Healthcare News of Note: Healthcare workers are more emotionally exhausted as pandemic continues

• Healthcare worker well-being resources and programs may be inadequate or difficult to complete, with most workers reporting an increase in emotional exhaustion since the onset of the pandemic.
• Average wait times are 20.6 days to see a family medicine specialist and 34.5 days for a dermatologist.
• Among people with employer-sponsored healthcare coverage, there are large health disparities across chronic conditions, maternal health and behavioral health.

1. Most healthcare workers report increased emotional exhaustion since the onset of the pandemic

Although emotional exhaustion (EE) trajectories have varied among healthcare worker (HCW) roles since the start of the pandemic, EE has increased overall and among most roles, according to results of a three-year study published Sept. 21 in JAMA Network Open.

“These results suggest that current HCW well-being resources and programs may be inadequate and even more difficult to use owing to lower workforce capacity and motivation to initiate and complete well-being interventions,” wrote the authors.

The overall sample included 107,122 completed surveys — conducted September 2019, September 2020, and September 2021 through January 2022 — with 40.9% of the respondents in nursing roles. The study looked at how individuals perceived not only their own EE, but also the EE climate of their workplaces.

Key findings

Results show:

• Overall healthcare worker EE increased from 31.8% in September 2019 to 34.6% in September 2020 to 40.4% in the September 2021-January 2022 period.
• From September 2019 to September 2021 through January 2022, shares of healthcare workers who perceived emotional exhaustion in their workplace climate increased from 53.3% to 59.8% to 64.9%.

The study results also were broken down among three broad categories: primary care physicians, nurses and other healthcare workers. The researchers also looked at results by specific title, such as pharmacists and physical therapists.

Role-specific results include:

• Aggregated categories of physicians showed a decrease in EE from 31.8% to 28.3% between 2019 and 2020 — but an increase during the second year to 37.8%. (The study authors noted: “Flexibilities afforded by increases in telehealth and decreases in patient volume may explain some of the 2020 decrease in physician EE.”)
• Nurses reported an increase in EE during the first year from 40.6% to 46.5% and another increase during the second year to 49.2%.
• All other roles showed a similar pattern to nurses but at lower levels.

2. Average wait times to see a physician in 5 specialties have increased by nearly 2 days since 2017

New patients will have to wait an average of 26 days for a first-time appointment with a physician in several specialties, according to the 2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.

The wait times increased 8% from 24.1 days in 2017, the last time AMN/Merritt Hawkins conducted the survey. The specialties in the survey include cardiology, dermatology, obstetrics-gynecology, orthopedic surgery and family medicine.

The survey of 1,034 physician offices — conducted over about 10 weeks in the spring of 2022 — presents a snapshot of physician availability in the five medical specialties in 15 major metropolitan areas.

“It should be noted that physician-to-population ratios in the 15 major metropolitan areas are historically some of the highest in the country,” wrote the authors. “If access to physicians in metropolitan areas with a large number of physicians per capita is limited, it may be reasonable to infer that physician access could be more problematic in areas with fewer physicians per capita.”c

They added that a change to the timing of the survey, location of the physician offices surveyed or methodology “could yield different results.”

Wait-time changes

Average wait times have increased since 2017 for four of the specialties and decreased significantly for family medicine physicians. Wait times are:

• 34.5 days to see a dermatologist, up from 32.3 days
• 31.4 days to see an OB-GYN, up from 26.4 days
• 26.6 days to see a cardiologist, up from 21.1 days
• 20.6 days to see a family medicine physician, down from 29.3 days
• 16.9 days to see an orthopedic surgeon, up from 11.4 days

Medicare and Medicaid acceptance rate changes

The report also has results for Medicare and Medicaid acceptance rates in 2022 compared with 2017 for all markets in the study:

• The average rate of physician Medicare acceptance is 82.4%, down from 84.5%.
• The average rate of physician Medicaid acceptance is 54.1%, up from 53%.

Surveys were conducted in Atlanta, Boston, Dallas, Denver, Detroit, Houston, Los Angeles, Miami, Minneapolis, New York, Philadelphia, Portland, San Diego, Seattle and Washington, D.C.

3. Large health disparities are seen among those with employer-sponsored healthcare coverage

Among people with employer-sponsored healthcare coverage, “large health disparities across chronic conditions, maternal health and behavioral health” were revealed after an analysis of three nationally representative public surveys and national vital statistics records, says a report by Morgan Health and NORC.

“Some of the most significant differences appear to be statistically associated with race,” wrote the authors. “Furthermore, the analysis uncovered significant substance use issues and disparities across sexual orientation subgroups,” and it “revealed challenges related to care accessibility, which was primarily associated with income differences.”

Some of the high-level findings of the report published in July include:

• The burden of chronic disease varies significantly across races, with data revealing underdiagnosis of key conditions for certain patient populations.
• Behavioral health and substance use issues were prevalent among all enrollees, but there were stark differences in severity of these issues and related outcomes for lesbian, gay or bisexual enrollees.
• Despite perceptions around the robustness of coverage within employer-sponsored insurance, enrollees experience significant barriers to accessing care, particularly members of racial or ethnic minority groups and individuals with low or modest incomes.
• Even with employer-sponsored coverage, some enrollees have unmet social needs that can further exacerbate gaps in health outcomes.

HFMA bonus content

Listen to the Voices in Healthcare Finance podcast episode “The five essential people on every patient’s cancer care team (and why a financial advocate should be one of them),” hosted by Erika Grotto, senior editor with HFMA.

Read the article “Hospitals issue plea for healthcare policymakers to do more to buttress the industry” by Nick Hut, HFMA senior editor.