Staff Attrition — A Chronic Disease of Analog Clinics?

The continuing global battle against Covid-19 has put an enormous strain on healthcare systems all over the world. Consequently, working conditions for medical personnel have deteriorated in many institutions and the already inadequate numbers of staff to fill these challenging positions continue to plummet.

According to the latest projections by the AAMC (Association of American Medical Colleges, 2021), the United States of America will be faced with a total shortage of 37,800 to 124,000 physicians by 2034.¹ This problem is not unique to the United States. Contrary to the overall positive reputation of the German healthcare system, here too, a shortage of nearly 165,000 doctors and about 800,000 non-physician professionals can be expected by 2030.² Despite the growing need for a reliable and highly functional healthcare system during times of a global pandemic, projections for healthcare staff numbers such as these are far from improving.

A recent representative survey with 291 German hospitals revealed that more than half of the clinics expect problems due to a lack of nursing personnel to intensify in the next years, with about 25% expecting significant aggravations of the situation.³

Insufficient numbers of staff lead to an increased workload and overall pressure for the remaining personnel. This may explain why employees in the healthcare sector demonstrate comparatively high rates of presenteeism⁴, the phenomenon of attending work despite being ill⁵. The difficulty to arrange temporary replacements for their position is one of the reasons why doctors work even when they are unwell.⁶

Presenteeism has been linked to:

• lower levels of productivity,
• reduced concentration and performance as well as
• higher error rate.⁷

Especially in the medical field, these are serious consequences with potentially detrimental outcomes in terms of patient care. In a study on errors, stress and teamwork in medicine with more than 1000 healthcare professionals, numbers of staff as well as communication were both identified as critical factors regarding patient safety outcomes.⁸

Healthcare professionals protesting against poor working conditions in November 2020. Retrieved from: https://www.theguardian.com/society/2021/jul/30/us-nurses-strike-covid-coronavirus-conditions-understaffing

Why are healthcare professionals quitting?

The adverse developments regarding personnel retention in healthcare, especially in these times of heightened pressure on the system, beg the question of why doctors and non-physician medical staff are so inclined to leave their profession.

Optimal medical treatment for most diseases involves a thorough investigation of underlying root causes rather than an isolated treatment of symptoms. Similarly, when it comes to the body of medical institutions, solutions and changes can only be implemented once critical causes for the high attrition rates have been identified.

High workloads, the degree of required emotional labour and role discrepancies are some of the reasons, why healthcare professionals may choose to leave their jobs:

1. High workloads are a major contributing factor: In a recent survey conducted with over 8000 physicians, 80% of the doctors who participated indicated that they were working at full capacity or felt overburdened and 78% reported to be experiencing feelings of burnout at least sometimes.⁹ Together with the aforementioned high rates of presenteeism, this draws a bleak picture in terms of occupational well-being and explains why so many healthcare professionals may be looking for less straining job opportunities.
2. Apart from the very large volume of tasks, the quality of work in medical professions ought to be taken into consideration as well. Direct human interactions are a central part of many jobs in the health sector and tend to involve a high degree of emotional labour¹⁰, such as showing socially or situationally “appropriate”emotions rather than displaying one’s true feelings.¹¹ This has been shown to increase health workers’ intention to quit by decreasing their overall job satisfaction.¹⁰ Especially aspects of a doctor’s job like patient education, which require a high degree of empathy and a relatively large amount of time, may entail emotional labour and thus impact job satisfaction.
3. Role discrepancies at work emerge when employees carry out roles that do not match their expectations.¹⁰ Results by Takase et al. (2006) indicate a link between nurses’ experience of role discrepancies with their intention to quit. The healthcare professionals participating in their study experienced pronounced mismatches of their expected and actual roles in decision making with hospital policies and patient education.¹² For many doctors the desire to help people and provide care is a major driver in the pursuit to become a medical professional. Oftentimes these aspects of the job fall short under intense time pressure and a heavy workload, rendering role discrepancies a very likely consequence. If these particularly fulfilling parts of being a healthcare professional are consistently overridden by other very strenuous and less rewarding tasks, it may well lead to reflections about whether or not the chosen profession was indeed the right one.

How can we turn around declining trends in staff numbers?

To improve these unfavourable conditions in healthcare, Ostwald et al. (2010) stress the need for higher salaries, especially for nursing personnel. Additionally, the authors propose the provision of more child care options in order to help establish better work-life balance for employees.

The notion that the current devision of tasks in many clinics is lacking efficiency is supported by the aforementioned study by Merritt Hawkins (2018) which revealed that doctors currently spend 23% of their time on non-clinical paperwork alone.⁹

At medudoc, we believe that the smart integration of technology in clinical work settings can disrupt the vicious circle of overburdened medical personnel giving up their positions, leading to a distribution of the same workload on fewer remaining staff and ultimately resulting in poor employee or patient health outcomes (figure 1). The medudoc solution enables digital, highly individualised patient education through personalised videos and integrates options for clinical documentation, such as informed consent sheets. The increase in workflow efficiency creates the necessary space for more in-depth patient-physician conversations. This, in turn, may help with role discrepancies by reducing the gap between doctors’ expected and actual roles.

Our platform and services are aimed at:

• alleviating all healthcare professionals’ workload and time pressure
• reducing the amount of time spent on manual, analog documentation and repetitive work tasks
• improving the patient experience through higher quality patient education as well as more pleasant interactions with unburdened doctors and nurses

Figure 1. medudoc’s potential to disrupt the vicious triangle of overburdened healthcare professionals and staff attrition.

Join us in innovating healthcare!

If you are a healthcare professional currently feeling the effects of continuously declining numbers of staff and are looking for ways to improve the situation in your clinic, adapting the medudoc solution may be a valuable option for you to consider. Take the first step, learn more about our service and connect with us through our website. In our modern working world, we already have the technology to reduce workloads and vastly improve working conditions for healthcare professionals. Are you ready to start making use of it?

Further reading

If you’re curious to learn more about the importance of communication in the medical field and the role modern technology plays in this, have a look at our recently published article “Communication is Key and Always Will Be: Disruptive developments in modern speech technology and how they may transform healthcare for the better”.

About the author:

Evelyn Lange works as a Medical Education Writer at the digital health start-up “medudoc” in Berlin. With a background in psychology she is now working on bridging the digital gap between doctors and patients through the creation of intelligible medical education content.

You can contact Evelyn via e-mail and LinkedIn.

References:

¹Association of American Medical Colleges. (2021). The Complexities of Physician Supply and Demand: Projections From 2019 to 2034. IHS Markit Ltd.. https://www.aamc.org/media/54681/download

²Ostwald, D.A., Ehrhard, T., Bruntsch, F., Schmidt, H., & Friedl, C. (2010). Fachkräftemangel Stationärer und ambulanter Bereich bis zum Jahr 2030. PricewaterhouseCoopers AG. https://www.pwc.de/de/gesundheitswesen-und-pharma/assets/fachkraeftemangel.pdf

³Blum, K., Heber, R., Levsen, A., Löffert, S., Offermanns, M., & Steffen, P. (2021). Krankenhaus Barometer Umfrage 2021. Retrieved from: https://www.dki.de/sites/default/files/2021-12/20211221_Final_KH-Barometer-komprimiert_0.pdf

⁴Aronsson G, Gustafsson K, Dallner M. Sick but yet at work. An empirical study of sickness presenteeism. J Epidemiol Community Health 2000;54:502–9.

⁵Sanderson, K., & Cocker, F. (2013). Presenteeism: Implications and health risks. Australian family physician, 42(4), 172–175.

⁶McKevitt C, Morgan M, Dundas R, Holland WW. Sickness absence and ‘working through’ illness: a comparison of two professional groups. J Public Health Med 1997;19:295–300

⁷Voermans, S., & Ahlers, G. (2009). Präsentismus: Krank zur Arbeit: Was kosten uns „tapfere “Kollegen? 2. Bremer Fachaustausch „Gemeinsam neue Wege “. Bremen, 30, 2009.

⁸Sexton, J. B., Thomas, E. J., & Helmreich, R. L. (2000). Error, stress, and teamwork in medicine and aviation: cross sectional surveys. Bmj, 320(7237), 745–749

⁹Merritt Hawkins. (2018). 2018 Survey of America’s Physicians: Practice Patterns & Perspectives. https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Content/Pdf/MerrittHawkins_PhysiciansFoundation_Survey2018.pdf

¹⁰Anafarta, N. (2015). Job satisfaction as a mediator between emotional labor and the intention to quit. International Journal of Business and Social Science, 6(2), 72–81.

¹¹Lu, Y., Wu, W., Mei, G., Zhao, S., Zhou, H., Li, D., & Pan, D. (2019). Surface acting or deep acting, who need more effortful? A study on emotional labor using functional near-infrared spectroscopy. Frontiers in human neuroscience, 13, 151.

¹²Takase, M., Maude, P., & Manias, E. (2006). The impact of role discrepancy on nurses’ intention to quit their jobs. Journal of clinical nursing, 15(9), 1071–1080.