Surgeon General Issues Advisory Addressing Health Worker Burnout: Gamechanger?

Promoting the wellbeing of physicians has long been a top priority for ACEP, and now, I’m happy to say that the federal government is also stepping up to the plate. A few months ago, I wrote about an interview that Dr. Glaucomflecken had with the U.S. Surgeon General, Dr. Vivek Murthy, about the strain that the COVID-19 pandemic is putting on clinicians and how that is leading to significant burnout. Dr. Glaucomflecken is an ophthalmologist and comedian who posts hilarious, but extremely poignant, short videos (featuring himself) about important health care topics on Twitter. During the interview, Dr. Murthy made a “personal” appeal (on behalf of the federal government) to all health care workers on the frontlines, saying that “we see you, we appreciate you, and we have your back.”

Well, it took him a while, but this week, the Surgeon General took a significant step forward fulfilling this promise. On Monday, the Office of the Surgeon General issued an advisory formally acknowledging the mental health crisis amongst health workers. The 70-page document affirms what ACEP members already know firsthand: that the pandemic magnified and amplified the societal, cultural, structural, and organizational factors contributing to burnout. It identifies groups of health workers whose health and well-being have been disproportionately impacted both before and during the pandemic, including health workers of color, immigrants, women, and those in rural settings. Overall, the advisory estimates that the financial impact of workforce turnover amongst physicians is $6 billion.

The advisory also outlines factors leading to severe burnout and the pathway to mending these challenges with workforce preservation in mind. These guidelines include:

• Protecting the health, safety, and well-being of all health workers;
• Eliminating punitive policies for seeking mental health and substance use care;
• Reducing administrative and other workplace burdens to help health workers make time for what matters;
• Transforming organizational cultures to prioritize health worker well-being and show all health workers that they are valued;
• Recognizing social connection and community as a core value of the health care system; and
• Investing in public health and our public health workforce.

Further, it includes specific resources to support health workers’ health and well-being, including ACEP’s Being Well in Emergency Medicine: Guide to Investing in Yourself.

While it is great that the Surgeon General is making this issue a priority, it is important to treat the advisory for what it is and to understand its limitations. It is truly a call-to-action and includes some great ideas about what specific steps different stakeholders (government officials, health insurers, technology companies, health care organizations, and health workers themselves) can take to “invest in health workers and safeguard their wellbeing.” The advisory also highlights some previous accomplishments from this administration, suggests best practices, and provides useful resources.

HOWEVER, it does not include any new, concrete policies that the federal government will either formally introduce in the near future or begin enforcing. The bottom line is that the Office of the Surgeon General does not have any regulatory authority, so it can’t effectuate any changes on its own.

Let me give you a couple of examples of this. In the section of the report called “What Federal, State, Local and Tribal Governments Can Do,” the Surgeon General lists ideas with which we all strongly agree, including the following:

• States and local governments should protect all healthcare workers from workplace and community violence.
• We should build on and evaluate the impact of investments such as The Dr. Lorna Breen Health Care Provider Protection Act 2022.
• We should examine state health professional licensing board questions in applications and renewal forms for licensure so that health workers are only asked about “conditions that currently impair the clinicians’ ability to perform the job”; and
• The federal government will partner with health care delivery organizations, professional associations, and other stakeholders to reduce documentation burden by 75% by 2025.

Sounds awesome right? These are all our top priorities (which I have discussed in previous Regs and Eggs blogs), and we couldn’t have written these policy recommendations better ourselves! However, the Surgeon General needs Congress, other federal agencies, state and local governments, and health care organizations to step up in order to accomplish all of these policies. Thus, it definitely remains to be seen whether these different stakeholders play ball and whether any of the Surgeon General’s policy recommendations will actually come to fruition.

Although the advisory won’t improve the situation on the ground immediately, I’m hopeful that it will build on the momentum we achieved through the passage of the Lorna Breen Act and that it will help pave the way for the changes we desperately need. The advisory also isn’t sitting alone in a vacuum. Simultaneous to this advisory, the National Academy of Medicine (NAM) released a draft National Plan for Health Workforce Well-Being. ACEP has provided feedback on this plan and is exploring opportunities to take an active role in some of the initiatives that are included within it. We have also been partnering on a national level with the ALL IN: Wellbeing First for Healthcare Coalition (started by the Lorna Breen Foundation) and will be working hand-in-hand with that coalition to devise a game plan of how we can actually implement some of the policies included in both the advisory and NAM’s national plan.

Before concluding, I want to let you know that we have a great team at ACEP dedicated to this work, led by Dr. Jonathan Fisher and Alyssa Ceniza, and they are happy to talk to you in depth about ACEP’s many wellness resources and initiatives.

We know that we still have our work cut out for us to address the numerous underlying factors that are contributing to burnout and affecting your mental health, but with the Surgeon General’s backing and momentum on this issue growing, hopefully more and more of the policies that we have been advocating for will finally be implemented.

Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!