Occupational burnout is a long-standing issue in the physician community, and the COVID-19 pandemic has only increased pressures on physicians. In 2021, the overall physician burnout rate was 42%, according to a survey by Medscape. While this rate is similar to what it was in 2020, the COVID-19 pandemic appears to have affected some specialties more than others, the survey suggests. For instance, in 2020, physicians reporting the most burnout included those in the specialties of urology, neurology, nephrology, endocrinology, and family medicine. In contrast, physicians in critical care, rheumatology, and infectious diseases reported the highest rates of burnout in the 2021 survey.
Physicians report that a major cause of burnout is administrative tasks, such as completing electronic health records and otherwise documenting care. Other factors physicians cite include a lack of adequate personal protective equipment, grief from losing patients, watching families suffer, long hours, and difficult working conditions, especially since the start of the COVID-19 pandemic. These factors have resulted in in a high level of stress, mental and physical exhaustion for physicians, and chaotic working environments. Many physicians prefer to reframe clinician distress as “moral injury.” When external factors—such as lack of equipment, insurance and payment options, administrative work, and other factors—hamper physicians’ ability to provide the necessary level of care, they face a moral dilemma. Although physicians want to provide the best quality care to all of their patients, they need support to address those aspects of patient care that lie outside their control.
Implications of Physician Burnout
Physician burnout can lead to reduced access to care, as medical practices close and physicians retire early. Physicians leaving the profession for any reason is cause for concern, particularly as more providers are needed to keep pace with the health care needs of the aging U.S. population and to address gaps in physician distribution across the country. For example, metropolitan areas tend to have an abundant supply of physicians, while rural areas do not. Specifically, the Robert Graham Center for Policy Studies, in collaboration with the Agency for Health Research and Quality (AHRQ), notes that there are 68 primary care physicians per 100,000 people in rural areas, compared with 84 per 100,000 in urban areas. According to AHRQ, 77.5% of primary care physicians are in urban areas, 11.1% are in large urban areas, 7.2% are in small urban areas, and 4.2% are in rural, remote, or frontier areas.
A mismatch between physician supply and demand could result in inadequate community care and overburden an already fragile health care system.
Who Are Community Health Workers, and How Can They Help?
The Centers for Disease Control and Prevention defines community health workers as trained public health workers who serve as a bridge between communities, health care systems, and state health departments, with the primary goal of enhancing capacity. Community health workers are recruited directly from the community in which they will serve, meaning they speak the same language, have similar cultural understanding, and have shared experiences with the community members they will serve.
Because of the community-based nature of their work, community health workers are uniquely positioned to connect members of their communities to resources, even more so than traditional health care workers. They have the capacity to identify needs within the health care delivery system and bridge gaps between the community and providers. In recognition of the importance of community health workers in bridging access to care gaps, President Biden has called for adding 150,000 community health workers.
Community health workers can play a particular role in addressing social determinants of health. Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age. These conditions affect a wide range of health, functioning, and quality-of-life outcomes and risks.
The Five Domains of Social Determinants of Health
Social determinants can have a major effect on health outcomes, especially for the most vulnerable populations, and health care professionals should consider factors such as a patient’s education, income level, and living environment when providing treatment and care. However, social determinants of health are often outside the control of physicians, and they vary from patient to patient, making them difficult to directly address.
Community health workers, who can act as provider liaisons, embedded in the community who understands how external factors affect an individual’s health could be better positioned than a physician to address social determinants and bridge gaps in care. For instance, a community health worker could meet with a patient before they see a clinician and provide connections to community resources outside of the traditional health care system. Such resources might address housing and food insecurity, access to transportation, provider availability, language and communication needs, and patient-friendly information about the health care system—all factors that can affect an individual’s health. Beyond connecting patients to resources, community health care workers can provide health screenings for patients in the community and assist in provision of basic care when certification and licensure allows.
Community health workers also have the potential to strengthen health equity within a community by forming connections with harder-to-reach community members. By triaging community needs and addressing social determinants of health before patients need clinical care, community health workers can both decrease strain on physicians and help lower the overall cost of care. More specific ways that community health workers can address social determinants of health are below.
How Community Health Workers Can Address Social Determinants Of Health
|Economic Stability||Educate patients about financially feasible access to nutritious foods or employment services|
|Education||Serve as a liaison for health information when working with patients with low health literacy and assist patients with navigating the healthcare system when faced with barriers to care.|
|Healthcare Access & Quality||Provide access to healthcare education before and after provider appointments and assist with scheduling appointments or identifying providers.|
|Neighborhood & Built Environment||Assist patients in finding access to transportation to healthcare appointments, connect patients to housing services, and educate about physical activity opportunities|
|Social & Community Context||Encourage and educate patients on using IT and patient portals to communicate with providers in between appointments and during treatment and connecting patients with care that respects their culture and traditions|
Policy Implications and What’s Next
A growing body of evidence shows the positive effect community health workers can have. For instance, one study examined a community health worker intervention focused on addressing unmet social needs. According to the study, every dollar invested in the intervention returned $2.47 to the average Medicaid payer. Another study showed that after a community health worker program was implemented, visits to emergency departments declined by 40% and hospital readmissions declined by 33%. Additionally, physician Medicaid reimbursements declined by 27%, a sign that community health care workers might have lifted some burden from physicians.
In order to continue to integrate community health workers into the formal health care system on a wider scale, it will be essential to determine how to professionalize, legitimize, and reimburse community health workers for their work on a state and/or national level. For instance, community health workers do not have a universally defined and specified scope of practice, leading to challenges around reimbursement. Nineteen states so far have developed certification processes with a clearly defined role for community health workers to address this. Evidence shows the positive effects community health care workers can have on patients, communities, and even physicians, and IMPAQ will continue to explore this issue.
- The Effectiveness of a Community Health Worker Outreach Program on Healthcare Utilization of West Baltimore City Medicaid Patients with Diabetes, with or without Hypertension (Ethnicity & Disease, 2003)
- Evidence-Based Community Health Worker Program Addresses Unmet Social Needs And Generates Positive Return On Investment (Health Affairs, 2020)
- Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women (Journal of General Medicine, 2010)
- Cost-Effectiveness Analysis of a Community Health Worker Intervention for Low-Income Hispanic Adults with Diabetes (Preventing Chronic Disease, 2012)
- Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial (A Journal of Public Health, 2011)