, the issues of the clinical health care workforce often overshadow those of the public health workforce (eg, epidemiologists and local health officials), despite the critical role of public health workers on the frontline of COVID-19 response. Public health workers are experiencing burnout and other mental health issues on par with and even at higher rates than clinical health care providers. A 2020 study on burnout in the public health workforce observed that two-thirds of public health workers, which they defined as “anyone with either an academic degree in a field related to public health or a professional role in a governmental or academic public health department that included participating in the public health response to COVID-19,” reported burnout.⁶

In addition to experiencing increased burnout as a result of the COVID-19 response, the 2021 Public Health Workforce Interests and Needs Survey revealed that public health workers also reported increased post-traumatic stress symptoms, where 56% of public health workers surveyed reported at least one symptom of post-traumatic stress disorder (PTSD) and 25% reported experiencing three or more post-traumatic stress symptoms (PTSS). A December 2021 study among state, tribal, local, and territorial public health workers observed that PTSD levels among public health workers were 10-20% higher than PTSD levels of clinical health workers⁷. Similar to clinical health care providers, almost 50% of public health workers reported in the 2021 Public Health Interests and Needs Survey (PH WINS) that they were planning to retire or leave in the next five years, with about 40% reporting that burnout was a cause for considering to leave (see PH WINS 2021 National Dashboards for dashboard visualizations of 2021 PH WINS).

Research also discusses the negative impact that bullying, threats, and harassment during the COVID-19 pandemic have on governmental public health workers. Almost 25% of governmental public health workers reported experiencing bullying, threats, and/or harassment⁴. The bullying, threats, and harassment experienced by governmental public health workers have led to hundreds of workers leaving the workforce.

If we fail to pay more attention to burnout among the public health workforce, we may lose a new generation of critical workers. The Surgeon General’s Advisory recommended that we invest in evidence-based practices, plans, and partnerships that ensure the health, safety, and well-being of health workers, which includes enacting laws that protect public health workers from threats and harassment. In addition to ensuring the safety of health workers, the Surgeon General’s Advisory also provides collaborative recommendations that stakeholders such as policy makers, health care organizations, communities, academic institutions, and researchers can use to address burnout. Within the workplace, the Surgeon General’s advisory recommends the following: 1) the elimination of punitive policies for seeking mental health and substance abuse care, 2) the reduction of administrative and other workplace burdens to help health workers make time for what matters, 3) the transformation of organizational cultures to prioritize health worker well-being and show all health workers that they are valued, and 4) the prioritization of social connection and community as a core value of the health care system.

Public health workers, like clinical health care providers, are on the frontline protecting the public’s health and responding to public health emergencies. It is thus important to include them with clinical healthcare providers when seeking to characterize and address health worker burnout. The public health workforce is already understaffed and underfunded and has been since well before the pandemic began. Efforts need to be made to support, sustain, and grow the current public health workforce. Public health emergency response, such as COVID-19, places public health workers at increased risk for burnout and experiencing bullying, threats, and/or harassment, all of which greatly challenge public health’s emergency response abilities.

References

1. Metlaine A.; Sauvet F.; Gomez-Merino D.; et al. Sleep and Biological Parameters in Professional Burnout: A Psychophysiological Characterization. PLoS One 2018, 13, e0190607. doi: 10.1371/journal.pone.0190607.
2. Shanafelt T.D.; West, C.P.; Dyrbye L.N.; et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians Over the First 2 Years of the COVID-19 Pandemic. Mayo Clinic Proceedings 2022,
3. Shanafelt T.D.; Dyrbye L.N.; West C.P.; Sinsky C.A. Potential Impact of Burnout on the US Physician Workforce. Mayo Clinic Proceedings 2016, 91, 1667–1668. 
4. Willard-Grace R.; Knox M.; Huang B.; Hammer H.; Kivlahan C.; Grumbach K. Burnout and Health Care Workforce Turnover.  Annals of Family Medicine 2019, 17, 36-41.
5. National Academies of Sciences, Engineering, and Medicine, Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press. Retrieved from https://nam.edu/systems-approaches-to improve-patient-care-by-supporting-clinician-well-being/
6. Stone K.W.; Kintziger K.W.; Jagger M.A.; Horney J.A. Public Health Workforce Burnout in the COVID-19 Response in the U.S. International Journal of Environmental Research and Public Health 2021, 18,4369 https://doi.org/10.3390/ijerph18084369
7.  Bryant-Genevier, J., Rao, C., Lopes-Cardozo, B., et al. Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021. Morbidity and Mortality Weekly Report 2021, 70, 1680–1685. DOI: https:// http://www.cdc.gov/mmwr/volumes/70/wr/mm7048a6.htm?s_ cid=mm7048a6_w

Skky Martin, PhD (c), MA, is a researcher at the Center for Public Health Systems. Her research interests include health disparities, social determinants of health, and the interrelationship between public health and medical education. She has experience in qualitative methods and analysis, writing surveys, and using STATA to create and analyze quantitative datasets. Ms. Martin holds a master’s degree in sociology and a Certificate in Public Health from Loyola University Chicago. She is a doctoral candidate at Loyola University of Chicago in sociology. Her dissertation specializes in medical sociology and health education, focusing on the ways in which patients, providers, and medical schools experience and conceptualize racial and ethnic disparities in maternal health.