Blame The Regulatory State For The Healthcare Burnout Crisis

The surgeon general just came out with an ominous new warning—but it doesn’t involve tobacco, alcohol, or any other substance.

Instead, Dr. Vivek Murthy raised the alarm about the growing burnout crisis among America’s healthcare workforce. His report details the problem at length and even proposes a long list of solutions that state and federal policymakers could pursue.

Unfortunately, the report mostly downplays one of the best solutions — reducing the thicket of unnecessary regulations that so frustrates doctors, nurses, and administrators.

Job burnout—defined by the Mayo Clinic as “a special type of work-related stress” that leads to “a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity”—is rampant among healthcare professionals. The surgeon general cites a National Academy of Medicine study that found that up to 54% of nurses and physicians and up to 60% of medical students and residents report symptoms of burnout.

In fairness, Dr. Murthy’s report does note that administrative burdens are a cause of the problem. But it understates the role of ill-conceived regulations, which are perhaps the single biggest driver of the burnout crisis.

In a 2018 poll sponsored by the Physician’s Foundation, 40% of doctors identified regulatory burdens as one of the least satisfying aspects of their job. In another survey that same year, 79% of doctors named administrative hassle—a common side-effect of overregulation—as the top factor ruining the practice of medicine.

Doctors spend a significant amount of time on “indirect patient care”—paperwork, in layman’s terms. According to a recent study published in the journal JAMA Internal Medicine, first-year residents collectively spend more than 10 hours a day interacting with a patient’s medical record or documenting what they’re doing.

Or consider the onerous scope-of-practice restrictions in many states. These rules prohibit nurse practitioners and physician assistants from providing certain types of routine care without the supervision of a doctor, even though studies have shown that patients treated by these professionals experience health outcomes that are just as good, or even better, than the outcomes reported by patients treated by physicians. Fortunately, 26 states and the District of Columbia now allow nurse practitioners and physician assistants to practice independently, without the supervision of a physician.

These restrictions increase the workload on doctors and can demoralize nurses and physician assistants. And that can cause people to leave the medical field. Almost 22% of doctors are contemplating an early retirement because they feel overworked, according to a December 2021 survey by Doximity. Another 12% are considering a career change.

As this burnout crisis grows more acute, even more healthcare professionals will quit their jobs. The remaining workers will find themselves stretched even thinner than they are today. That will create a negative feedback loop that leads to yet more exhaustion and early retirements.

The Association of American Medical Colleges estimates that the country will be short as many as 124,000 physicians by 2034. The undersupply of nurses is already so severe that more than one in six hospitals reported “critical nursing shortages” this winter. Some states had to request assistance from the National Guard to staff hospitals.

Ironically, all of this regulation, which is intended to keep people safe, actually endangers patients by fostering burnout. Doctors who report symptoms of burnout are 2.2 times more likely to make medical errors.

The sheer number of regulatory and administrative requirements placed on doctors and other healthcare workers has made these professions far more stressful, tedious, and exhausting than they need to be. Reducing this regulatory burden, and thus combating burnout, is quite literally a matter of life and death for patients.