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EDITORIAL: The cost of health care worker burnout

Katie Tabeling

Health care workers are pushed to the brink, leaving Delawareans to face gaps in health care coverage. | PHOTO COURTESY OF ONLINE MARKETING/UNSPLASH

At the end of last year, the Delaware Journal of Public Medicine wrote a report titled “Unraveling Healthcare Shortages in Delaware and Charting a Course for Equity and Resilience.” It noted that Delaware faces multifaceted challenges, not just in the workforce but in the skillset of those practitioners who choose to leave.

That means when mental health practitioners or OB-GYNs leave, it’s harder to fill those spots. That report found that primary care services are needed in low-income populations in South Wilmington and the greater Newark area, as well as dental health. In Sussex County, La Red Health Center shows the greatest need, scoring the highest on the scale.

It’s no secret that our health care services in Delaware have long been under pressure. For years, there’s been reports about primary care and nursing shortages and constant struggles to keep providers here. In 2021, the state Department of Public Health and Social Services issued a report stating that there were 865 physicians in the state and, while 83% were accepting new patients, only 68% took Medicare and 76% took Medicaid.

By 2026, an average of 70% physicians predicted they would continue practicing. But in Kent County, arguably the most rural county of the state, that percentage drops to 53%.

Another report by the Delaware Academy of Medicine/Delaware Public Health Association found that 3,226 nursing licenses expired in 2019. Another 1,194 Delaware nurses, of all license types, were of retirement age.

The COVID-19 pandemic added more stress on services. In January 2023, ChristianaCare told the Delaware Business Times it had 400 nursing positions open. Nemours faced a turnover of 50% between 2022 and 2023. Inflation has driven up costs and the turnover has required many health care providers to rely on contract workers to fill the gaps when hospital systems were in critical need for health.

But here we are in 2024, and the issues seem to be getting more dire. The American Medical Association partnered with the Mayo Clinic and Stanford Medicine on a survey that showed the burnout rate doubled between 2021 and 2020. Around that same time, the AMA called it a health crisis.

What does it mean for patients when our health care system has to struggle with overworked providers?

I can’t speak for the whole of Delaware, but I will share my personal experience.

It means that if I had to call three different doctors’ offices to try and find where the best doctor I ever had as an adult went after her practice closed. I failed, by the way, and I had to settle for an appointment with a new one a year out.

It means that unless I schedule appointments before I leave the office, even if the nurse or doctor doesn’t say so, or I won’t see them at all. It makes staying on top of my one-year-old daughter’s doctor one of my most top priorities in my life. But it also means I have fallen out of touch with many members of my care team, ranging from therapists to OB-GYNs.

It means that when my mother broke her elbow, she had to wait four hours in the emergency room to be seen and was discharged at 5 a.m. Granted, it was a busy night in the ER, but also that trip coincided with ChristianaCare doctors filing paperwork to unionize, citing being overloaded and not having enough time with patients.

From an economic standpoint, another study published in “Annals of Internal Medicine” estimated the cost of burnout was $4.6 billion on a national scale, tied to costs of physician turnover and reduced clinical hours. At an organizational level, the annual economic costs are $7,600 employed physicians per year.

There are some solutions on the table, such as continuing to find ways to minimize the clerical work and maximize time with patients. That can also be done not only through digitization, but by dramatically reducing the documentation required and leveraging virtual assistants or even artificial intelligence to document patient encounters.

In Delaware, looking at student loan forgiveness programs, tax incentives and more may be an excellent way to draw talent here, specifically to underserved areas. The state is well known for its unique ability to collaborate quickly to find solutions. It should also start to unite to find workforce development institutions and other partnerships to share resources.

The health of the state is everyone’s business, and we need to be invested to work and solve this for all Delawareans.

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