The Health Care Crisis Nobody Is Talking About - Annals of Internal Medicine: Fresh Look Blog


Wednesday, February 16, 2022

The Health Care Crisis Nobody Is Talking About

“And the moral of that is—‘Oh, ‘tis love, ‘tis love, that makes the world go round!’”

“Somebody said,” Alice whispered, “that it’s done by everybody minding their own business!”

“Ah well! It means much the same thing,” said the Duchess, digging her sharp little chin into Alice’s shoulder as she added, “and the moral of THAT is—‘Take care of the sense, and the sounds will take care of themselves.’”
—Chapter 9, Alice's Adventures in Wonderland, by Lewis Carroll

If the practice of medicine is making you miserable, that’s because it is. Miserable.

I spent my “lunch break” going to a coding session. It was the adult physician equivalent of a timeout. The coders explained to me that if my clinic encounter didn’t match up with the correct financial identification number, my encounter could not be appropriately billed and therefore “didn’t count.” I can only say that during the meeting, my soul left my body for a brief moment, wondering: Even if we code everything perfectly, how much does our work really count?   

This pandemic didn’t create burnout, but it didn’t do it any favors. Han and colleagues (1) analyzed the financial costs of burnout and estimated that it resulted in approximately $4.6 billion because of physician turnover and reduced clinical work. This was an estimate based on mathematical modeling, with upward estimates of $6.3 billion in burnout-related costs. This was prepandemic.

As we near the 2-year mark of the COVID-19 pandemic, I would venture to guess that burnout costs far exceed those previous models. Fear of transmitting the virus led health care professionals to isolate from family and others for several months. We changed on a dime to incorporate telemedicine to meet the needs of our patients who were understandably reluctant to come to the hospital. Health care workers suffered financial losses from cancellations of office visits and elective procedures. The COVID-19 pandemic has disproportionately affected women in health care who have had to fulfil their professional responsibilities all while navigating child care, homeschooling, and elder care as well as running their households (2). Medical trainees at all levels had their education abridged, the effects of which we may not know for quite some time. Ironically, 2020 saw an increase in medical school applicants, whereas health care workers across the spectrum are leaving the workforce.

Many of these are unavoidable effects of a global outbreak of a deadly, highly contagious virus. However, it has affected the psyche of patients and health care workers alike. More people seem to be struggling with mental health issues on top of other medical problems. We are also navigating the precarious landscape of a patient population who has grown highly distrustful of science and facts themselves, many of whom channel their own frustrations by abusing health care workers.

Who is helping us? Where is the support? Quitting is 1 way to deal with the problem, but what happens when we run out of health care personnel? That would be a devastating public health crisis, and it is unfortunately imminent.

The true cost of burnout isn’t $6.3 billion. It is health care itself. If we go too far down this rabbit hole, we won’t have anything left to save.


  1. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170:784-790. [PMID: 31132791] doi:10.7326/M18-1422
  2. Mehta S, Machado F, Kwizera A, et al. COVID-19: a heavy toll on health-care workers. Lancet Respir Med. 2021;9:226-228. [PMID: 33556317] doi:10.1016/S2213-2600(21)00068-0

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