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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
2022
Addressing
Health Worker
Burnout
The U.S. Surgeon General’s Advisory
on Building a Thriving Health Workforce
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Table of Contents
Introduction from the Surgeon General 3
About the Advisory 5
Dedication Page 6
Background 7
We Must Take Action 18
What Health Care Organizations Can Do 21
What Federal, State, Local and Tribal Governments Can Do 31
What Health Insurers and Payers Can Do 39
What Health Care Technology Companies Can Do 42
What Academic Institutions, Clinical Training Programs,
and Accreditation Bodies Can Do 45
What Family Members, Friends, and Communities Can Do 52
What Health Workers Can Do 54
Where Additional Research is Needed 56
Conclusion 59
Glossary 60
Acknowledgments 63
References 64
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Years ago, when I was training to be a physician, the older, more experienced
doctors passed down a morsel of wisdom to those of us who were just
beginning our careers: “Never stand when you can sit. Never sit when you can
lay down. And never stay awake when you can sleep.” They knew then what we
would come to discover: that health workers, across clinical and community
settings, whether caring for patients or managing a public health crisis,
have long faced difficult, irregular hours in challenging, and extraordinarily
stressful, working environments.
That so many health workers have been able to persevere and perform despite
those conditions is a testament to our training, our teammates, and the
ideals that have called us to serve. But day after day spent stretched too thin,
fighting against ever increasing administrative requirements, and without the
resources to provide our patients and communities with the care they need,
drove many nurses, doctors, community health workers, and public health
staff to the brink. Then came COVID-19. The pandemic has accelerated the
mental health and burnout crisis that is now affecting not only health workers,
but the communities they serve.
During the pandemic, each shift and overtime hour for a health worker often
meant putting their own health and their family’s health at risk in order to
heal, comfort, and protect others. Fear, loneliness, and uncertainty were
pervasive. The threat of targeted harassment and violence underscored many
interactions. Some health workers were forced to wall themselves off from
their loved ones. And too many served as the final comfort for patients walled
off from theirs. COVID-19 has been a fully and uniquely traumatic experience
for the health workforce, and for their families.
The initial reaction to the unprecedented public health impact of COVID-19,
from Italy to New York City, was to recognize and honor the courage of
health workers who stepped up in our collective moment of need. But after
more than two years, multiple waves of infection, and more than one million
precious lives lost in the United States alone, this sense of acknowledgment
and gratitude has faded—one more victim of the fatigue and frustration
wrought by a prolonged pandemic. Today, when I visit a hospital, clinic, or
health department and ask staff how they’re doing, many tell me they feel
Introduction from
the Surgeon General
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
exhausted, helpless, and heartbroken. They still draw strength from their
colleagues and inspiration from their patients, but in quiet whispers they
also confess they don’t see how the health workforce can continue like this.
Something has to change, they say.
They are right. As we transition towards recovery, we have a moral obligation
to address the long-standing crisis of burnout, exhaustion, and moral distress
across the health community. We owe health workers far more than our
gratitude. We owe them an urgent debt of action. This Surgeon General’s
Advisory helps show what’s needed, and how we can do it.
The stakes are high. If we fail to act, we will place our nation’s health at
increasing risk. Already, Americans are feeling the impact of staffing shortages
across the health system in hospitals, primary care clinics, and public health
departments. As the burnout and mental health crisis among health workers
worsens, this will affect the public’s ability to get routine preventive care,
emergency care, and medical procedures. It will make it harder for our nation
to ensure we are ready for the next public health emergency. Health disparities
will worsen as those who have always been marginalized suffer more in a
world where care is scarce. Costs will continue to rise. Equally as important,
we will send a message to millions of health workers and trainees that their
suffering does not matter.
Instead, we can choose to make this moment a collective commitment to care
for those who have always cared for us. When health workers look ahead, they
should see a future where their dedication isn’t taken for granted, and where
their health, safety, and well-being is as much a priority as the well-being of
the people and communities in their care.
Addressing health worker burnout is about more than health. It’s about
reflecting the deeper values that we aspire to as a society—values that guide
us to look out for one another and to support those who are seeking to do the
same. Health workers have had our backs during the most difficult moments
of the pandemic. It’s time for us to have theirs.
Vivek H. Murthy, M.D., M.B.A.
Vice Admiral, U.S. Public Health Service
Surgeon General of the United States
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
A Surgeon General’s Advisory is a public statement that calls the American people’s
attention to an urgent public health issue and provides recommendations for how
that issue should be addressed. Advisories are reserved for significant public health
challenges that need the American people’s immediate awareness.
This Advisory contains steps that different stakeholders can take together to address
health worker burnout. It calls for change in the systems, structures, and cultures that
shape health care. Given the nature and complexity of the challenges outlined, this
Advisory is not intended to be comprehensive in its recommendations.
For this Advisory, we are defining health workers broadly as all the people engaged in
work to protect and improve the health of individuals, communities, and populations,
including those who assist in operating health care facilities.
1, 2, 3
For additional background and to read other Surgeon General’s Advisories, visit
surgeongeneral.gov
About the Advisory
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
During the COVID-19 pandemic,
thousands of health workers lost
their lives. They put their own
health and safety at risk so they
could heal and comfort others.
This call to action is dedicated to their memory.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Our health depends on the well-being
of our health workforce
Even before the COVID-19 pandemic, the National Academy of Medicine found that
burnout had reached “crisis levels” among the U.S. health workforce, with 35-54%
of nurses and physicians and 45-60% of medical students and residents reporting
symptoms of burnout.
4
Burnout is an occupational syndrome characterized by a high
degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low
sense of personal accomplishment at work. People in any profession can experience
burnout, yet it is especially worrisome among health workers given the potential
impacts on our health care system and therefore, our collective health and well-
being. Burnout is associated with risk of mental health challenges, such as anxiety
and depression—however, burnout is not an individual mental health diagnosis.
While addressing burnout may include individual-level support, burnout is a distinct
workplace phenomenon that primarily calls for a prioritization of systems-oriented,
organizational-level solutions.
Burnout among health workers has harmful consequences for patient care and safety,
such as decreased time spent between provider and patient, increased medical errors
and hospital-acquired infections among patients, and staffing shortages.
5, 6, 7, 8
In
addition, health worker burnout can have costly repercussions for the health care
system, with the best estimates linked to the costs of replacing staff. Researchers
estimate that annual burnout-related turnover costs are $9 billion for nurses and $2.6
to $6.3 billion for physicians. These estimates do not include turnover among other
types of health workers across the continuum of care.
9, 10
Background
“I just believe that we need to take good
care of our health care workers, so that
they can take good care of other people.”
Isobel R., NYC, NY / Psychiatry Resident
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Chronic work-related stress, a precursor to burnout, has been associated with
poor physical and mental health outcomes for health workers, including impaired
cognitive function, increased risk of heart disease, type 2 diabetes, fertility issues,
sleep disruptions and insomnia, isolation, family and relationship conflict, anxiety,
depression and increased risk for substance use and misuse.
4, 5, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20,
21, 22, 23, 24, 25, 26
While data on health worker suicides and linkage to burnout are limited, some
researchers have documented that prior to the pandemic, U.S. physicians, particularly
women physicians, may be at greater risk for suicide than their counterparts in
Europe and Australia.
27
Moreover, a cross-sectional survey of physicians that preceded
the COVID-19 pandemic found that one out of 15 had thoughts of taking their own
life and were less likely to seek help than their counterparts who did not report
suicidal thoughts.
28
When examining burnout, it is important to note another phenomenon—moral
distress—which can intersect with burnout. In health care settings, it can manifest
when health workers know the best health care decision to make, but feel helpless and
unable to act due to limited resources or circumstances beyond their control.
29, 30
Sustained moral distress can lead to moral injury, which has been linked to feelings
of profound guilt, shame, anger, and other psychological impacts.
31
While education,
training, and career experience have been shown to help prepare health workers for
morally distressing situations, many may still experience moral injury if additional
systems reforms are not implemented.
32, 33
The National Academy of Medicine has
previously also called for action on moral distress, in particular additional dialogue,
empirical research, effective interventions, as well as interventions to 1) identify
factors that mitigate the impacts of moral distress or impair moral strength, and
2) identify and implement organizational and systems changes to prevent moral
distress and foster moral strength among health workers.
34
Figure 1 (next page) includes a larger list of wide-ranging consequences that are
associated with health worker burnout.
18
This is not a comprehensive list.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
FIGURE 1
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
A system already at a breaking point
Several factors likely contributed to the immense challenges and demands that health
workers faced even before the COVID-19 pandemic: a rapidly changing health care
environment, where advances in health information and biomedical technology are
accompanied by burdensome administrative tasks, requirements, and a complex array
of information to synthesize.
4, 35, 36
Meanwhile, decades of underinvestment in public
health, widening health disparities, lack of sufficient social investment which results
in higher costs and worse health outcomes, and a fragmented health care system have
together created an imbalance between work demands and the resources of time and
personnel.
37, 38, 39
Amid the exhaustion and burnout that health workers have long been experiencing,
our dependence on a healthy, thriving, robust workforce will only continue to grow.
With over half a million registered nurses anticipated to retire by the end of 2022, the
U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses
across the U.S.
40
A Mercer Health Care Market Analysis report projects a national
shortage within five years of more than 3 million low wage health workers, who
consist predominantly of women of color and are caregivers within the community,
in nursing homes, and are nursing or medical assistants in health care settings.
41, 42
Similarly, according to The National Association of County and City Health Officials
(NACCHO), since 2008, the estimated number of local health department full-time
equivalents (FTEs) decreased by approximately 16% in 2019.
43
The Association of
American Medical Colleges (AAMC) projected in 2020 that physician demand will
continue to grow faster than supply, leading to a shortage of between 54,100 and
139,000 physicians by 2033, with the most alarming gaps in primary care and rural
communities.
44
The Association of American Medical Colleges (AAMC) projected
in 2020 that physician demand will continue to grow faster than
supply, leading to a shortage of between 54,100 and 139,000
physicians by 2033, with the most alarming gaps in primary care
and rural communities.
44
In the future, health workers will care for a population that is growing older and
living with multiple and increasingly complex chronic health issues, as well as
populations impacted by systemic health inequities.
45
The reasons for this include
what some experts term the “U.S. health disadvantage”—the poorer health in the U.S.
compared to other wealthy nations.
38, 46
This “disadvantage” in our country, and the
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
challenges in addressing patients’ social determinants of health, not only results in
racial, geographic, and socioeconomic disparities in health outcomes, but also has an
impact on the prevalence of burnout among health workers, which in turn may impact
the quality-of-care patients receive.
47, 48
A 2022 survey of over 1,500 U.S. physicians
found that 61% feel they have little to no time and ability to effectively address their
patients’ social determinants of health, and 83% believe that addressing patients’
social determinants of health contributes to physician burnout rates; and 87% want
greater time and ability to do so in the future.
49
This gap between health workers’
desire to contribute more to their patients’ health and social security, and their ability
to do so in practice, seeds and compounds their sense of moral distress and burnout.
A 2022 survey of over 1,500 U.S. physicians found that 61% feel
they have little to no time and ability to effectively address their
patients’ social determinants of health, and 83% believe that
addressing patients’ social determinants of health contributes to
physician burnout rates; and 87% want greater time and ability
to do so in the future.
49
During the pandemic, all of these pressures became magnified and amplified.
50, 51
There are a range of societal, cultural, structural, and organizational factors that
contribute to burnout among health workers, and examples of these are depicted in
Figure 2. Where these factors exist, they often amplify one another, which is why
the response to burnout and health worker well-being must be multi-pronged. For
example, a health worker may find it difficult to spend sufficient time with patients
due to their immediate and overwhelming workload, documentation in electronic
health records, or prior authorization paperwork for billing purposes. This health
worker may also be dealing with the effects of health misinformation, leading to a
loss of trust by patients and the community. They may also face barriers to their own
access to physical health, mental health, and substance use care.
52, 53
While personal stressors are important aspects of burnout, addressing the systems
that health workers operate within—those that include staffing, assigning of tasks,
and allocating resources in ways that can create or amplify burden—is critical to
preventing and reducing burnout.
54
Figure 2 (next page) illustrates the many factors contributing to burnout among
health workers. This is not a comprehensive list; it is adapted from the National
Academy of Medicine.
55
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
FIGURE 2
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
“The primary concern for burnout is not
being able to emotionally take care of
each patient individually or uniquely.”
Derick S., Nevada / Respiratory Therapist
The effects of the COVID-19 pandemic
on our health workforce
The pandemic not only intensified work demands and long working hours, it added
new challenges in unprecedented ways. Early in the pandemic, health workers across
public health, laboratory, and clinical settings worked rapidly to understand, detect,
and prevent transmission, provide guidance, and treat patients. Despite early stay-
at-home orders and social distancing recommendations, the virus moved quickly,
and health workers were overwhelmed by waves of seriously ill patients—more than
most systems were prepared for or equipped to handle. Many health workers had to
work without adequate personal protective equipment, putting their own health and
the health of their families at risk, often working without days off.
56, 57
They treated
patients, including their own colleagues, who were sick, frightened, and isolated from
their loved ones. As the pandemic became politicized, some faced hostility, threats,
and acts of violence often related to misinformation about the virus.
58, 59
Throughout the pandemic, health workers have reported high rates of stress,
frustration, exhaustion, isolation, feeling undervalued, loss of sleep, anxiety, increased
risk for substance use, and suicidal ideation.
29, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69
Researchers
who conducted a survey from June through September 2020 found that, of more
than 1,100 health workers, 93% reported they were experiencing stress, 86% reported
anxiety, 76% reported exhaustion and burnout, and 41% reported loneliness.
70
Although there is more research in this area focused on clinicians, researchers are
finding high rates of burnout, and mental health challenges such as stress, anxiety
and depression, among non-clinical health workers as well, including operations
staff in health facilities and public health workers.
71, 72, 73
One study in October 2020
found 49% of health workers, including nursing assistants, medical assistants, social
workers, and housekeepers, reported burnout and 38% reported symptoms of anxiety
or depression.
72
Notably, this study found that inpatient workers, women and persons
of color, nursing and medical assistants, and social workers reported higher levels of
stress related to workload and mental health, though importantly, these impacts were
mitigated when health workers felt valued.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
The mental health impacts of the pandemic also extend to public health workers
across state, tribal, local, and territorial governments, with more than 50% of public
health workers surveyed early in the pandemic reporting symptoms of at least one
mental health condition, including increased levels of post-traumatic stress disorder
(PTSD) when compared with rates previously reported among health workers,
frontline personnel, and the general population.
73
Many of these impacts on health
workers may be felt for years to come.
74
Like all of us, health workers who are caregivers have faced pandemic-related
challenges at home, too, such as caring for children attending school virtually, and
keeping relatives or older adults in their care healthy and safe. During the pandemic, a
survey of health workers who had children found that 76% reported that they worried
about exposing their child or children to COVID-19, and half reported lacking quality
time or being unable to be present as a parent or support their children.
70
In a survey
of health workers across National Health Service Corps sites in late 2020, half of
respondents reported having no childcare assistance, and among them, 75% reported
moderate or severe stress in meeting their children’s needs.
75
Many hospitals have been forced to close departments, delay treatment or procedures,
and fill vacancies with travel nurses.
76, 77, 78
Health workers and patients have felt the
impacts of workforce shortages; among the general U.S. population reporting delayed
care for serious problems during the ongoing pandemic, 69% cited nonfinancial access
barriers. This included reasons such as being unable to get an appointment, find a
physician who would see them, or access the care location.
79
The combination of
distressing work environments and increased demands for care during the pandemic
has led to record numbers of health workers quitting or reporting that they intend to
quit. Among 20,665 respondents surveyed in 2020, approximately 1 in 3 physicians,
advanced practice providers (APPs), and nurses surveyed intend to reduce work
hours. One in 5 physicians and 2 in 5 nurses intend to leave their practice altogether.
57
In this same survey, by the end of the first year of the pandemic, 1 out of 3 health
workers surveyed said they considered leaving their jobs. In September 2021, among
over 100,000 health workers, nurses younger than age 35 who had been at their
current employer for less than a year were most likely to report that they would leave
voluntarily.
80
Among nurses surveyed by the American Association of Critical-Care
Nurses (AACN) at this same time, 92% reported that the pandemic “depleted nurses
at their hospitals and cut careers short.”
81
In the same study, 66% of nurses reported
that they considered resigning because of COVID-19 experiences. According to the
U.S. Department of Labor, nursing homes have reported a loss of 15% of their total
workforce after two years of the pandemic.
82
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Finally, workplace violence for health workers had been increasing even before the
pandemic.
58
Since the beginning of the pandemic, they have faced additional threats,
harassment, and acts of violence.
83, 84
Among 26,174 state, tribal, local, and territorial public health workers surveyed during
March-April 2021, nearly a quarter (23.4%) reported feeling bullied, threatened, or
harassed at work.
73
In a national survey among health workers in mid-2021, eight
out of 10 experienced at least one type of workplace violence during the pandemic,
with two-thirds having been verbally threatened, and one-third of nurses reporting
an increase in violence compared to the previous year.
85
By October 2021, at least
300 health department leaders had left their posts during the pandemic due to
reported threats, intimidation, lack of funding and lack of support from lawmakers
and government leaders.
86
The widespread falsehoods and misinformation about
COVID-19 have contributed to worker exhaustion, frustration, burnout, and not
feeling valued.
87
While the pandemic has affected all health workers, some groups have been
disproportionately impacted based on their unique circumstances. Some of these
groups are highlighted on the following pages.
“There was a point where I could no longer
contain the heartbreak of everyone that
had been lost.”
Kevin C. Miami, FL / Nurse
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
HIGHLIGHT
Groups of health workers whose
health and well-being have been
disproportionately impacted before
and during the pandemic
Many of these challenges existed before the pandemic, and some health workers
may belong to multiple groups. The following is not intended to be a complete
list, nor suggest that health workers not listed here do not experience burnout
or mental health challenges.
Health workers of color
Health workers of color perform a variety of jobs across the health care system but are
more highly represented among low wage health workers.
88, 89
They were more likely
to care for patients with suspected or confirmed COVID-19, more likely to report
inadequate personal protective equipment and have been nearly twice as likely
as white colleagues to test positive for COVID-19.
89, 90, 91
Health workers of color
continue to experience the effects of racial injustice due to longstanding structural
inequities and may also face interpersonal racism in the workplace or learning
environment, including implicit bias and microaggressions.
92
Immigrant health workers
While immigrant health workers represent only 18% of health workers, more than a
third of the health workers who died in the first year of the pandemic were born
outside the United States.
93
Foreign born health workers comprise nearly one third
of physicians, and more than one out of five nursing assistants. They also include 38%
of home health aides and 25% of personal care aides, providing long term services and
supports to people with disabilities and older adults.
94
Female health workers
Compared to male counterparts, female health workers, who make up nearly 70%
of the health workforce globally, have reported higher rates of burnout, depression,
anxiety, insomnia, and occupational distress before and during the pandemic.
95, 96, 97,
98, 99
They are also more likely than men to be responsible for childcare, and as a result,
face greater disruptions in their careers and widening disparities in professional
advancement.
97, 100
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Low wage health workers
Millions of low wage health workers have worked on the frontlines of the pandemic
including as health support workers such as orderlies and phlebotomists; direct care
workers such as home health and personal care aides; and health care service workers
such as housekeepers and cooks.
101, 102
Median wages across these occupations were
just $13.48 per hour in 2019.
103
More than 80% of them are women, and they are also
disproportionately workers of color.
9 of 10 lower-earning health workers are women, nearly two-thirds are minorities
and almost one-third live below the federal poverty level (44% living below
200 percent of the poverty line).
104, 105
Compared to clinical practitioners
who diagnose and treat patients, the likelihood of being food insecure was
5.1 times higher for health support workers and 2.5 times higher for health
technologists and technicians.
106
Many are also susceptible to irregular hours,
contract positions and the need to juggle multiple jobs.
Health workers in rural communities
Rural hospital closures can create access challenges for the communities they serve.
Rural areas experienced staffing shortage crises in nursing homes that corresponded
with trends in COVID-19 cases.
107, 108
Between January 1, 2010, and March 31, 2022, 138
rural hospitals across the nation closed completely or converted to provide services
other than inpatient care. In March 2020, rural areas had between 37 and 42 percent
fewer ICU beds per persons who were at risk of developing severe COVID-19 based
on age and comorbidities than persons in urban areas. Rural areas were already facing
severe health care constraints; although there were only two rural hospital closures in
2021, there were 18 closures in 2019 and 19 closures in 2020.
109
Health workers in tribal communities
Health workers in tribal communities face increasing work demands from chronic
lack of program funding and ongoing workforce shortages, including a lack of
behavioral health specialists.
110
In addition, health workers in tribal areas may
chronically experience challenges with safe water, food insecurity, and housing
insecurity in their communities which were exacerbated by the pandemic.
111
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Investing in health workers and safeguarding their well-being protects their health,
our health, and our entire health care system. The demand for health workers will
only continue to grow in the U.S. and globally. Too often, interventions to address
burnout and well-being focus on single, individual-level factors instead of systemic
and multi-pronged efforts, and therefore have limited long-term impact on preventing
burnout and improving well-being.
112
We must seize this moment to reimagine and create a health care system where
patients, communities, and health workers can all thrive. That will require us to take
a whole-of-society approach, one that addresses systems-level challenges associated
with organizational culture, policy, regulations, information technology, financial
incentives, and health inequities.
4, 113
This calls for collaboration from a variety of
public and private stakeholders, as well as community partners, to tackle the root
causes of health worker burnout, while rebuilding trust among all our communities.
Here is what we must do now:
Protect the health, safety, and well-being of all health workers. Never again
should health workers be expected to work under the unsafe conditions that many
of them faced during the pandemic. Protecting health workers from workplace
violence must be prioritized by all institutions and communities, and must be
supported by legislation. Health systems must ensure that health workers are
adequately trained for all scenarios and provided with a robust supply of personal
protective equipment. In addition, health systems should address and prepare for
staffing challenges, and identify sources of workplace illness and injury.
Eliminate punitive policies for seeking mental health and substance
use care. We must ensure that every health worker has access to affordable,
confidential, and convenient mental health care. We must address the spillover
effects of burnout, most prominently, mental health challenges such as anxiety
and depression. We can offer flexible care models (e.g., telemedicine and virtual
care) after working hours, improve parity and access to care, increase insurance
coverage for mental health care, and eliminate punitive language in the licensing,
We Must Take Action
“Something has to change. Something
good has to come out of this or it will
be for nothing.”
Nisha B., Pittsburgh, PA / Palliative Social Worker
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
accreditation, and credentialing of health professionals. We can encourage
vulnerability and open communication around mental health and substance use
care, and promote care seeking as a sign of strength. We can offer evidence-based
training and practices that support prevention, early intervention, and treatment
of an array of conditions including burnout and mental health challenges.
Reduce administrative and other workplace burdens to help health workers
make time for what matters. This must include reducing administrative
and documentation burdens, as well as the cognitive load on health workers,
increasing flexibility in work scheduling, ensuring health information technology
that is human-centered, interoperable, and equitable, and aligning payment
models to recognize the value of a conversation, not just of a procedure.
Transform organizational cultures to prioritize health worker well-being
and show all health workers that they are valued. Employers, policymakers,
and professional associations can support health workers by identifying and
measuring factors contributing to burnout, and co-developing solutions to
respond to and prevent it, while advancing worker well-being. We must ensure
living, competitive wages, paid sick and family leave, rest breaks, evaluation of
workloads and working hours, educational debt support, and family-friendly
policies including child care and care for older adults for all health workers.
Health workers are the pillars of our collective health and well-being, and
therefore should be valued and respected by their organizations and society.
Recognize social connection and community as a core value of the health
care system. Strengthening social connection and community enhances job
satisfaction, protects against loneliness and isolation, and improves the quality of
patient care. Peer and team-based models are one way to strengthen collaboration,
create important opportunities for social support and community for health
workers, while also mitigating burnout and moral distress. Collaboration and a
sense of belonging also contribute to the well-being of health workers and patients
by building connections between health care, public health, and the community.
Invest in public health and our public health workforce. We must improve
disease surveillance systems and expand and diversify the public health workforce
so we can address the impacts of social determinants of health, health inequities,
counter the spread of health misinformation and disinformation, strengthen
partnerships cross clinical and community settings, and consider other societal
factors that shape health and well-being. These are critical measures to protect
our health systems.
Figure 3 (next page) includes a list of solutions to health worker burnout. This is not
intended to be comprehensive.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
FIGURE 3
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Health care organizations can implement evidence-based policies, programs
and solutions that identify, address, and help prevent adverse health outcomes
and burnout for health workers. The pandemic has highlighted opportunities to
strengthen organizational cultures and environments to be safer, more generous,
and more just for all health workers.
Below are some recommendations that span a variety of public and private health care
organizations, including hospitals, health systems, community health centers, as well
as government-funded or operated health care delivery organizations.
Transform workplace culture to empower health
workers and be responsive to their voices and needs.
We can begin by listening to health workers and seeking their involvement to improve
processes, workflows, and organizational culture. In one study of primary care
practices, those with “zero-burnout” were found to have strong practice cultures that
fostered teamwork and communication in quality improvement.
114
A workplace that
cultivates relationships and uses open communication and participatory management
to solve problems empowers staff to speak up and engage in efforts that can improve
patient safety, quality of care, and build trust.
115, 116, 117, 118
The Institute for Healthcare
Improvement (IHI) offers tools, strategies and nationwide learning networks
for engaging health workers and fostering a culture of constant learning toward
improvement.
119, 120
For instance, applying structured rounding with staff or asking
them direct questions of reflection via regular one-on-one sessions, huddles and
group brainstorming, builds positive organizational cultures.
121
Show health workers how much they are valued.
Organizational cultures where staff feel unsupported and undervalued have been
strongly associated with feelings of stress, burnout, and intent to leave the health
sector.
71, 72, 118, 122
Priority opportunities for showing health workers that they are
valued employees while recognizing their work-life demands include transparent
What Health Care
Organizations Can Do
We Must Act
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
communication, ensuring living competitive wages and affordable health coverage
that is inclusive of mental health and substance use care, promoting family friendly
policies such as parental leave and support for child care and care for older adults,
and a periodic review of staff workloads, patient caseloads and coverage, working
hours, and hazard or retention pay opportunities.
57, 80, 123, 124, 125
Historically, special,
periodic supplemental allowances for staff working in environments that could
threaten their health and well-being have been applied in some U.S. agencies and
health care organizations.
126, 127
Organizations can also provide opportunities for
recruiting and training health workers from the communities they serve; support
rapid training for deployments to unfamiliar units; promote continuing education
and professional development; and expand opportunities for career advancement,
leadership, mentoring, and coaching at every level, especially for women and
underrepresented minorities.
Build a commitment to the health and safety of health
workers into the fabric of health organizations.
This includes at a minimum:
Commit to health worker well-being at the highest levels of leadership.
Priority opportunity examples include establishing a Chief Wellness/Well-
being Officer role with dedicated resources and decision making power,
developing online staff safety hubs with resources, adding well-being metrics
into key performance indicators for the organization, and linking executive
compensation with improvements in health worker well-being.
128, 129, 130
This
can also include updating policies for staffing standards that ensure patient
safety and health worker well-being, and improving other workplace policies
that affect job resources and demands.
131, 132
The Department of Veterans Affairs
(VA) implements a Whole Health System (WHS) of care that aims to empower
and equip Veterans and VA employees to take charge of their health and well-
being. The WHS approach includes active encouragement of multi-disciplinary
committees and coordinators to support a culture of well-being and resiliency, as
well as resources for leaders and staff, such as needs assessments and evaluation
mechanisms; early outcomes suggest a meaningful impact on employees
personally and professionally.
133
The American Medical Association offers guidance
for health care leaders to create the organizational conditions for joy, and purpose
and meaning in work, including a Joy in Medicine Health System Recognition
Program to recognize organizations that support health worker well-being.
134
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Regularly assess, measure, respond to and intervene to prevent occupational
distress and burnout using validated tools. This can include validated metrics
for measuring recovery and well-being. The National Academy of Medicine
Resource Compendium for Health Worker Well-Being offers a collection of
evidence-based measurement tools for organizations to use.
135
Organizations can
consider annual engagement surveys, as well as real-time and proxy measures in
their surveys and dashboards.
125
Data should be confidential and when possible be
evaluated by race, ethnicity, age, departmental units, role, and levels of seniority
to understand differences and help identify tailored interventions.
Build in time for and encourage all health workers on staff to take paid leave,
sick leave, family leave, and rest breaks. Many health workers report coming
to work sick because of a desire to not burden colleagues with additional work,
a belief that it is unprofessional to take a sick day, a desire not to disappoint
patients, or fear of being ostracized by colleagues.
136, 137, 138, 139
Paid time off with
coverage can help staff refresh and care for themselves as well as family members,
while protecting colleagues and patients in their care.
140, 141
Leadership at all
levels in an organization can serve as powerful role models by communicating
these opportunities during orientation and regularly afterwards, and by modeling
their use.
Establish a zero-tolerance policy for violence, and institute a workplace
violence prevention program to address violence and abuse in the workplace,
(this includes physical, verbal, and/or cyber-based). Safe workplace
environments are critical for the delivery of safe, quality care for patients whether
that is at a clinical, community, or other setting.
142
The Joint Commission offers
workplace safety standards and resources, including policy guidance for assisting
health care organizations on how to assess facilities and evaluate strategies.
143
Commit to the safety and health of the workforce by prioritizing adequate
personal protective equipment. Periodically evaluate the workplace
environment to identify and mitigate hazards. Establish safety and occupational
health teams that can identify key issues impacting health workers in all areas.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Review and revise policies to ensure health workers
are not deterred from seeking appropriate care for
their physical health, mental health and/or
substance use challenges.
This means we need to:
Examine questions on applications and renewal forms for jobs and hospital
credentialing so that health workers are not deterred from seeking mental
health and substance use care. Many health workers fear negative repercussions
for their health professional licensing, credentialing, commercial insurance, and
careers if they seek out mental health and substance use care.
144
A review of forms
can ensure that questions are aligned with recommendations from The Joint
Commission in 2020, the Federation of State Medical Boards and the American
with Disabilities Act.
145, 146
Normalize conversation about the use of mental health and substance use
care for health workers. Create and normalize opportunities for health workers
and peers to communicate about occupational distress, grief, and mental health
challenges in the workplace, especially during and following stressful episodes.
Health workers should be continually reassured by leadership that speaking out
about workplace concerns or seeking mental care will not have negative impacts
on their employment.
Increase access to high-quality, confidential mental
health and substance use care for all health workers.
Ensure that all health workers have access to confidential mental health services
for themselves and family members, including hotlines and Employee Assistance
Programs (EAP).
147
Organizations can provide protected time for employees to
access EAP or other mental health services and reiterate the confidential nature of
those services. Leaders at every level of an organization should be trained in these
programs, address barriers for use, and periodically promote these services to their
health workers.
148
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Develop mental health support services tailored
to the needs of health workers.
Examples include implementing in-person “rounds” by mental health professionals
who regularly visit units and workplaces, offering support groups for health workers
while ensuring time is available for participation, and expanding opportunities for
telemedicine and other virtual care services.
149
Incorporate a proactive, evidence-based approach to suicide prevention,
including identification and response in the workplace. Health care
organizations can help to identify the work stressors that may put health workers
at higher risk, including feelings of inadequacy, lack of preparation for their
role, and new work environments.
150
The Healer Education Assessment and
Referral (HEAR) Program is a best practice example recognized by the American
Medical Association. Developed by the University of California San Diego School
of Medicine together with the American Foundation for Suicide Prevention to
prevent depression and suicide, this program ensures voluntary, anonymous
screening and referral, including system-wide grand rounds on burnout,
depression, and suicide.
151
The program has been expanded from physicians to
include nurses and has been scaled to over 60 medical campuses.
Rebuild community and social connection among
health workers to mitigate burnout and feelings
of loneliness and isolation.
Decreased social support is related to increased rates of burnout among nurses, and
has been associated with increased stress and anxiety, as well as decreased sleep
quality.
152
Some example strategies are:
Invest in peer support model programs, learning networks, and
opportunities during working hours to reflect on challenging circumstances
and ethical dilemmas. For instance, the Battle Buddy program has been shown
to mitigate burnout, address feelings of isolation, and offer psychological
and emotional well-being support and resources in times of crisis.
74, 153
Other
examples include various “rounds” with and for health workers that have
been found to increase honesty and openness, while improving teamwork and
compassion.
154, 155
The Agency for Healthcare Research and Quality’s National
Nursing Home COVID-19 Action Network connected staff from over 9,000
nursing homes with local expert mentors and quality coaches to keep residents
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
and staff safe during the pandemic.
156
While sharing evidence and best practices
was central to the success of the program, the value of the Network was enhanced
because it created critical connections among front-line team members who were
feeling tremendous isolation.
Another example is the Community of Practice and Safety Support
(COMPASS) program;
157
developed to prevent injuries and advance the health
and well-being of home care workers, this program integrates elements of peer-led
social support groups with scripted team-based programs to help workers learn
together, solve problems, set goals, make changes, and enrich their supportive
professional network. One of the critical aspects of the program is its use of an
evidence-based dissemination strategy designed to overcome the evidence to
implementation gap which some researchers have reported averages 17 years.
Support interprofessional training and initiatives. Integrated team-based care
is associated with health worker satisfaction, greater joy in practice, decreased
levels of burnout, and improved patient safety.
158, 159, 160, 161, 162
One example is the
U.S. Department of Veterans Affairs (VA) Patient Aligned Care Team (PACT)
“teamlet” model which integrates multi-disciplinary clinical and support staff to
coordinate and deliver care, including specialty care, for a panel of patients. It
has been shown to improve workflow, ensure continuity of patient care, and was
associated with lower burnout among VA health workers.
163
Help health workers prioritize quality time
with patients and colleagues.
Inefficient work processes, burdensome documentation requirements, and limited
autonomy can result in negative patient outcomes, a loss of meaning at work and
health worker burnout.
164
Employers can help in the following ways:
Implement strategies and approaches developed by the 25x5 Symposium
to reduce administrative burdens by 75% by 2025 so that health workers
can spend more time with patients.
165, 166
Example opportunities include
reviewing and improving staffing, scheduling and care team delegation plans
(for instance, including scribes or automating data collection for any needs that
are secondary to clinical care such as billing, quality reporting, and other local
health care system or regulatory requirements); reviewing the volume of and
requirements for prior authorizations together with health workers; streamlining
fax-based work such as prior authorizations to electronic and automated systems,
reducing duplicative work (e.g. multiple care team members documenting the
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
same information, credentialling applications);
167
and ensuring human-centered
technology (e.g., usability of electronic medical records).
168
De-implementation
checklists can help address common administrative burdens in the workplace.
169
Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program asked employees
to assess their experiences with the electronic health record (EHR) and nominate
tasks to eliminate that they found either unnecessary or poorly designed; this
resulted in 1,700 nursing hours saved per month across their health system.
170
Optimize technology to increase time spent between health workers and
patients. Example opportunities include simplifying EHR-based workflows
and addressing patient and health worker usability issues with virtual care.
Organizations can also utilize other innovative technologies to rapidly expand
needs for team collaboration and clinical decision support.
171, 172
Increase work schedule flexibility and autonomy. An example opportunity
includes recognizing the scheduling needs for health workers who are also parents
or caregivers by providing flexibility to start and end workdays. This can help
reduce health worker stress and demonstrates an organization’s compassion.
96, 125
Other examples include opportunities for health workers to schedule their
preferred off days, options to use virtual care when clinically appropriate (e.g.,
telephone, telemedicine), job-sharing and periodic coverage options by hiring
internal or external temporary contract workers, and shifting tasks and decision
making across a care team.
173
Combat bias, racism, and discrimination
in the workplace.
The long-term impact of racism and discrimination among health workers as it
relates to job satisfaction and burnout is not well documented. However, many have
anecdotally found a greater incidence of discrimination and racism experienced at
work to be associated with higher levels of burnout and the spillover consequences of
burnout, such as anxiety and depression.
92
This means we can:
Promote health worker diversity, equity, inclusion, and accessibility. Diversity
within teams can help address structural racism, microaggressions, implicit bias,
and has been shown to improve patient care quality, innovation, and ensure more
accurate risk assessments.
174
Similarly, racial concordance between health workers
and their patients and communities is associated with longer-than-average
medical visits, as compared to race-discordant visits, which may lead to greater
trust and communication, and a greater frequency of necessary medical visits.
175
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Identify and call attention to racist and discriminatory behavior to inform
solutions. For instance, Massachusetts General Hospital instituted a code
of conduct that clarifies a zero-tolerance policy for discriminatory behavior
toward staff and allows removal of patients who repeatedly break this code.
176
Penn Medicine will pilot the Lift Every Voice program, that will give staff
at two emergency departments—including physicians, nurses, technicians,
environmental service workers, and unit clerks—a simple way to make
anonymous reports when racism in the workplace is witnessed or experienced.
177
The goal is to identify patterns and explore solutions among senior leadership
and to develop future trainings.
Build equity-centered data systems infrastructure. This means disaggregating
data to better identify risk and health outcomes by race, gender, and ethnicity;
building data capacity in under-resourced communities; and involving
communities in shaping more interoperable data systems.
178
Systems may also
encourage the inclusion of non-randomized, large-sample data, such as lived
experiences, as valid data for decision making.
Work with health workers and communities
to confront
health misinformation.
While addressing health misinformation requires a whole-of-society response,
employers and payors can help to recognize and ensure time for addressing
health misinformation and for deepening trust between health workers and their
communities. Priority example strategies include the following:
Ensure that patients and health workers have adequate time for and access
to credible information, consistent with the best scientific evidence available
at the time. Establishing trusted health messengers during non-crisis times
will facilitate increased communication and decreased misinformation during a
health crisis.
To learn more, please visit Confronting Health Misinformation: The U.S.
Surgeon General's Advisory on Building a Healthy Information Environment.
179
Provide professional education on proactively addressing health
misinformation. This can include increasing health worker awareness of reliable
resources, and access to best practices on engaging and presenting information to
patients, including linkages to community groups and local organization partners,
such as health departments and public libraries, where information flows both
ways—to and from communities.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Invest in health prevention and social services
to address health inequities.
This improves patient health while reducing the strain on our health care system
and on health workers, many of whom report ongoing stress and moral distress due
to the complexity of societal factors and social determinants of health that impact
their patients.
179, 180
This can include partnering with community-based organizations
and local governments and making evidence-based investments in social factors that
contribute to health and prevent illness such as housing, employment, and education.
181
One example is the National Association of Chronic Disease Directors’ Building
Resilient Inclusive Communities which supports state and local health departments
to engage communities, promote healthy living and reduce social isolation.
182
Care organizations can leverage Community Health Needs Assessments
and Community Benefit funds, either individually or regionally, towards
community investments such as affordable or low-cost housing, public
transportation, food security, economic opportunities, and to address
environmental health challenges in the communities they serve.
183, 184, 185, 186
An example of this includes Kaiser Permanente’s Thriving Communities Fund,
which partners with community residents, community development financial
institutions, and other organizations to create a health action plan to identify and
address public health needs.
187, 188
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
FIGURE 4
Resources for Health Care and Public Health Organizations
This is not a comprehensive list.
In addition to the examples shared
throughout the above section and
from the National Academy of
Medicine Collaborative Resource
Compendium for Health Worker
Well-Being,
135
the list below offers
resources for health care delivery
organizations and employers.
Transforming
Cultures
Advancing Health Equity: A guide
to language, narrative and concepts
American Medical Association
(AMA), American Association of
Medial Colleges (AAMC)
Best Practice Guide for Telehealth
U.S. Department of Health
and Human Services (HHS),
Health Resources and Services
Administration (HRSA)
Creating a Caring Workforce Culture
Secretary for Preparedness and
Response (ASPR)
Joy in Work Framework Institute for
Healthcare Improvement (IHI)
Standards and Tools for Healthy
Work Environments American
Association of Critical-Care Nurses
(AACN)
Strategies to Reduce Burnout:
12 Actions to Create the Ideal
Workplace Mayo Clinic
Team Strategies & Tools to Enhance
Performance and Patient Safety
(STEPPS) U.S. HHS, Agency for
Healthcare Research and Quality
(AHRQ)
Well-Being Playbook American
Hospital Association (AHA) American
Physician Alliance
Well-Being and Professional
American
College of Physicians (ACP)
Preventing Suicide and
Moral Injury
Comprehensive Blueprint for
Workplace Suicide Prevention
National Action Alliance for Suicide
Prevention (Action Alliance)
Conversations about Moral Distress
and Moral Injury National Association
of Community Health Centers (NACHC)
Nurse Suicide Prevention/Resilience
American Nurses Association (ANA)
Preventing & Addressing Moral Injury
Affecting Health Workers During
COVID-19 U.S. HHS, ASPR
Preventing Physician Suicide AMA
Reducing
Administrative Burdens
Advocacy Toolkit – Revising Licensing
and Credentialing Applications ACP
Best Practices for E/M Clinical
Documentation ACP, Electronic
Health Record Association (EHRA)
Checklist for Health Care Leadership
on Health IT and Clinician Burnout
National Academy of Medicine (NAM)
De-Implementation Toolkit AMA
Health IT Playbook
of the National Coordinator (ONC)
Reducing EHR-based clinician
burden U.S. HHS, AHRQ
Addressing
Workforce Stafng
Healthcare Provider Shortages-
Resources and Strategies for
Meeting Demand U.S. HHS, ASPR
Technical Resources, Assistance
Center, and Information Exchange
(TRACIE)
Mitigate Absenteeism by Protecting
Healthcare Workers’ Psychological
Health and Well-being during
COVID-19 U.S. HHS, ASPR
ANA
Ensuring Health Care
Safety and Preventing
Violence
A Community Toolkit for Addressing
Health Misinformation
the Surgeon General (OSG)
Guidelines for Healthcare and
Social Service Workers to Address
Workplace Violence U.S. Department
of Labor, Occupational Safety and
Health Administration (OSHA)
Hospital eTools U.S. Department of
Labor, OSHA
Safe Patient Handling Tools and
Resources U.S. Department of Labor,
OSHA
Workplace Violence Resources and
Tools The Joint Commission
Supporting
Health Workers
Design Your Own Well-Being
Program ACP
Guide to Promoting Health Care
Workforce Well-Being During & After
the COVID-19 Pandemic IHI
Preventing Suicide: A Technical
Package of Policy, Programs, and
Practices U.S. Centers for Disease
Control and Prevention (CDC)
Resources for Nursing Home Staff
U.S. HHS,
AHRQ
Steps Forward Health Care Work-
force Well-Being Resources AMA
Whole Health Program Resources
U.S. Department of Veterans Affairs
(VA)
Well-Being Initiative ANA
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Optimizing health worker well-being calls for long-term investments and
collaboration across levels of government along with health systems, health care
technology companies, community organizations, health professional associations,
and academic institutions.
Below are examples of steps that federal, state, local, and tribal governments can
take to improve the health and well-being of health workers:
Invest in evidence-based practices, plans and
partnerships that ensure the health, safety,
and well-being of health workers.
In January 2022, the U.S. Department of Health and Human Services (HHS), through
the Health Resources and Services Administration (HRSA), invested $103 million
to support evidence-informed programs, practices, and trainings on preventing and
addressing burnout, suicide, mental health challenges, and substance use challenges,
including technical assistance.
189
Other priority opportunities include:
Enact paid leave and rest time policies. This will allow health workers the
time needed to routinely seek care, for their physical and mental health, not only
during public health emergencies.
190
Align inter and intra-agency federal investments and efforts as outlined
through the Equitable Long-Term Recovery and Resilience Plan (ELTRR).
191
This whole-of-government effort within HHS includes recommendations for
a thriving workforce such as expanding peer workforce initiatives that include
behavioral health coordination, recovery and resilience-focused initiatives
and resources.
Strengthen local policies that can protect all health workers from workplace
and community violence. For example, many states have recently enacted
laws that further protect their public health officials from harassment, threats,
and acts of violence.
192, 193
Encourage multi-sectoral partnerships including
workforce representation, health care organization leadership, human services
What Federal, State, Local and
Tribal Governments Can Do
We Must Take Action
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
decision makers, and other relevant public health stakeholders as part of the
implementation strategy.
Expand support for programs such as PH-HERO (Public Health, Equity,
Resilience, and Opportunity) and HERO-NY (Healing, Education, Resilience
& Opportunity for New York’s Frontline Workers). These efforts, developed
with federal, state, and local stakeholders are aimed at addressing health worker
burnout, resiliency, and morale and to support a culture of well-being.
194, 195
Develop and invest in reimbursement models
that are aligned with the goals of high-quality
person-centered care, including prevention
services, and coordinated care teams.
This includes steps to re-value components of the health care system that prevent
disease, promote health and well-being, address health information, improve care
quality, all while reducing spending, advancing health equity, and addressing health
worker well-being.
196, 197
One example is the Maryland Primary Care Program which
launched in 2019 as part of the Maryland Total Cost of Care Model, a hospital
focused All-Payer Model from 2014-2018. The Centers for Medicare & Medicaid
Services partnered with the state of Maryland to implement a model where primary
care providers receive support to provide comprehensive care via interdisciplinary
care management teams that address both the medical and social needs of patients
in addition to performance-based incentive payments.
198
This program resulted
in improved delivery and outcomes of care, integration with public health efforts
to respond to COVID-19, and decreased health care costs, all while investing in
structural change.
199
Address punitive policies that deter health workers
from seeking mental health and substance use care.
Many health workers are often reluctant to seek formal care for mental health or
substance use conditions because of concerns about losing their license, credentialing,
and careers. Priority opportunities include:
Support national, state, and local education and awareness campaigns on
burnout, moral distress, and well-being. For example, the Health Worker
Mental Health Initiative from the CDC’s National Institute for Occupational
Safety and Health (CDC/NIOSH) aims to improve awareness about mental
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
health and substance use challenges in health workers and offer strategies for
prevention, screenings, and services.
200
Build on and evaluate the impact of investments such as The Dr. Lorna
Breen Health Care Provider Protection Act 2022 which establishes grants and
requires other activities to improve mental and behavioral health among health
care providers.
201
Examine state health professional licensing board questions in applications
and renewal forms for licensure so that health workers are only asked about
“conditions that currently impair the clinicians’ ability to perform the job,”
as recommended by The Joint Commission in 2020, Federation of State
Medical Boards, and aligned with the American with Disabilities Act.
146, 202
It is critical that when licensing boards do make these changes that they
effectively communicate this to health professionals.
Ensure that state boards and legislatures approach burnout from a non-
punitive lens. This includes considering offering options for “safe haven”
non-reporting for applicants receiving appropriate treatment for mental
health or substance use challenges.
146
They should also prevent public
disclosure of health workers’ illness or diagnosis as part of any board process,
regularly communicate the value of health worker well-being, and help clarify with
applicants that any investigation is not the same as disciplinary undertaking.
Increase access to quality, confidential mental health,
and substance use care for all health workers.
This means we can:
Increase funding for convenient, flexible care models such as telemedicine
and virtual care, especially for vulnerable and low-income health workers
in rural and underserved areas.
203, 204
Expand and invest in a diverse mental health workforce. This will reduce
waitlists and increase access to quality mental health and substance use care for
all, including for health workers in need of mental health and substance use care.
Extend the hours of confidential mental health services to include times that
are not during work and provide coverage to enable health workers to attend
appointments.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Provide resources to health care organizations for mental health support
through grant programs from HRSA.
205
This also includes supporting policies
that would provide tailored mental health and substance use care for all
health workers.
Strengthen mental health parity provisions. This includes strengthening parity
laws to clarify that network adequacy and provider payment are a component
of parity analysis; requiring that medical necessity criteria be consistent across
behavioral health (mental and physical health services); authorizing funding
for parity enforcement in compliance with the 2008 Mental Health Parity law,
and providing authority to impose civil monetary penalties for noncompliance,
allowing individuals to recover losses from their health plan due to a parity
violation; removing ability for government health plans to opt out of complying
with mental health parity; and extending parity to Medicare to adhere to mental
health parity laws.
206
Reduce administrative burdens contributing
to health worker burnout.
This means that we need to:
Examine reporting requirements and identify opportunities for aligning
policy, improving health professional licensing processes, and ensuring
equitable and increased access to telemedicine and other virtual care.
207, 208, 209
This may include a timely, formal review of policy changes that were enacted
under the COVID-19 public health emergency to reduce administrative burdens
and ensure minimal disruptions in patient care delivery.
Partner with health care delivery organizations, professional associations,
and other stakeholders to reduce documentation burden by 75% by 2025.
166, 210
This includes clarification of regulations and documentation requirements,
optimization of the prior authorization process, and review of additional
challenges with stakeholders, such as coding validations and electronic health
record (EHR) technology.
211
Sustain support for CDC’s Data Modernization Initiative. This initiative is
an ambitious, multi-billion-dollar program with a goal of creating a connected,
resilient, adaptable, and sustainable “response-ready” public health infrastructure
that works across diseases and conditions and enables access to the right data
at the right time to better serve patients, communities, and populations. This
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
includes capacity development in health information technology and data science
to ensure effective, seamless stewardship of large quantities of health data.
213, 212
Recruit, expand, and retain a diverse health care and
public health workforce to meet current and future
health challenges.
Ensuring adequate staffing in the health sector including surge capacity for public
health emergencies, that is representative of the communities they serve, is critical
to protect and sustain health workers and communities.
213, 214
Example
opportunities include:
Pay health workers what they are worth. Priorities can include policies to
ensure living, competitive wages, hazard compensation during public health
emergencies, equity focused career advancement opportunities, and a review
of hiring, salaries and salary caps.
103, 215
Given that nine of 10 low wage health
workers are women, nearly two-thirds are minorities, and almost one-third live
below the federal poverty line, developing and promoting equitable career ladders
with on and off ramps for individuals of all backgrounds is critical to strengthen
the health workforce.
216
Expand Graduate Medical Education (GME) positions to best meet the
nation’s future health care needs. By 2034, there will be an estimated shortage
of up to 48,000 primary care physicians and nearly 77,100 physicians in non-
primary care specialties.
217
The Centers for Medicare & Medicaid Services will
create 1,000 residency positions for rural communities, but many more are still
needed.
218
Example opportunities include development of a comprehensive,
transparent, and coordinated planning and funding approach to guide its health
workforce development programs by U.S. Health and Human Services (HHS) and
relevant stakeholders.
219, 220, 221
Invest in long-term programs such as the Behavioral Health Counselor
Apprenticeship program, SAMHSA’s Minority Fellowship Program and
HRSA’s Nurse Scholarship program.
222, 223
Expand loan repayment programs such as HRSA’s National Health Service
Corps, Nurse Corps, and Substance Use and Disorder Treatment and
Recovery Loan Repayment programs, and support new initiatives for health
workforce loan repayment and forgiveness.
224, 225, 226
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Sustain investments for a representative health workforce through long-
term support of American Rescue Plan investments to recruit, hire and
train health workers from underrepresented backgrounds, including HRSA’s
investments in community health workers from underserved communities and
public health workers in the Indian Health Service.
227
By expanding support and
training for community health workers (CHWs) and health support workers,
these programs will continue to increase access to care and improve public health
beyond the pandemic’s emergency response efforts.
Address societal contributions to health to improve
patient outcomes and decrease demand on health
workers and health systems.
Health disparities, lack of access to preventive services and accurate health
information, and delays in care can all create higher workloads and demands on
health workers. We can work to:
Expand access to health insurance and preventive services for all. People
who are uninsured often delay seeking care, and experience greater morbidity
and mortality which can lead to increased strain on health workers.
228, 229
States
can take advantage of the Affordable Care Act’s expansion of Medicaid for low-
income adults to increase health care access to millions of Americans. Medicaid
expansion has been shown to improve outcomes by reducing the likelihood that
patients forgo preventive services and care.
230, 231
Medicaid expansion also reduces
hospitals’ uncompensated care which allows health care organizations to better
allocate resources.
Commit to improving health equity. This includes building equity-centered
data collection systems that increase availability of data by race, ethnicity,
geography and disability,
38
developing metrics to measure and monitor health
equity, reimbursing health care models that demonstrate equity-centered health
care and incentivize providers to improve health outcomes in underserved
communities,
232
and supporting local organizations to lead equitable initiatives
through collaboration with community health workers, social support specialists,
librarians, and others.
38
Build trust between underserved and marginalized communities and
health workers. This begins by engaging communities and populations in the
development of public health interventions and messaging, while elevating
trusted individuals and organizational stakeholders to deliver public health
information.
37
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Proactively address health misinformation. To learn more about what
governments can do, please visit Confronting Health Misinformation: The U.S.
Surgeon General’s Advisory on Building a Healthy Information Environment.
179
Commit to a coordinated, whole-of-government
approach to adequately prepare public health,
health care systems, and health workers for
future public health emergencies.
Opportunities include:
Increase and sustain federal and state funding for public health. Prior to the
COVID-19 pandemic, the public health workforce had decreased by more than
15%.
233
Sustained funding beyond the pandemic would allow local and state health
departments to attract, hire, train, build capacity, and retain diverse staff who
reflect the communities they serve. To provide a minimum set of health services,
some estimates suggest that the public health workforce needs to grow by 80%;
this would also build stronger partnerships and trust across the continuum of
care and our health care system.
234, 235
It would also ensure a ready and capable
workforce in times of emergencies.
Strengthen health workforce education, training and resources for disaster
and public health emergency response such that frontline health workers
across all settings are prepared to respond to all hazards and future public health
emergencies.
236
Support a National Health Care Workforce Commission, a multi-stakeholder
workforce advisory committee charged with coordinating a national health
workforce well-being strategy.
237
Desired outcomes of this commission can
include, but are not limited to, identification of appropriate federal levers to
stabilize workforce factors that drive health worker burnout.
Ensure and strengthen collaborative strategic planning across sectors and
government agencies to improve our readiness and coordination for future
public health crises. In addition to the ELTRR described above, the HHS Office
of the Assistant Secretary for Preparedness and Response (ASPR) through its
National Health Security Strategy (NHSS) engages every level of government in
addition to health care, public health, emergency management, communities, and
the private sector in planning for future health security threats.
238
Similarly, the
Federal Emergency Management Agency (FEMA)’s 2021 National Preparedness
38
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Report calls for better strategies across all levels of government to manage longer,
increasingly complex disasters.
239
Decrease the risk of COVID-19 infection and other respiratory infections
among health workers. To prepare for future pandemics caused by respiratory
viruses, steps must be taken to ensure that all health workers have access
to vaccinations and appropriate personal protective equipment, improved
engineering controls to minimize exposures in high-risk settings, and
strengthened capacity to rapidly administer effective therapeutics for those with
high-risk exposures or early disease, especially those with risk factors for severe
disease outcomes.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Health workers need to spend meaningful time with patients to build relationships
and provide high-quality care. Unfortunately, administrative requirements, such as
prior authorizations, can delay patient care and contribute to poor health outcomes
among patients and health worker burnout.
240, 241
In addition, when it comes to
their own mental health and well-being, health workers don’t always have access to
affordable health and mental health and substance use care.
Below are some steps health insurance companies and payers can take:
Improve the quality of health care by supporting
both the quality and quantity of time that health
workers can spend with patients.
In some reimbursement systems such as fee-for-service, health workers, especially
health professionals who deliver care, feel penalized for spending the time that they
need with patients to provide adequate care. When health care is constrained to
be delivered in 15-minute intervals, trust and communication between patient and
provider can suffer.
242
Priority opportunities can include engaging health workers in
determining optimal visit length standards to ensure both efficiency and quality of
care, increasing transparency, and aligning payment systems accordingly.
Reduce the administrative burden posed by prior
authorization requests and other documentation
and reporting requirements.
In a 2020 survey, 85% of physicians described the burden associated with prior
authorization as high or extremely high, and 34% reported that prior authorization has
led to a serious adverse event for a patient in their care.
243
We can work to:
Reduce the overall volume of and streamline prior authorization requests.
In 2018, the U.S. Office of the Inspector General found high rates of inappropriate
prior authorization requests; many health workers consider these requests to be
What Health Insurers
and Payers Can Do
We Must Take Action
40
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
their most burdensome regulatory challenge.
244, 245
To change this, health care
organizations, health systems, medical groups, and payors can commit to
regularly review and revise the need for prior authorizations requirements,
and improve transparency, communication, and timely resolution of prior
authorization requests.
246
Leverage technology to streamline administrative requirements, including
documentation, reporting, and provider credentialing. For example, insurers
could partner with medical groups and health systems to implement
electronic prior authorization processes.
247, 248
According to the 2020
CAQH Index, which tracks adoption of HIPAA-mandated and other electronic
administrative transactions for conducting routine business between health care
providers and health plans, electronic prior authorization could save $417 million
annually.
249
Transitioning to a fully electronic prior authorization process would
also save health workers up to 12 minutes per transaction.
249
Ensure health workers have access to quality mental
health and substance use care.
For example:
Ensure parity in mental health coverage, including for quantitative
treatment limits such as cost-sharing as well as for non-quantitative
treatment limits such as network adequacy. To ensure network adequacy, make
it easier for providers to become in-network providers, including streamlining
credentialing processes and increasing reimbursement rates.
206
Expand telehealth coverage so that health workers can access behavioral
health care when and where they need it.
250, 251
Ensure adequacy of mental health and substance use providers participating
in networks, including making efforts to ensure providers in network are
accepting new patients—this will help minimize ghost networks.
Ensure mental health and substance use benefits are defined in an objective
and uniform manner pursuant to external benchmarks that are based in
nationally recognized standards.
In partnership with governments, health care professionals, and other
stakeholders, develop reimbursement policies that account for the unique
41
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
nature of telemedicine. For example, adapt policies to account for between-visit
work such as secure text messaging with patients.
Partner with health care delivery organizations
to improve clinical care and preventive services.
Standardizing administrative processes at the state level can improve care and
reduce administrative burden on individual health care providers or organizations.
For example, a health plan in Minnesota partnered with state medical groups and
hospitals to develop standard guidelines for managing key chronic diseases, reducing
paperwork, and improving evidence-based care across the state.
252
Increase transparency for health care providers to
make better health decisions.
Adopting standardized, evidence-based metrics, such as those created by the Core
Quality Measures Collaborative, will not only reduce data collection burden for health
workers, but can promote better patient outcomes, increase transparency for patients
and clinicians and provide beneficial information for health care decision making
and payment.
253, 254
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
All technology companies and industry leaders that intersect with our health care
system can play a role to improve health worker well-being. Rapid advancements
in technology, and health information technology, have enhanced our capability
to deliver, process and access health care, yet more work remains to ensure these
advances do not contribute to health worker burnout.
While comprehensive recommendations that span the spectrum and diversity of
health-related technology companies are beyond the scope of this Advisory, below are
some guiding principles and key steps that health care technology companies can take
to help address health worker burnout:
Design technology to serve the needs of health
workers, care teams, and patients across the
continuum of care.
This includes identifying, delivering, and evaluating experiences that meet all users’
needs, including health workers, multi-disciplinary teams, and patients. Companies
can also:
Work with health workers to design and improve electronic health records
(EHR) to be easily accessible, understood, efficient and to not add to cognitive
load or compete with the time health workers spend with patients. Priority
opportunities include examining factors that may be contributing to information
overload, clinical decision complexity, and interruptions. Example solutions can
include reducing EHR pop-up messages to minimize work interruptions, improving
EHR integration into daily workflows, requiring minimal mouse clicks to carry out
a task, curating health data to better visualize patient health data and including
resources to better support clinical decision support.
255, 256, 257, 258
Co-design telemedicine and virtual care services together with end-users,
including health workers, patient populations, and families.
259
Example
opportunities that can ensure inclusive, accessible design in technology tools
include the evaluation and understanding of patient and caregiver users and
context, usability testing with patient groups and advocates, and considerations
What Health Care Technology
Companies Can Do
We Must Take Action
43
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
for varying levels of digital literacy and education, including accommodations
such as for different age groups and people with disabilities.
168, 258, 260
Design platforms with the goal of interoperability
at the outset.
Technology companies can ensure that patient-generated data is accessible in a
meaningful way and does not result in increased burdens on health workers.
37, 261, 262
This includes improvements in interoperability to optimize communication between
and across disparate systems and sources, such as care teams, laboratories, and public
health. This will help alleviate pressure points faced by health workers across the
continuum of care.
Strengthen integration of data across different
platforms and health sectors.
Having automated health data integration across systems allows for a more
comprehensive picture of a patient’s health profile while ensuring coordinated care.
Priority opportunities include improving data infrastructure to allow for integration
of information from all members of a clinical care team, including the patient,
caregivers, and across care teams.
Improve seamless storage of and access to health data.
This can include adopting a standard format for how health data is stored and
exchanged, and allowing the data to be accessed on computers, mobile phones and
other devices. This ensures seamless information flows across settings for diverse
members of the care team across the continuum of care to access securely, regardless
of data storage location.
258, 263
44
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
FIGURE 5
Physicians spend 2 hours on the electronic health
record (EHR) and other administrative tasks for every
hour directly caring for patients. Nurses spend up to
41% of their time on the EHR and documentation.
264
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Students and trainees (“learners”) are particularly vulnerable to burnout, therefore,
mental health services and support must be integrated throughout health professional
programs at all levels.
265
During the COVID-19 pandemic, several studies found high
levels of anxiety, fear, sleep disturbances, and depression reported among college
students; 70% of medical trainees surveyed in June-July 2020 reported that their
mental health was worse than baseline.
266, 267
Undergraduate, graduate, and post-
graduate programs have an opportunity to promote a culture and community that
supports their well-being and sets learners up for success.
Studies suggest that integrated programs among learning communities that require
resilience and mindfulness curricula and experiences strengthen community
cohesion and are associated with significantly lower levels of stress, depression, and
anxiety.
268
Applying the health care organization recommendations noted previously,
academic institutions can work with clinical training sites, health care and community
organizations, professional associations, and government partners on the following
actions:
Prioritize, assess, and support learner well-being.
Burnout and psychological distress are prevalent among students and trainees but
often understudied and not systematically monitored in the U.S. For instance, one
pre-pandemic study conducted at a tertiary academic center reported rates of burnout
as high as 69% among residents of all specialties.
269
In another example, a worldwide
meta-analysis of over 16,000 medical students found that 44% suffered from burnout.
270
We can help to:
Ensure periodic measurement and early intervention of learner stress,
burnout, and well-being.
Promote a culture and curriculum that recognizes the harms of sleep
deprivation to learning and enforce trainee shift schedules that minimize
sleep deprivation.
What Academic Institutions, Clinical
Training Programs, and Accreditation
Bodies Can Do
We Must Take Action
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Promote peer support and clearly communicate, encourage, and offer
students opportunities to rest and access well-being resources.
Develop integrated programs focused on supporting student wellness.
Academic institutions can better prepare students and trainees for coping with
morally and psychologically distressing situations, stress, sleep deprivation, and
preventing burnout. One example is the “Healer’s Art” course, started at the
University of California San Francisco by Dr. Rachel Remen, which helps students
stay connected to their core values and humanity and equips them with tools
to manage moral injury and stress.
271
Another example is Vanderbilt Medicine
School’s Student Wellness Program which is designed to alleviate the stress and
challenges that students commonly face. The program is designed with three core
pillars: 1) mentoring and advising, in which junior students develop relationships
with senior students as well as with students and faculty, 2) student leadership, in
which students are actively engaged in, and contribute to, the development of their
curriculum, and 3) personal growth, through which students are nurtured to build
an appreciation and understanding of their own psychological development.
272
Ensure educational and all-hazards training opportunities for disaster
preparedness.
273
Provide interdisciplinary rounding and coursework to support opportunities
for camaraderie, connection, and community.
274
Acknowledge the hidden curriculum within health
professional education and address the impact it has
on trainee development and well-being.
The hidden curriculum represents lessons learned that are embedded in an
organizational or learning environment culture and are not explicitly intended. It can
have large scale impacts on the culture of health, psychological well-being of trainees,
as well as the health and well-being of patients.
275
In 2018, The American College of
Physicians noted that more than half of medical students experienced disconnects
between what they were explicitly taught and what they perceived from faculty
members’ behaviors.
276
For example, while formal curricula may promote team-based
care, faculty member behavior may reinforce individualistic values or the idea that
certain specialties are better than others. Similarly, formal curricula may include
the importance of advancing health equity in medical education such as training
on implicit-bias, however longstanding hidden curricula may promote race and/or
gender-based bias towards learners and/or patients.
277, 278
While some hidden curricula
may reinforce positive behavior, such as prioritizing communication with patients in
47
Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
addition to physical exam, efforts should be made to address the impact on trainee
well-being and align efforts with formal education. We recommend implementing the
recommendations from the American College of Physicians Position Paper on the
hidden curricula, ethics, and professionalism which includes the following principles:
276
Faculty and senior health leaders should model empathy, encourage
reflection and discussion of both positive and negative behaviors, and
promote health worker wellness.
Teamwork and respect for colleagues must be taught and demonstrated.
Learning environments should foster respect, inquiry, honesty, and empower
every individual to raise concerns.
Health leaders and educators should create and sustain a strong ethical
culture by encouraging discussion of ethical concerns, making values explicit in
everyday decision making, and expectations of professionalism in which patient
well-being is a core value.
278
Promote and increase access to mental health and
substance use care for health professional learners
and faculty.
While burnout is distinct from mental health challenges, efforts should be made to
tackle the potential mental health consequences of burnout. Educational institutions
and health leaders should normalize conversations in the health professional school
community about mental health challenges, including substance use, anxiety,
depression, and suicide. They should foster a learning culture that supports mental
health and substance use care. This will improve knowledge of treatment for
learners and their future patients, while promoting a model of comprehensive care.
This can include:
Communicating regularly about free, accessible, and confidential resources.
For instance, the University of Pittsburgh School of Medicine program features
a dedicated medical student mental health care team comprised of a faculty
psychiatrist and full-time psychologist.
279
This team is complimented by the
Student Health Advocacy Resource Program (SHARP), a confidential peer-
counseling referral and advocacy service for medical students.
Investing in training for educators, mentors, faculty, and clinical training
program leaders on supportive supervision and on burnout prevention strategies.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Equipping students and trainees with evidence-based tools and trainings
where health and well-being are at the core. For example, resilience-building
workshops and curricula, which have been identified as tools for sustaining the
health workforce, can improve care quality and offer a sense of community
among health workers.
280
Raising awareness of health hazards and the role of safety culture in
health care as part of training curricula. Similarly, students in health care
management courses should be taught about the importance of safety culture,
the organizational benefits of having one, and how to achieve one in their
learning community.
Respond to the unique needs of students and
promote inclusion and diversity to support
well-being for all.
According to new data from the Association of American Medical Colleges (AAMC) the
first-year medical school class of 2021 is larger and more diverse than any before it, yet
we have more work to do in this area.
281
Institutions must take different backgrounds
and experiences into account when developing curriculum as well as mental health and
burnout mitigation programs. In addition, a pledge to accept a diverse student body
or hire a diverse workforce must be coupled with emphasis on retention, specifically,
developing a culture where all feel that they are valued and heard.
Address systemic barriers that keep students from diverse backgrounds from
entering and remaining in the health professions. The cost and complexity
of health care education, including the application process, can be daunting
for students from low-income backgrounds and underrepresented minorities.
Programs can decrease or waive application fees and offer remote or virtual
interviews for prospective applicants who may not be able to afford to take time
off work for in-person interviews. In the setting of the COVID-19 pandemic, AAMC
reported record number of applications from students from diverse backgrounds.
281
Learning environments should promote inclusive policies, mitigate stigma
and discrimination, and prioritize diversity efforts among faculty, students,
and trainees. A recent study found that female, underrepresented minority,
Asian, multiracial, and LGBTQ students bear a disproportionate burden of
the mistreatment reported in medical schools.
282
The same study found that
38% of underrepresented minority medical students have endured some form
of mistreatment, and more than 20% experienced either discrimination or
mistreatment in medical school based on their race or ethnicity.
282
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Increasing support and training for students, trainees, and faculty from
underrepresented minority communities. In addition to near-peer programs
which pairs mentors close to the social, professional, or age level of the mentee,
academic institutions should implement pipeline programs for supporting
and training students, trainees, and faculty. One example is the Harold Amos
Medical Faculty Development Program, established by the Robert Wood Johnson
Foundation, which offers four-year postdoctoral research awards to physicians,
dentists, and nurses from historically marginalized backgrounds.
283
Foster peer connectedness.
Some strategies include:
Promoting student-led, faculty-sup ported programs to improve student
navigation within the existing learning environment. One opportunity
example is the Navigating Medical School Program at Wake Forest School
of Medicine.
284
After the program was implemented, near-peer mentoring
significantly increased from 46% before to 70%. Students who gained a near-peer
mentor demonstrated improved self-directed learning behaviors.
285
Offering seminars and programs specific to medical school and trainee
transitions that create a collaborative environment for peers to provide
insight, advice, and strategies to maintain success.
According to new data from the Association of
medical school class of 2021 is larger and more
diverse than any before it.
281
Provide safe spaces and mentorship opportunities for underrepresented
minority students and faculty to share their experiences without fear of
retribution. For instance, the Student to Resident Institutional Vehicle for
Excellence program, or STRIVE program, which connects underrepresented
minority medical students at Northwestern’s Feinberg Medical School with
underrepresented minority resident mentors, serves as a space for students
to learn about approaches to confront bias and discrimination from peers and
mentors who have lived similar experiences.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Strengthen connection between trainees and the
communities they serve to mitigate burnout,
build trust and connection.
This means we need to:
Promote a synergistic relationship between patients and health workers
early in training to combat the decreased sense of purpose and connection
seen in health worker burnout. As an example, as part of the Health Systems
Science (HSS) curricula at Penn State College of Medicine (PSCOM), the
institution offered panel discussions with community leaders involved in a free
medical clinic, food pantry, and transitional housing program. Due to this, several
students at PSCOM developed a program that was ultimately funded by the
institution to provide fresh produce to at-risk patients and train fellow students
as “nutrition liaisons” to provide nutritional mentoring to families at market.
286
Design curricula that convey the importance of the continuum of care
across health care, public health, and the community. For instance, an early
focus on population health will help learners begin to understand and address
social and environmental factors that lead to repeat admissions and poor patient
outcomes.
287, 288
Research institutions should invest in and promote a research profile that
is centered in population health and health equity. Research institutions have
a unique opportunity to promote “community-engaged research,” a process
that incorporates input from people whom the research outcomes will impact
and involves such people or groups as equal partners throughout the research
process.
289
Research institutions should also encourage the uptake, acceptance,
and proliferation of new metrics that reflect community experiences and needs.
Incorporate professional education on misinformation and promote
awareness of reliable resources to students and trainees. This can include best
practices on how to present information to patients and communities and how to
access health information designed for non-technical audiences.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Accreditation organizations can
revise clinician accreditation standards
to recognize and communicate
the importance of health worker
well-being.
Accreditation organizations can play a key role by setting
and raising standards across health care organizations for
continuous monitoring, reporting, and action to improve
health worker well-being.
In addition to monitoring for burnout, consider
adding measures for staff “sense of feeling valued”
to organizational dashboards.
290
NAM offers validated
tools to measure a baseline of health worker well-being,
and ensure best practices are standardized across
hospitals.
Institutionalize health worker thriving and well-
being as an organizational value. For instance,
the American Nurses Credentialing Center
(ANCC) Pathways to Excellence Program or the
Magnet Recognition Program recognize health care
organizations through excellence in nursing care, and
high-quality patient care and outcomes.
291
Resources for Students,
Trainee and Faculty/
Mentors in Learning
Environments
Better Help Resources American
Medical Student Association
(AMSA)
Medical Student Well-Being
Association of American Medical
Colleges (AAMC)
Resources for Courses in Ethics,
Moral Distress and Resilience
Johns Hopkins Medicine
Well-Being Resources
Accreditation Council for
Graduate Medical Education
(ACGME)
Guidebook for Promoting Well-
Being During the COVID-19
Pandemic ACGME
FIGURE 6
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
What Family Members, Friends,
and Communities Can Do
The pandemic has caused tremendous suffering and pain, yet it has also reminded us
of the importance of working together and supporting one another. Health workers
are our family members, friends, colleagues, and neighbors. While addressing health
worker burnout requires systemic change, here are steps we can take as individuals to
support the health workers in our lives:
Learn to recognize when a health worker you know
needs support.
The pandemic has challenged all of us and increased our risk of psychological distress,
which, like physical stress, can harm the body and mind. Health workers are at
increased risk for burnout given their work caring for others.
Check-in with the health workers you know. Help them stay connected. Ask
them how they are doing and how you can help them, such as “what can I do for
you right now?” You can also ask, “what was the hardest part of your day?” or
“what worked well for you today?” Know your quiet presence and listening can
convey support and compassion.
Pay attention to warning signs that indicate that they may need professional
support from a mental health provider. People experience distress differently,
but common behaviors to watch out for include increased irritability, withdrawal
from friends and family, impaired judgment, excessive alcohol or substance use,
reduced ability to manage emotions and impulses, and decreased personal hygiene.
Learn about national and local resources, including the ones listed below,
that are available to health workers who may be struggling.
Protect your health and the health of your family.
To reduce strain on the health care system and health workers, take care of your
health as much as possible. This includes staying up to date with all vaccinations
and other preventive care whenever indicated, such as blood pressure checks,
We Must Take Action
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
mammograms, cervical cancer screenings, and colon cancer
screenings. Optimize your physical activity, sleep, healthy
nutrition, social support, and spiritual connection.
Adhere to local public health
guidelines.
For example, stay home if you are ill unless you need to seek
medical care. Follow public health advice on community
mitigation measures to reduce the burden on the health care
system and help protect others.
292
Help friends and family do their part
to support health workers.
For example, if you have friends or family who are hesitant
to get vaccinations, engage with them in non-judgmental
and constructive ways. Showing them that you care and are
willing to listen can go a long way toward building trust.
For actionable tips, check out the Surgeon General’s
Community Toolkit for Addressing Health
Misinformation.
293
As a patient, be kind to health
workers.
While you should absolutely expect quality care and
professionalism, acknowledging the pressure that health
workers are experiencing can go a long way. Many may be
feeling undervalued, overworked, or isolated. Some have
faced harassment, stigma, and violence. Health professionals
are doing their best to care for you, often with limited
resources in underserved communities, and may be facing
financial or other personal challenges.
Resources for Families
and Friends of Health
Workers
COVID-19 Vaccine Resources
COVID-19 Community Corps
I’m Looking for Mental Health
Help for Someone Else Mental
Health America (MHA)
Tools and Resources for
Communicating on Public Health
Public Health Communications
Collaborative (PHCC)
Resources on PTSD for Families
U.S. Department of Veterans
Affairs (VA) National Center for
PTSD
Resources for Families Facing
Domestic Violence
Call 1-800-799-SAFE (7223) or
Text START to 88788
National Domestic Violence
Hotline
Resources for Families
Coping With Mental Health
and Substance Use Disorders
U.S. Department of Health
and Human Services (HHS),
Substance Abuse and Mental
Health Services Administration
(SAMHSA)
Seize the Awkward
Call 1-800-273-8255 or Text
SEIZE to 741741
American Foundation for
Suicide Prevention (AFSP), Jed
Foundation, Ad Council
Supporting a Family Member
Who is a Health Care Worker
Suicide Prevention Resource
Center (SPRC)
FIGURE 7
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
What Health Workers Can Do
We Must Act
While preventing burnout and associated mental health challenges calls for both
an employer and a whole of society effort to ensure lasting change, there are
evidence-based strategies that health workers can take to prevent burnout and
improve their well-being.
294
Many organizations and associations have developed
and compiled resources to help health workers protect their health and well-being.
Below are a few of their recommendations:
Learn to recognize the signs of distress, mental
health challenges and burnout in yourself and
in your colleagues.
You are not alone in whatever you are feeling. Start with a simple question for
yourself or peers, “how are you doing, really?” You may also find a training such as
Psychological PPE helpful to identify and help respond to signs and symptoms of
distress in yourself or in your peers.
295
Stay connected and reach out for help.
Identify a list of 2-3 friends and/or family members who you can lean on and call
during moments when you feel overwhelmed, even if it’s just for 5 minutes. Ask your
employer about your organization’s employee assistance program (EAP) which is a
free and confidential resource. Employers should be regularly communicating with
all health workers on available supports and services, including support for child care
or care for older adults. See the resources listed below to find support from trained
professionals to help with mental health conditions, stress, insomnia, or any other
emotions you may be feeling.
Prioritize moments of joy and connection.
This may mean returning to old hobbies, spending time with friends or family, or
trying something new when you’re ready.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Get back to basics with good health habits.
Eating nutritious meals, exercising regularly, getting enough sleep, and limiting
alcohol and harmful substance use can help you cope with stress at work and home.
A 10-minute walk outside in sunlight can help improve your energy and focus.
Use your voice to advocate for positive changes
in your workplace, learning environment
or communities.
Participate in peer support programs, workplace safety committees, and worker teams
focused on problem solving. You can also join a health professions association or
specialty organization for local, state or national level advocacy, to connect to peers
outside of your workplace who may be having similar experiences, or to find additional
resources for support or learning opportunities. Many associations have health worker
well-being initiatives and committees. They may also offer advocacy opportunities
across a variety of topics, including around the social determinants of health that may
be impacting your patients and communities.
FIGURE 8
Resource Compendium for
Health Care Worker Well-Being
National Academy of Medicine
(NAM)
Resources for Health
Professionals National Alliance
on Mental Illness (NAMI)
Stress First Aid Module American
Medical Association (AMA)
Support for Public Health
Workers and Health Professionals
U.S. Centers for Disease Control
and Prevention (CDC)
Tips for Coping with Stress and
Compassion Fatigue SAMHSA
Toolkit for Addressing
Workplace Violence American
College of Physicians (ACP)
Well-Being Initiative American
Nurses Association (ANA)
Resources to support health worker health and well-being This is not a comprehensive list.
24/7 Hotlines If you are in
a crisis now, or concerned that you
or someone may harm themselves or
someone else, seek immediate help
by using these 24/7 hotlines.
National Suicide Prevention
Lifeline
Call 1-800-273-TALK (8255)
Crisis Text Line
Text HOME to 741741
Veterans Crisis Line
Call 1-800-273-8255 and press 1,
or Text to 838255
Physician Support Line
Call 1-888-409-0141 (staffed by
volunteer psychiatrists)
Disaster Distress Helpline
Call or Text 1-800-985-5990
Substance Abuse and Mental
Health Services Administration
(SAMHSA)
Additional Resources
Behavior Health Treatment
Locator SAMHSA
Being Well in Emergency
Medicine: Guide to Investing in
Yourself American College of
Emergency Physicians (ACEP)
Compassion Fatigue Resources
Mental Health America (MHA)
Disaster Behavioral Health
Resources
of the Assistant Secretary for
Preparedness and Response
(ASPR)
Moral Injury in Health Care
Workers U.S. Department of
Veterans Affairs (VA) National
Center for PTSD
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Where Additional Research
is Needed
Call for further coordinated research to develop a
national, validated tool to regularly assess, measure,
track and respond to health worker burnout and
well-being across settings.
This includes support of research that is inclusive of the diversity of professions and
health workers across the health care system. Priorities areas can include:
Measure, track, respond to, and share findings on the extent of health worker
burnout, moral distress, moral injury, and well-being across health care
settings using validated tools.
135, 296
This includes studies that systematically
examine and analyze differences by health care setting and department, as
well as by race, ethnicity, gender, age, disability, and among groups of health
workers, including those in low wage occupations, rural settings, and in tribal
communities. This data will strengthen our understanding of the causes and
consequences of burnout and moral distress on all health workers, including
historically overlooked groups, and help stakeholders to best allocate resources,
and evaluate timely, culturally appropriate interventions.
Support research on the effects of integrated team-based models of care on
health worker well-being, patient outcomes and other impacts.
Expand research that can evaluate and inform future health worker
well-being projects, programs and policies across health care and public
health settings. For example, the Patient-Centered Outcomes Research Institute
(PCORI) has offered support on innovative studies using diverse methodology
that examine strategies to protect the well-being of the health workforce.
297
There is also an opportunity for increased understanding on the effectiveness of
programs related to health worker well-being, such as psychological and mental
health first aid.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Improve our understanding of the immediate and
long-term impacts of the pandemic on health worker
well-being.
This can include continued research on:
The extent of mental health challenges among health workers, including
health professional students and trainees. This can include studies on the
relationship between burnout, moral distress, moral injury, and risk for anxiety,
depression, substance use challenges, and suicidal ideation. This will help inform
future policies and programs.
Post-COVID conditions and short and long-term disabilities. This will help
us understand the impacts, better support health workers who are suffering from
post-COVID conditions, and better protect health workers from other respiratory
diseases and future pandemics.
Inclusive of research on optimal approaches to early detection, prevention,
treatment, and rehabilitation; approaches to assessment of impairment and
disability; and tracking prognosis of post-COVID conditions among health
workers to identify opportunities for supporting their well-being.
298
Role of payment models, technology, and private equity
in shaping health worker well-being.
This can include:
Further research on the impact of telemedicine and other virtual care
services on health worker well-being, the patient-clinician relationship,
and patient outcomes to inform future telemedicine standards.
299
Research to examine the effects of value-based models of care on health
worker well-being.
Research on resource allocation, health worker well-being, health care
access, and patient outcomes within private equity owned health care
facilities and other for-profit structures.
300
This will ensure appropriate
accountability and oversight to protect health worker well-being and
patient safety.
301, 302
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Further exploration of the role and potential for current and emerging
artificial intelligence technologies and applications to reduce administrative
burden on health workers while also improving patient safety and care.
303, 304
Improve our understanding of how to develop and
apply health information technology (IT) that more
effectively supports health workers in the delivery
of care.
This can include:
Research to examine how to design and develop effective health IT, including
better tools to summarize, organize, and display data to better support
health workers with decision making, documentation, and care delivery.
Research to evaluate the impact, effective implementation, and role of health
IT in various health settings, including assessing training needs of health
workers. This could include research into the development and validation of
effective measures, including impact on productivity, utilization, morale; and how
to incorporate evaluation findings into systems improvement.
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Conclusion
A few weeks before this Advisory was published, I met with a group of health workers
at Jackson Memorial Hospital in my hometown of Miami, Florida. When I went
around the room and asked everyone how they were coping with the pandemic and its
impact on their work, one nurse told me he felt “helpless, but not hopeless.”
I was struck by his faith. After two unfathomably traumatic years, he was still showing
up—sometimes tired, sometimes overwhelmed, sometimes scared or lonely, but
always confident in the power of his compassion, his colleagues, and his community
to make things just a little bit better every day.
Millions of health workers like him are now counting on us to make the policy,
institutional, and systems changes necessary to address the burnout crisis decimating
their colleagues—and to do so with the urgency this moment demands.
Will we step up, and meet our moral obligation to care for those who have cared for
us? It won’t be easy. Many of the recommendations in this Advisory require significant
structural change and sustained investment. They will take time and require our
continued attention and action.
But the hope of health workers has endured through far worse. Our efforts must
as well.
“Will we step up, and meet our moral
obligation to care for those who have
cared for us?”
Dr. Vivek Murthy, Surgeon General of the United States
Vivek H. Murthy, M.D., M.B.A.
Vice Admiral, U.S. Public Health Service
Surgeon General of the United States
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Glossary
Anxiety is an emotion characterized by
feelings of tension, worried thoughts, and
physical changes like increased blood pressure.
Occasional anxiety is an expected part of life.
Anxiety disorders are medical diagnoses that
arise when the anxiety does not go away, and the
symptoms interfere with daily activities such as
job performance and relationships.
https://www.nimh.nih.gov/health/topics/anxiety-disorders
https://www.apa.org/topics/anxiety
Behavioral health encompasses traditional
mental health and substance use challenges, as
well as overall psychological well-being.
https://www.cms.gov/outreach-education/american-
indianalaska-native/aian-behavioral-health
https://www.cdc.gov/pcd/issues/2020/20_0261.htm
Burnout is an occupational syndrome resulting
from chronic workplace stress due to an
imbalance between job demands and resources.
It is characterized by having at least one of the
following feelings when thinking about one’s job:
emotional exhaustion; feeling detached from
and cynical about work and reduced professional
efficacy.
https://www.who.int/news/item/28-05-2019-burn-out-an-
diseases
Cardiovascular conditions (e.g., high blood
pressure, heart attack, stroke) relates to the
heart or blood vessels. The risk of certain
cardiovascular diseases may be increased by
high blood pressure or unhealthy behaviors (e.g.,
smoking). The most common cardiovascular
disease is coronary artery disease (narrow or
blocked coronary arteries), which can lead to
chest pain, heart attacks, or stroke.
https://www.nccih.nih.gov/health/cardiovascular-disease#:~:
text=Cardiovascular%20diseases%20(diseases%20of%20
the,heart%20become%20narrowed%20or%20blocked
Chronic workplace stress relates to multiple
different factors that health workers may
face pertaining to their occupations which
negatively impact them, including the immediate
workplace environment (e.g., relationships with
supervisors), organizational system (physical
structure of the work environment, company
policies), and societal influences (e.g., patient
expectations, government policies that affect the
workplace).
https://nam.edu/wp-content/uploads/2017/01/Multifacted-
Systems-Approach-to-Addressing-Stress-Within-Health-
Professions-Education-and-Beyond.pdf
Cognitive load is the relative demand imposed
by a particular task, in terms of the mental
resources required. Also called mental load,
mental workload.
https://dictionary.apa.org/cognitive-load
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Compassion fatigue is the phenomenon of
stress resulting from exposure to a traumatized
individual rather than from exposure to
the trauma itself. It can be characterized by
exhaustion, anger and irritability, negative
coping behaviors including harmful alcohol and
drug use, reduced ability to feel sympathy and
empathy, a diminished sense of enjoyment or
satisfaction with work, increased absenteeism,
and an impaired ability to make decisions and
care for patients and/or clients.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/
Depression is a medical diagnosis defined
as a prolonged episode of at least 2 weeks of
depressed mood or anhedonia occurring most of
the day, nearly every day. It is a common mental
disorder and is treatable. A combination of
therapy and antidepressant medication can help
ensure recovery.
https://www.nimh.nih.gov/health/topics/depression
https://www.apa.org/topics/depression
Employee assistance program (EAP) is a
voluntary, confidential program that helps
employees (including management) work
through various life challenges that may
adversely affect job performance, health, and
personal well-being to optimize an
organization’s success.
https://www.opm.gov/policy-data-oversight/worklife/
employee-assistance-programs/
Food insecurity is a household-level economic
and social condition of limited or uncertain
access to adequate food.
https://www.ers.usda.gov/topics/food-nutrition-assistance/
Health equity is achieved when every person
can “attain his or her full health potential” and
no one is “disadvantaged from achieving this
potential because of social position or other
socially determined circumstances.”
https://www.cdc.gov/chronicdisease/healthequity/index.htm
Low wage—There is no consensus around a
definition or metric for this.
https://www.brookings.edu/research/meet-the-low-wage-
workforce/
https://www.brookings.edu/research/essential-but-
undervalued-millions-of-health-care-workers-arent-getting-
the-pay-or-respect-they-deserve-in-the-covid-19-pandemic/
Mental health encompasses our emotional,
psychological, and social well-being and is an
essential component of overall health.
https://www.mentalhealth.gov/basics/what-is-mental-health
Moral distress describes a situation when health
workers know what care their patients need
but are unable to provide it due to constraints
beyond their control. Having to choose between
keeping their own families safe and caring for
patients, witnessing patients dying in isolation,
or not having the right tools to help save a patient
are examples that can cause moral distress.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506903/
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Moral injury is the lasting psychological,
spiritual, behavioral, or social impact that can
result from repeated experiences where one
experiences moral distress. When health workers
have moral injury, they may experience feelings
of guilt, shame, and anger and these can result in
stress reactions such as sleep changes, isolation,
and a weakened sense of empathy. Moral injury
and its relationship to burnout and other chronic
workplace stress phenomena is an active area
of research.
https://www.ptsd.va.gov/professional/treat/cooccurring/
moral_injury.asp
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-
0366(21)00113-9/fulltext#:~:text=Moral%20injury%20is%20
understood%20to,person’s%20moral%20or%20ethical%20
code
Post-Traumatic Stress Disorder or PTSD is
disorder that develops in some people who have
experienced a shocking, scary, or dangerous
event. It is a medical diagnosis and is defined by
having all of the following for at least 1 month:
At least one re-experiencing symptom (e.g.,
flashbacks), a least one avoidance symptom
(staying away from places that are reminders of
the traumatic experience), at least two arousal
and reactivity symptoms (e.g., having difficulty
sleeping, or angry outbursts), at least two
cognition and mood symptoms (e.g., guilt, loss
of interest in enjoyable activities).
https://www.nimh.nih.gov/health/topics/post-traumatic-
stress-disorder-ptsd
Public health promotes and protects the health
of people and communities where they live, work,
learn and play.
https://www.apha.org/What-is-Public-Health
Resilience is the ability to persevere, adapt,
recover, or even grow from adversity, stress,
or trauma.
https://nam.edu/systems-approaches-to-improve-patient-
care-by-supporting-clinician-well-being/
Social determinants of health are conditions
in the places where people live, learn, work,
and play that affect a wide range of health and
quality-of-life risks and outcomes.
https://www.cdc.gov/socialdeterminants/index.htm
Substance use disorders occur when
the recurrent use of alcohol, opioids,
benzodiazepines, and/or other drugs causes
clinically significant impairment, including health
problems, disability, and inability to meet major
responsibilities at work, school, or home.
disorders#:~:text=Substance%20use%20disorders%20
occur%20when,work%2C%20school%2C%20or%20home
Telehealth is defined as the use of electronic
information and telecommunication technologies
to support long-distance clinical health care,
patient and professional health-related education,
health administration, and public health.
https://www.hrsa.gov/rural-health/topics/telehealth/what-is-
telehealth
https://www.cms.gov/newsroom/fact-sheets/medicare-
telemedicine-health-care-provider-fact-sheet
Well-being is described as a state in which
people perceive their lives as going well,
including aspects of their physical, emotional,
and psychological health, productivity, and
economic well-being.
https://www.cdc.gov/hrqol/wellbeing.htm
https://nam.edu/systems-approaches-to-improve-patient-
care-by-supporting-clinician-well-being/
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
Acknowledgments
This Advisory was prepared by the Office of the Surgeon General (OSG)
with valuable contributions from the following U.S. interagency partners:
Department of Health and Human Services
Agency for Healthcare Research and Quality (AHRQ)
Office of the Assistant Secretary for Health (OASH)
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Office of the Assistant Secretary for Preparedness and Response (ASPR)
Centers for Disease Control and Prevention (CDC)
Office of the Director
National Institute for Occupational Safety and Health (NIOSH)
Centers for Medicare and Medicaid Services (CMS)
Office of the Administrator
Center for Clinical Standards and Quality (CCSQ)
Center for Medicare and Medicaid Innovation (CMMI)
Office of Burden Reduction and Health Informatics (OBRHI)
Health Resources and Services Administration (HRSA)
Office of the Administrator
Bureau of Health Workforce (BHW)
Indian Health Service (IHS)
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Office of Minority Health (OMH)
Office of the National Coordinator for Health Information Technology (ONC)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Additional Partners
White House Domestic Policy Council (DPC)
Department of Defense (DOD)
Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA)
Department of Labor (DOL)
Federal Emergency Management Agency (FEMA)
US Department of Veterans Affairs (VA)
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Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce
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