For the last four years, Atromitos has been privileged to sponsor the Greater Wilmington Business Journal’s annual recognition of healthcare workers in southeast North Carolina – Health Care Heroes. We know first-hand the dedication, commitment, and sacrifice that healthcare workers demonstrate every day. The experience of the COVID-19 Pandemic over the last year and a half has provided a more prominent view of what healthcare workers do for each of us, individually and as a community.
We’ve all seen the media pictures of healthcare workers with bruised faces because of the extended time wearing multiple layers of masks and other protective equipment. We’ve read the stories of health care providers suffering emotional exhaustion and depression as they continue their Sisyphean task to prevent the deaths of patients hospitalized with COVID-19, convince the public to get the vaccine and find the best way to care for patients with long term effects from the virus.
Communities across the country provided encouragement and support through billboards recognizing the health care heroes in their communities, sending meals to hospitals and other health care settings, holding car parades with signs thanking them for all that they are doing. All these efforts were wonderful, and I am certain they brought small moments of joy to those who they were directed at.
But we also must recognize that, while these individual and collective acts of recognition and gratitude are important and valued, if we are not willing to address the systemic problems that make being a healthcare worker in the United States so hard – then it all rings a little hollow.
In many ways, COVID shined a floodlight on our health care system. While we saw incredible moments of innovation and heroism, the strain of the crisis has also exposed and accelerated the many failings of our health care system. Among these issues is how hard it can be for our healthcare workers to operate in environments where they do not have the resources or support to meet their mission. From the physician to the community health worker to the janitorial staff member: healthcare workers are asked to do more with less, and for more people. This is not sustainable, healthy, or fair.
Indeed, provider burnout is a real problem, and we have the data to back it up. The Agency for Healthcare Research and Quality has evaluated the problem for the last fifteen years, examining the causes of burnout and evaluating its impact on patient care. Through this research they have identified the primary causes of burnout: and it is not the demands of providing clinical care itself – instead, it is the work conditions providers operate in. Namely, time pressure, chaotic environments, low locus of control over work pace, poor organizational culture, and (the ever-present) frustrations with EHRs. It says something (and nothing good) when the hardest part of one’s job (a job that might involve life and death, code reds and comforting grieving patients or family members) is that one consistently doesn’t have enough time to do the job. I also found this study interesting in what it tells us about patient outcomes as it relates to physician burnout – namely that burnout is not consistently associated with quality of care. Instead, “although physicians are affected by work conditions, their reactions do not translate into poorer quality care because the physicians act as buffers between the work environment and patient care.” [emphasis added] That there is heroic.
But it isn’t sustainable, and it is profoundly unjust that we continue to exploit the self-sacrifice and vocational commitment of our healthcare workers. Over half a million healthcare workers have left the workforce since February 2020. A national survey concluded that 31% of those who’ve remained in their roles have considered leaving. For decades we have had a shortage of healthcare workers. In North Carolina, we have 547 designated health professional shortage areas and that only covers primary care, behavioral health, and dental professionals.
In the absence of action to correct the reasons for this exodus and burnout, the gap between supply and demand is only going to get greater – and quicker.
So, what do we do?
COVID has forced us to confront several disparities and problems that exist in our health care system – from racial and ethnic, to economic, to how we fund aspects of our health care infrastructure. We have seen and experienced the consequences when we fail to take action to address the root causes of issues or, otherwise fail to follow (and implement) the evidence.
This is one of those #wicked problems that requires collective and political action to correct. That problem is this: how do we create and maintain a sustainable health delivery infrastructure that is not wholly dependent upon the sacrifice of the health workforce? How do we fix a system where the biggest battles our health care heroes confront isn’t a once-in-a-century pandemic but the conditions in which they work?
We are a democratic, representative society. At the end of the day, the actions of our leaders, reflect our values. While we may (and I do) descry the failures of our leaders over the last two years to (consistently) implement hard decisions informed by valid information, at the end of the day, the buck stops with us.
In North Carolina and other states across the country, municipal elections are taking place in early November. For those who think that local elections don’t matter, you couldn’t be more wrong. All politics are local – but this is particularly true in the health and welfare space, where the decisions that directly impact health and wellbeing (public health, social services, education, infrastructure) are implemented.
I want to be clear: I’m not advocating for any candidates or a political party. Instead, I am advocating for the electorate – each and every one of us – to take the time and ask questions of the candidates and insist on real answers – not sound bites. We must be tenacious – and hold our candidates, our representatives and ourselves accountable. To quote the great Abraham Lincoln “Elections belong to the people. It’s their decision. If they decide to turn their back on the fire and burn their behinds, then they will just have to sit on their blisters.”
Finally, on a more personal note: earlier this month, I joined one of my Atrómitos colleagues in Washington, DC and visited the memorial dedicated to those lost to COVID in the US – In America: Remember. Looking out over acres of small white flags, 700,327 to be exact, each representing a life lost to COVID, it was impossible not to be reminded of a war memorial. The analogy does not stop there, of course. It made me think about collective action, sacrifice, and what we owe to those who serve. It reminded me of Winston Churchill’s commemoration of the Royal Air Force following the Battle of Britain: “never in the course of human conflict was so much owed by so many, to so few.” We owe more than just our thanks to healthcare workers, we owe positive, concrete action which includes providing the tools necessary to complete the mission. We owe it to them, and to ourselves, to be informed and active citizens in our society so that we are able to build a future “fit for heroes.”
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