Posted: December 5th, 2022

Implicit Bias in Healthcare Linked to Burnout

Implicit Bias in Healthcare Linked to Burnout, Causing a Staffing Crisis

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In today’s world, we could gather and discuss a wide range of issues concerning the healthcare industry, particularly the factors that contribute to many disparities. For example, we could look at preventable medical errors, high healthcare costs, a lack of insurance coverage, and a lack of medical insurance education (Medifind, n.d.). The list could go on forever. One issue that I believe is one of the most serious in today’s healthcare industry is staffing shortages caused by burnout. Because one can specifically research staffing shortages in a specific state, one may discover staffing shortages in nearly every county in the state (Mua-find, n.d.). Burnout is causing shortages not only in hospitals but also in outpatient clinics and skilled nursing facilities in our country (Stulick, 2021). We are experiencing significant shortages in nursing and physicians. As the list continues, consider the following questions: Why is there so much burnout in nearly every healthcare discipline? Is burnout contributing to differences in implicit bias among the many patients seen? And how can burnout be addressed, which contributes to implicit bias disparities?
It is clear that the healthcare industry today has taken a physical and mental toll on those who work in it. Burnout is a significant issue in the healthcare industry (Reith, 2018). The healthcare workforce is known to be aging, and burnout is leading to earlier retirement (Boyle, 2020). Compassion fatigue is also a problem in the healthcare industry, leading to rash decisions and a bias toward patient care. Burnout among healthcare professionals, as stated in the Surgeon General’s Current Priorities, is harmful to everyone. If the health worker burnout crisis is not resolved, it will make it more difficult for patients to receive needed care, raise healthcare costs, make it more difficult to prepare for the next public health disaster, and exacerbate health disparities (Current Priorities of the U.S. Surgeon General, n.d.).
Nurses and doctors are currently facing the greatest increase in staffing shortages (Reith, 2018). Numbers of nurses and doctors vary from state to state, and this is especially true in the midst of a pandemic. According to “The 2021 American Nursing Shortage: A Data Study,” the nursing shortage did not begin during the pandemic, but had reached an all-time high by 2012. According to the same study by the University of St. Augustine for Health Sciences, 1.2 million nurses are needed by 2030 to cover the current shortage in the United States. And, as of February 2021, the nursing industry is the fifth most in-demand job.
Physician supply and demand are nearly identical to those in the nursing industry. By 2032, the supply will have met a much lower demand than expected. Thus, with a significant decrease in physician population, how will these numbers meet the needs of an ever-growing population? According to Renfrow, the Association of American Medical Colleges (AAMC) describes the supply and demand for physicians as increasing (2021). The factors that contribute to these figures continue to be consistent across all healthcare disciplines. The article “U.S. Physician Shortage Growing” provides a comprehensive understanding of the specific known factors that contribute to the figures below (Boyle, 2020).
As more research in the healthcare industry linking burnout to a shortage crisis is presented, we will be able to delve deeper into how healthcare professionals may develop a bias toward patients. Unconscious or implicit bias pervades all of our interactions with other members of society. These biases are caused by attitudes and/or previous experiences, both of which influence how we perceive the world. As a result, our behavior, judgment, and interpersonal interactions are affected. From an evolutionary standpoint, these ingrained biases evolved to protect the human race’s survival (Cawcutt et al., 2021).
Based on previous experiences, the ability to quickly determine whether a situation was dangerous or secure was critical. These brain shortcuts and associations still exist today and help us categorize and react to situations and relationships. Prejudices, both explicit and conscious, as well as implicit and unconscious, exist in the field of health care, just as they do in society. These biases influence how we interact with coworkers, how we approach specific situations, and how we care for patients (Cawcutt et al., 2021).
Another study, led by Dr. Vineet M. Arora and Dr. Anita Blanchard of the University of Chicago Medicine’s Department of Medicine, explains burnout and bias in resident physicians. Given the study’s validity, it may be easy to conclude that prejudice among resident physicians is a result of burnout. It is explained that in this case, burnout is not the primary cause of the prejudice. Instead, the study demonstrates that burnout reveals a bias that was present from the start. In this case, preventing burnout may temporarily reduce the sense of prejudice, but it will not eliminate the underlying bias, which still exists and may become apparent if a doctor is exposed to another external stressor. To break the cycle, it will be necessary to address both bias and exhaustion simultaneously (Arora VM, Blanchard A, 2019).
The article by Dr. Vivek H. Murthy delves deeper into health worker burnout and well-being. It is stated that more than half of healthcare professionals experience burnout symptoms, and many also struggle with mental health issues such as insomnia, depression, anxiety, or post-traumatic stress disorder. Burnout appears in some people; it is essentially a systemic issue. Furthermore, the issue of health professional burnout existed prior to COVID-19. The inability to provide patients with the care they require causes moral harm. Other factors considered were a lack of support, increased workloads and administrative responsibilities, a history of underinvestment in public health facilities, and insufficient funding. Working long hours is not the only cause of burnout. The motivational goals of health professionals and the purpose they serve are fundamentally at odds (Murthy, 2022).
These systemic deficiencies have pushed millions of health professionals to their breaking point. According to the American Nurses Foundation and the Mayo Clinic Proceedings, 20% of doctors and 52% of nurses plan to retire from clinical work. The US Bureau of Labor Statistics predicts a shortage of more than 1 million nurses by the end of the year, as well as 3 million low-wage health workers over the next three years (Mercer). Overall, there is a severe shortage of public health professionals, which is required to strengthen defenses against potential threats to public health. Burnout among health-care workers is a serious threat to the nation’s health and economic security (Murthy, 2022).
As we can see from the research, working in the healthcare industry can be extremely stressful. These stressors include a lack of social support at work or poor relationships with management, heavy workloads, uncertainty about how to care for patients, a lack of control over various work processes, and a tendency to have emotional outbursts as a result of dying or in pain patients. When a clinician is emotionally exhausted, their workload overwhelms them to the point of fatigue, inability to meet job demands, and inability to interact with other healthcare workers. The majority of studies show that healthcare burnout reduces care quality because doctors and nurses would rather do urgent or necessary tasks than provide good care (Eliacin et al., 2018).
Furthermore, burned-out professionals frequently experience impaired focus, memory loss, or poor function, which reduces their recollection of or attention to various important healthcare facts. Burned-out therapists are also cynically and directly disengaged from their jobs, developing negative attitudes toward patients in particular, who encourage a lack of interest in clinicians. Employee burnout also has an impact on healthcare delivery because it limits or stops interactions between providers, disrupts communication, and results in the loss of critical data needed to make decisions (Johnson, J., 2018).
After researching the various healthcare disciplines and the factors that contribute to burnout, which has resulted in such shortages, we discovered many similarities. The question remains: how do we address this issue? I strive to educate and promote the importance of health and wellness to not only the staff but the entire healthcare community as someone with experience in health and wellness education. Healthcare promotion will continue to remind the industry of the benefits of staying healthy, lowering the percentage of medical needs. It is also important to remind people that help is on its way during times like these. Knowing educational faculty in a variety of healthcare industries, it has been mentioned that schools intend to accept more students into programs and are expanding hybrid and online programs. This concept enables the number of healthcare workers to grow and meet demand by increasing graduation rates (Duquesne University School of Nursing, 2020). Having said that, licensed healthcare workers now have more opportunities than ever to advance their careers and earn more money online (U.S. Bureau of Labor Statistics, 2021). More help is known to improve staffing while decreasing burnout among overworked individuals. Less burnout, according to the trends, can lead to less implicit bias toward patients.
Finally, it is critical to encourage the healthcare industry to participate in an internal or external governing body that will allow positive change to be promoted. A governing body allows a group of people to gather data on what needs to change to help others work better, smarter, and thus more efficiently. It will give everyone a voice and support, as well as help to develop better policies and legislation (Duquesne University School of Nursing, 2020). Allowing for growth through positive incentives can help to keep the healthcare industry strong and intact, especially in times like these.

References
A growing crisis: the shortage of physicians. Health is the priority (2020, November 4). https://www.focusforhealth.org/a-growing-crisis-physician-shortage/ .
Arora, VM, and Blanchard, A. Breaking the Burnout and Bias Cycle in Resident Physicians 2019;2(7):e197774. doi:10.1001/jamanetworkopen.2019.7774.
P. Boyle (2020, June 26). The physician shortage in the United States is growing. AAMC. https://www.aamc.org/news-insights/us-physician-shortage-growing .
Clance, Cawcutt, and Jain (2021, November 16). Liebertpub.com. Liebertpub.com. Retrieved November 27, 2022, from https://www.liebertpub.com/doi/abs/ Health Worker Burnout — Current Surgeon General Priorities (n.d.). Current Priorities of the Surgeon General of the United States. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout (accessed November 27, 2022).
M. Flanagan, DeVita Monroe, and S. Wasmuth. Burnout and social capital among mental healthcare providers Journal of Mental Health, 27 (5), pp.388-394, 2018.

Johnson, J. Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and future intervention recommendations International journal of mental health nursing, vol. 27, no. 1, pp. 20-32, 2018.
Medifind.com. (n.d). (n.d.). Mua-find. https://www.medifind.com/news/post/problems-us-healthcare-system (n.d.). https://data.hrsa.gov/tools/shortage-area/mua-find.
V. M.D., M.B.A. Murthy (2022, August 18). https://www.nejm.org/doi/full/10.1056/NEJMp2207252. Burnout and Well-Being in Health Workers https://www.nejm.org/doi/full/10.1056/NEJMp2207252 (accessed November 27, 2022).
T. P. Reith (2018). A Narrative Review of Burnout in US Healthcare Professionals Cureus, vol. 10(12), p. e3681. https://doi.org/10.7759/cureus.3681
J. Renfrow According to the AAMC, 124k more physicians will be needed by 2034, with specialists facing the greatest shortage. FierceHealthcare, https://www.fiercehealthcare.com/practices/physician-shortage-continues-to-worsen-now-estimated-at-124,000-by-2034.
A. Stulick Staffing shortages affect 94% of nursing homes. Skilled Nursing Information. https://skillednursingnews.com/2021/06/94-of-nursing-homes-face-staffing-shortages/ .
“A Data Study of the American Nursing Shortage in 2021.” University of St. Augustine for Health Sciences, www.usa.edu/blog/nursing-shortage/, 11 August 2021. .
The shortage of healthcare workers in the U.S. Duquesne University School of Nursing. (2020, June 26). https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/ .
U.S. Bureau of Labor Statistics. (2021, March 31). 29-1141. registered nurses. https://www.bls.gov/oes/current/oes291141.htm .
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