A System That's Sick

Even before the pandemic, physicians in America were feeling the strain. Long hours, less time with patients, a broken insurer/payment system—all were driving physicians to contemplate leaving the profession. COVID only exacerbated the problem.

What’s surprised Sawyer Business School Healthcare Administration Professor Erin Sullivan is how deep-seated that problem is. Over the past few years, Sullivan has been the principal investigator on several studies exploring the issue of physician burnout, and the findings suggest an alarming prognosis for the future of American healthcare.

For example, a March 2023 survey cited in her article “Primary Care in Peril,” which appeared in the New England Journal of Medicine Catalyst, asked 850 primary-care clinicians to respond to this statement: “It was a rough three years [since the pandemic], but primary care has recovered and requires no intervention.”

A mere 1% of respondents agreed.

The article outlines a number of recommendations, including a two-phase approach to reforming primary care. The first “emergency” phase includes actions like establishing a federal emergency primary care support fund and maintaining pandemic innovations such as parity payments for telehealth visits and relief from administrative burdens. The second “urgent” phase includes making improvements to create sustainable work lives and articulating a vision for primary care.

If concerns are not addressed, the article posits, “there is widespread fear that primary care might not survive.”

The Sickness Is Spreading

It’s not just physicians who are feeling the fatigue: healthcare leaders are also under strain. In another paper published in the summer of 2024 in the Journal of Rural Health, Sullivan and her co-authors found that 40% of respondents were experiencing burnout, and that 50% intended to leave their leadership roles within two years.

“CEO turnover in rural hospitals negatively affects employee morale and relationships with the medical staff,” said Sullivan. “It can also stall an organization’s strategic planning at a time when the healthcare environment is constantly being disrupted.”

What’s causing such epic stress? Some factors are predictable: regulatory pressures, dealing with insurers, and finding and retaining staff. Others are less specific, like managing difficult relationships with providers and communities, as well as the relentless pace of change in healthcare.

Solutions are hard to come by. One conclusion from a pre-COVID paper that Sullivan published in HealthCare: The Journal of Delivery Science and Innovation found that healthcare teams that work on decreasing administrative waste while also strengthening bonds and building camaraderie had the best results in decreasing burnout.

But small solutions won’t cure systemic problems. Sullivan says it’s also a question of identifying and scaling evidence-based solutions to fix the problems. “We don’t need to keep asking: ‘Is there is a problem?’” she says. “That’s very clear. Instead, maybe we should be asking ‘How do we build better healthcare organizations where employees thrive?’”