Today in JAMA Network Open, researchers present findings on high levels of burnout—but decreasing professional stress—among workers (HCWs) in the US Veterans Health Administration (VHA), particularly at the peak of the COVID-19 pandemic.
VHA researchers led the analysis of annual survey responses from HCWs at 140 medical centers from 2018 to 2023. The number of participants ranged from 123,271 in 2018 to 169,448 in 2023. Participants responded to the statements, "I feel burned out from my work" and "I worry that this job is hardening me emotionally" from the Maslach Burnout Inventory in all study years and were asked about COVID-related professional stress from 2020 to 2023.
In 2018, the sample was 71.6% women, the average age was 46.3 years, and the estimated average number of years worked at the VHA was 8.5 years.
During and after the pandemic, "the VHA implemented many programs to continue to provide high-quality care for patients, mitigate employee burnout, and improve employee well-being, such as introducing whole health practices to employees, reducing workload by hiring more employees, and increasing options for telehealth and telework," the study authors wrote. "The impact of these incipient changes on burnout has not been studied."
Highest burnout in primary care docs
Burnout rates were 30.4% for 2018, 31.3% for 2019, 30.9% for 2020, 35.4% for 2021, 39.8% for 2022, and 35.4% for 2023. Conversely, rates of COVID-related professional stress were 32.0% for 2020, 26.9% for 2021, 29.2% for 2022, and 21.4% for 2023. Rates of both burnout and stress declined after the official public health emergency ended in 2023.
Primary care physicians reported the greatest burnout (range, 46.2% in 2018 to 57.6% in 2022), and burnout levels rose by at least 10% over the study period for dentists (from 26.7% to 41.7%), psychologists (from 34.1% to 47.6%), dietitians (from 26.3% to 38.6%), and optometrists (from 36.9% to 46.7%).
Burnout increased in all service areas between 2018 and 2021, with the largest jumps in dental (from 30.7% to 39.6%), mental health (from 30.4% to 38.2%), and rehabilitation (from 27.1% to 34.1%). But in 2022 and 2023, all service areas experienced a decrease in burnout, with the greatest reductions in emergency medicine (from 43.3% to 35.2%), laboratory and pathology medicine (from 46.6% to 39.0%), intensive care (from 39.7% to 32.5%), and acute care (from 44.5% to 37.3%).
COVID-19 stress fell by at least 10% in 20 occupations during the study period. The largest decreases were among registered nurses (eg, level 5, from 45.6% in 2020 to 24.2% in 2023), licensed practical nurses (from 36.0% to 24.7%, respectively), audiologists (35.0% to 15.5%), optometrists (from 29.9% to 11.0%), psychologists (from 31.9% to 14.3%), and physical therapists (from 27.9% to 14.3%).
All service levels saw less stress from 2020 to 2023
HCWs working in an intensive care unit (ICU; 48.6%), emergency medicine (45.8%), acute care (40.0%), and community living centers (39.6%) reported the highest stress levels when the pandemic began. But all service areas saw a decline in professional stress from 2020 to 2023, with optometry (16.3%), administration (14.1%), emergency medicine (13.2%), and ICU (12.9%) having the largest decreases.
Burnout rates among nurses were much higher than several of the physician specialties, highlighting the need for tailoring approaches to specific occupations.
The proportion of HCWs with limited telework climbed from 8.4% in 2018 to 20.9% in 2023 and increased for those with majority telework from 3.4% to 11.8%, respectively. In general, burnout levels among majority-remote workers ranged from 26.2% in 2018 to 37.7% in 2022, lower than for HCWs who worked only onsite (30.5% to 40.0%, respectively).
HCWs who worked at home most days of the week had lower stress rates by year, while those who worked only in person experienced the most stress.
Geographic regions with the largest increases in burnout from 2018 to 2023 were the Pacific (7.0%), West North Central (6.5%), New England (6.0%), and South Atlantic (5.7%). HCWs in the East South Central (6.6%), West North Central (6.1%), and Mountain (5.6%) regions had the largest drops in burnout from 2022 to 2023.
The largest decreases in professional stress between 2020 and 2023 were observed in the West South Central (-12.7%), East North Central (-12.2%), and East South Central (-11.7%) states.
"We noticed burnout increased over time during the pandemic, while professional stress began to decline," the authors wrote. "This may be due to the initial set of shocks and uncertainty followed by greater stabilization that led to pandemic-related stress to decrease."
They said research that evaluates wellbeing among only physicians is insufficient. "Burnout rates among nurses were much higher than several of the physician specialties, highlighting the need for tailoring approaches to specific occupations," they noted. "For example, offering alternative work schedules may be especially beneficial for nurses."
Sharing wellbeing data with patients, workers
In a commentary on the study, Eric Apaydin, PhD, of the VA Greater Los Angeles Healthcare System, said tracking burnout among HCWs at the organizational level is needed to understand and reduce the phenomenon, including among private-sector employees. "Employing organizational interventions is a key strategy to reduce job demands or increase job resources, ultimately reducing burnout," he wrote.
