The pandemic’s toll on healthcare workers has been beyond quantifiability. Long hours fielding medical unknowns, shifting targets, and ongoing personal and family risk mitigation have pushed providers to the brink, and for many, into burnout.

 Burnout is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed…characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and reduced professional efficacy.” For most healthcare providers, the working conditions during periods of the pandemic were unprecedented. Symptoms ranged from insomnia to PTSD. Research has found that factors affecting levels of provider stress during the pandemic have included the availability of protective equipment, the provision of mental health support, feelings of the sufficiency of one’s preparedness, and satisfaction with public behavior. ​​

Our team was interested in learning just how widespread COVID-19 burnout has been during the pandemic, how long it lasted, and which specialties were most impacted. To estimate any potential burnout or periods of extended sabbatical taken by healthcare workers, we identified physicians with three or more months (90 days) without medical encounters, as a proxy for work cessation. We further explored differences across specialties and provider roles. 

Here’s what we found:

• Fifteen months after the pandemic began, more providers began stepping away from work.
  We observed the first significant increase in provider claims cessation in March 2020, when the percentage of providers beginning a 90-day or more cessation in claims increased by 106%, from 3.7% in January to 7.5% in March. However, while burnout may have contributed to this, it was likely driven by the decline in elective and outpatient services during the pandemic shutdown. The rate quickly returned to normal by April, where it remained for fifteen months. 
  
  The second spike came in June of 2021, when the percentage of providers beginning a 90-day or more cessation in claims increased by 35%, from 3.1% in May to 4.1% in August. This more likely reflects a surge in provider burnout, having occurred after the lockdown was lifted and after medical services largely returned to normal. The timing may relate to public behavior (vaccination uptake, adherence to gathering, and masking guidelines) on worker morale.
  
• In the summer of 2021, providers in non-frontline specialties stepped away from work at nearly double the rate of frontline specialties.
  While this is counterintuitive, other research has identified similar trends — this systematic review on psychological distress among healthcare workers during the pandemic found that frontline workers scored lower on distress scales than non-frontline workers. Between May and August of 2021, we observed an increase of 23% in work cessation among frontline workers (from 2.2% in May to 2.7% in August), compared with an increase of 40% among non-frontline workers (from 3.4% in May to 4.8% in August). As providers from many non-frontline specialties were asked to work in emergency rooms and ICUs as hospitalization numbers surged, these findings may reflect differences in training and experience in crises/critical/frontline settings. More research is needed to elucidate this trend.
  
• The number of nurses that stepped away from work rose by 29% in the summer of 2021.
  Work breaks taken by providers in nursing specialties, including nurses, nurse
  practitioners, and advanced practice nurses, increased from 2.8% in May 2021 to 3.5% in August 2021. Nurses tend to take more time off than other providers, in general, and can have fewer barriers to time off in their employment compared with other specialties, but this finding also likely reflects a disproportionately high burden of difficult working conditions and staffing shortages for nurses during the pandemic.

This analysis emphasizes the importance of taking myriad and broad factors into account when considering the causes of burnout. Here, the timing of the surge in work cessation may point to a more complex story than one of the demands on providers and working conditions alone. The higher rates of work cessation seen in non-frontline workers, nurses, and critical-care providers should also be considered in further analysis and prioritization in the development of plans for ameliorative action. 

The task of minimizing burnout in times of acute medical demand will be best approached with a nuanced understanding of the problem — something Komodo Health’s high-fidelity claims and provider data are here to support. 

To read more about healthcare providers during the COVID-19 pandemic, check out our research brief on Ivermectin prescribing trends.

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