Abuse and Burnout in Health Profession Workplace Environments

The concept of a work environment, especially after the COVID-19 pandemic, has shifted immensely. Work environment encompasses the system, people, responsibilities, salary, location, structure, and conditions where one completes expected tasks. Unsurprisingly, one’s work environment has a significant impact on productivity and overall well-being. It is estimated that 80% of difficulties regarding employee productivity are connected to the type of work environment they are in (Anjum et al., 2018).

In 2023, the American Psychological Association (APA) conducted an online poll surveying about 2,500 American workers. A jarring one in five people surveyed disclosed work experiences that impacted their mental health. Job type was shown to be a protective factor and a risk factor simultaneously. Client-facing jobs, like healthcare workers, were more likely to experience verbal abuse, where manual labor jobs were more likely to experience physical abuse. When considering abuse that occurred toward racial and ethnic minorities, around 15% of participants endorsed this experience. Additionally, a quarter of participants disclosed witnessing toxic work environment acts toward someone with a marginalized identity (American Psychological Association, 2023). 

A toxic workplace can be defined as an environment that engages in discrimination, harassment, and/or disrespectful behavior. This may be a consequence of poor group cohesion or communication, power discrepancies, or excessive workload (Adam, 2023). Other definitions include, “sexual harassment, harassment based on race, national origin, color and religion, child labor, illegal work practices, physical threats, insults, and aggressive nature of speech” (Cass et al., 2010, pp. 303-306). Not only does a toxic work environment decrease the overall well-being of employees, but it also impacts financial outcomes. It was estimated that between $700 billion to $2 trillion is lost annually due to work place environment issues (i.e., increased sickness and productivity loss; Dhanani et al., 2021). Hostile workplace environments can be legally addressed as experiences of discrimination due to the punitive and targeted nature of the perpetrated behavior against a victim, as established in the 1986 U.S. Supreme Court case Meritor Savings Bank v. Vinson, 477 U.S. 57 (Meritor Savings Bank v. Vinson).

Toxic Work Environments Across Healthcare Professions

Toxic Work Environments for Surgeons

Burnout was in the top five most common reasons surgeons are influenced to retire prematurely (Cimbak et al., 2019). Workplace bullying, especially with surgical residents and interns as victims, is far too common in the medical setting as well. Depression and suicidal ideation have been reported across all career stages in the surgical profession regardless of the medical specialty they practice in (Albuainain et al., 2022; Ames et al., 2017). Burnout rates soar in this community, reaching nearly 50% for physicians and as high as 74% for residents (Ames et al., 2017). Not only do surgeons face frequent physical harm (i.e., stabs and cuts from sharp objects, burns from sterilizing equipment, noise-induced hearing loss), they also face a myriad of psychosocial concerns (i.e., exposure to severely traumatized patients, perfectionism related to perception of responsibility for patients’ lives). Physical and emotional exhaustion from long hours and critical decision-making make it so around 30% of the community experiences comorbid psychological concerns (Memon et al., 2016). Social exclusion, sexual assault, and harassment are embedded in the toxic culture for surgeons. One study indicated that nearly 60% of medical trainees experience at least one form of harassment or discrimination throughout their training (Fnais et al., 2014). Some believe the culture is creating such hostile environments, it is killing patients too (Ivory, 2015).

Toxic Work Environments for Veterinarians

Demanding work environments significantly and negatively impact veterinarians not just in their job satisfaction, but also in their health and safety (Rejula et al., 2003). The career field had a 16% turnover rate in 2021, which aligns with another study that indicated around 16% of the community was experiencing high amounts of burnout (Hansez et al., 2008; Nolen, 2023). Overarching concerns within veterinary medicine include navigating disgruntled or saddened clients, unpaid bills, euthanasia, and swing shifts (Anonymous, 2002, as cited in Hansez et al., 2008). However, when isolating gender as a construct, women typically reported stress due to relational disagreements with administration and from the effort required for continual education to remain qualified. Men more often reported struggles from financial disputes or career growth opportunities (Gardner & Hini, 2006). Unlike human healthcare, veterinary medicine does not use a team approach as veterinarians often work alone. One study suggests that implementing collaborative care could improve job satisfaction, so long as the team is effective. If the team engages in toxic work environment behaviors, there is an increased likelihood for employees to report exhaustion and cynicism (Moore, 2014). 

Toxic Work Environments for Mental Health Professionals

Few studies have addressed the potential negative consequences or toxic environments within mental health trainees (Pakenham & Stafford-Brown, 2012). Despite mental health professionals potentially researching or treating experiences of abuse, the same field sometimes perpetuates or conceals this very issue (Ross-Nash, 2022). This was evidenced when Dartmouth College’s Department of Psychological and Brain Sciences offered a $14 million settlement to several female students after three professors sexually harassed and assaulted them (Hartocollis, 2019) Hood and colleagues (2024) explored the impact of doctoral internship stipends frequently being below living wages. The average internship stipend between the years 2021-2022 was $31, 783, which is nearly $2,000 lower than the average wage. Stipends were adjusted based on the cost the area, however, around 15% of stipends had discrepancies of $10,000 when considering standard cost of living. Inadequate compensation is not only discredited the countless hours of higher education these trainees have accumulated, but also is harmful to the interns causing financial hardship (Hood et. al, 2024). 

Toxic Work Environments for Dentists

It is hypothesized that despite the growing number of women in the historically male-dominated field of dentistry, that workplace harassment, specifically sexual harassment, is higher in this community (Garbin et al., 2010). Halappa (2019) untangled the difference between job challenge and job stess; challenge should energize and motivate when forming new skill sets, while job stress is a mismatch between expectations and capabilities, resources, or needs. In one study, nearly 25% of dental hygienists experienced workplace bullying (i.e., opinions ignored, unmanageable case load, work being excessively monitored; McCombs et al., 2018). Toxic workplace concerns are not just a product of peer-to-peer interactions; some dentists reported being victimized by patients themselves or by relatives of a patient. Being a victim of assault, which included loud shouting, physical or verbal threats, and mobbing, was most commonly experienced by first year dental professionals. Long appointment times and cost of treatment were the most frequent catalysts for assault. Dentists reported they did not feel prepared to address these issues when faced with it (Ojukwu et al., 2020).

Burnout and its Consequences

Burnout, a psychological syndrome, consists of three key constructs: emotional exhaustion, depersonalization (negative and cynical attitudes), and reduced personal accomplishment (Maslach, 1993). Burnout is often viewed as a workplace hazard for individuals in service-oriented and people-driven professions. In these roles, it is industry standard to be altruistic with one’s time, help others, work long days, and go above and beyond. Additionally, the organizational infrastructure of such occupations is governed by sociopolitical factors that can create workplaces that are high in demand and low on personnel. Despite these systemic variables, the dynamics that healthcare professionals create with clients requires consistent and intense personal and emotional connections. Such rapport can be fulfilling; however, it can also lead to feelings of stress (Maslach & Leiter, 2016). Unsurprisingly, burnout has generally been associated with anxiety and depression (Morse et al., 2012).  

When examined further, burnout has been correlated with several implications at both the micro-level for providers and the macro-level for organizations (Morse et al., 2012). Individually, burnout can cause physical challenges, such as somatic symptoms, exhaustion, decreased social participation, difficulty with emotion regulation, and has been hypothesized to create an overall pessimistic view towards the self and others (Gorgievski & Hobfoll, 2008; McCormack et al., 2018; Paris & Hoge, 2010). At the organizational level, burnout has been associated with non-attendance, diminished productivity, decreased commitment to the organization, and high turnover (Ahola et al., 2008; Burke & Richardsen, 2000; Stalker & Harvey, 2002; Taris, 2006). In fact, the financial cost of burnout in public mental health is substantial and often considered “economically wasteful” (Gilbody et al., 2006, p.7).

Burnout can also negatively impact clients’ quality of care (Rupert et al., 2015). In the field of mental health, clinician absence and attrition has been correlated with decreased compliance to evidence-based practices and is thought to interrupt the continuity of services provided. All of these concerns impact care and can reduce patient satisfaction (Boyer & Bond, 1999; Halbesleben & Rathert, 2008; Leiter et al., 1998; Rollins et al., 2010).

Assessment and Healing

Despite the prevalence and correlation with a plethora of negative consequences, there has been minimal effort to decrease or prevent burnout for mental health providers (Morse et al., 2012) and across healthcare in general (Dyrbye et al., 2020). Many healthcare providers know what someone who struggles with burnout looks like. However, it can be hard to recognize the transition process from a high-energy, passionate person to a fatigued, apathetic, and autopiloted individual. Therefore, recognizing and stopping the process of an individual on their way to burnout is critical. For this to occur, providers must first comprehend and be aware of how to notice symptoms. De Hert (2020) shares that the outcome leading to a person being burned out occurs over time. Signs and symptoms can be allocated into feeling states, attitudes and actions, and somatic responses (Harris, 1984). Feeling states include helplessness, hopelessness, dissatisfaction, and emotional exhaustion. Attitudes and actions entail pessimism, rigidity, and powerlessness. Somatic responses consist of feeling fatigued and greater susceptibility to illness. Many people encounter some of these signs and symptoms at some point; however, repetitively experiencing these feelings or behaviors in conjunction with less job satisfaction suggests that an individual struggles with burnout (Harris, 1984). 

Preventive interventions to mitigate burnout aims to reduce the probability of negative outcomes by building one’s protective factors and decreasing risk factors. Preventative steps for burnout can be most impactful when considering reducing risk and increasing an individual’s capacities and resources (Di Fabio & Palazzeschi, 2015). Catering interventions toward the individual’s unique environment, attributes, and characteristics can be even more effective, for example, understanding one’s preferences, needs, goals, and skills (Beck et al., 2010).

Resources for Burnout in Healthcare Workers

Due to demanding jobs, high stress, and long hours, healthcare workers may be subject to toxic work environments. Whether it is a competitive colleague or a punitive supervisor, these situations can significantly impact workers who already have emotionally and physically exhausting occupations. Burnout is common, making self-care a necessary component of healthcare workers’ lives. If you are looking for resources on burnout, consider the following links to increase your engagement with self-care and self-compassion.

https://www.samhsa.gov/resource/dbhis/self-care-healthcare-workers-modules

https://www.mentalhealthfirstaid.org/2020/04/self-care-tips-for-health-care-workers/

https://wellbeingcollaborative.org/self-care/