When the COVID-19 pandemic receded, clinical workers expected three things: sustained recognition for what they had endured, a period of respite and a return to some version of normalcy. Most got none of them.
Instead, they returned to waiting rooms full of patients who had deferred care for years and walked into a new kind of burnout.
“There were a lot of patients waiting to come to the healthcare system,” said David Marcozzi, MD, chief clinical officer of Baltimore-based University of Maryland Medical Center and associate dean of clinical affairs at University of Maryland School of Medicine. “You really weren’t the hero that the public had originally thought you were — and I still consider everyone who came to work a hero. You couldn’t really step away. There was more work to do.”
Years later, the burnout has not disappeared. New AI capabilities have chipped away at documentation burden, but workforce burnout has changed shape, and that shift has made it harder to address.
Five leaders — a chief clinical officer, a chief nurse executive, a chief quality officer and two well-being leaders — described to Becker’s a clinical workforce navigating a new kind of strain: one without a common enemy or a clear end.
From a single cause to many
The defining feature of COVID-19 pandemic-era burnout, several executives said, was that it had a focus. Workers knew what they were battling, and they believed there would be an end.
“In COVID, there was a common cause to save people’s lives, and it was really easy to have that motivation,” said Mary Beth Lardizabal, DO, vice president of mental health and addiction and system medical director of provider well-being at Minneapolis-based Allina Health. “Plus, we had the belief that there would be a cure, there would be an end. Burnout is not like that now.”
What clinicians face today is harder to name. Financial pressure, staffing constraints, regulatory burden, patient volume and institutional uncertainty are all compounding at once.
“There’s stressors coming from so many different angles versus just one,” said Heidi Woodland-Leine, PsyD, manager of provider well-being at Allina Health.
That pressure has specific clinical and legal consequences. When financial constraints force institutions to cut services or change how care is delivered, clinicians experience what Dr. Lardizabal called moral distress — a term she was deliberate about.
“In the COVID pandemic everybody was kind of using all resources available, and now there are less and less resources,” she said. “Clinicians are being asked to do things differently in a way that might not be how they were trained or what they would think is the best possible care, simply because those resources or finances are not available… Some people call it moral injury, but I think the term moral distress captures it.”
Dr. Marcozzi framed the same pressure from a systems perspective. As healthcare expenditures approach 18% to 19% of the nation’s gross domestic product, the burden falls on clinicians: Do more with less.
“The inflection point that healthcare is considering right now is how to work smarter, not harder, with less,” he said.
Burnout looks different by discipline
Documentation burden — which research has consistently linked to physician burnout, including the after-hours charting known as pajama time — has started to ease as ambient AI tools and EHR improvements take hold. But experts caution against seeing AI technology as a general solution.
For nurses, the burnout equation looks different, according to James Ballinghoff, DNP, RN, chief nurse executive at Philadelphia-based Penn Medicine.
“For nursing, I think burnout is more around interactions with people: the disrespect, the violence, the aggression,” Dr. Ballinghoff said. “We spend the majority of time with the patient.”
Staffing is the other major factor, which Dr. Ballinghoff said is not simply nurse-to-patient ratios. When environmental services, food service, phlebotomy or nursing assistant teams run short, registered nurses absorb those gaps.
“Staffing does not necessarily mean RN staffing,” he said, recalling a time when environmental service workers were in short supply, “so there were no linens, [nurses] had to run and get this supply, they had to help turn over a room.”
These additional expectations can weigh on staff.
“The lemon has been squeezed so tight, meaning reimbursements are either flat, sometimes going down, very rarely is it going up, but our expenses went up, our labor costs went up, our supply costs went up, everything went up,” Dr. Ballinghoff said. “It’s just like how we’re living at home, our paychecks can go up, but the price of eggs and gas are going up, and you can’t always rely on your employer to fix that for you.
“We can’t rely on the government paying us the Medicare rates or the payers paying us to cover those increases,” he said. “So, where does it get cut? It gets cut in employees, you know, it always does. And people are feeling that.”
Dr. Ballinghoff also pointed to a subtler structural shift: the design of new hospital buildings. Where nurses once gathered at a central station to document, decompress and build relationships, newer facilities place workstations outside individual rooms, closer to patients, but farther from colleagues.
“Because there’s no longer that nurses station where people would gather and have conversations and create relationships,” he said. “That’s a negative to what you were trying to accomplish as a positive.”
The pizza problem
Organizations trying to address burnout through recognition gestures — catered lunches, T-shirts, Nurses Week giveaways — have found those efforts increasingly counterproductive, executives said, at least in part because of social media.
Dr. Ballinghoff, who monitors nursing influencers with millions of followers to gauge workforce sentiment, described watching content that reframes sincere gestures as insults or shames someone for their profession. At one event, an audience booed a nurse manager after hearing her job title.
“That is the worst message that you can be sending to people: that their managers are out to get them or they’re not supportive,” he said. “When millions of people are hearing that… you can’t underestimate or put your head in the sand that it’s not having an impact in a negative way on our profession.”
The effect is a chilling one: leaders now second-guess gestures they would once have made instinctively.
Dr. Lardizabal was direct about the limits of surface-level interventions: “If that’s your only intervention, you don’t have a well-being program. It has to be much more multifactorial.”
The well-being initiatives most likely to read as empty gestures, she said, are those that cannot be separated from the circumstances that produced them — an organization cutting services, reducing staff or asking clinicians to do more, then offering cold pizza as acknowledgment.
What’s actually working
The institutions seeing the most traction on provider well-being share a few traits: peer infrastructure, compensation for doing well-being work and consistent outcome measurement.
At Allina Health, the center for provider well-being runs refuel groups, direct care psychology and psychiatry services, employee assistance program counseling and a network of well-being leads embedded across the system. Those leads are compensated two hours per week for their well-being work.
“It shows the system that it’s valued,” Dr. Lardizabal said. “[With] the cost of replacing one of those docs, it’s money well spent.”
At NYC Health + Hospitals, Chief Quality Officer and Senior Vice President Hillary Jalon cited the system’s culture of safety infrastructure as the foundation for everything else — including a program called Helping Healers Heal and the reinvigoration of the Just Culture framework in 2024.
The New York City-based system’s most recent employee engagement survey found safety culture scores rising 9% in acute care hospitals and 10% in post-acute care facilities during a period when national scores declined.
“In order for performance improvement to thrive, you need to have a culture of safety,” Ms. Jalon said.
What’s at stake
The stakes of getting this wrong extend well beyond retention figures. A significant share of the clinical workforce is nearing retirement, while the incoming pipeline of physicians and advanced practice providers is smaller and carries different expectations about work and sacrifice.
“Gen Z docs don’t want to do it the way their dads or moms did,” Dr. Lardizabal said. “They really want to have a life, and they’re not going to do the same sacrifice of their health and their time. If you want to recruit those folks, we have to have a different system.”
Dr. Ballinghoff put it plainly: “The joy in work is not there. It’s there in pockets, but it’s not there” the way it was for earlier generations.
Dr. Marcozzi, who was the COVID-19 Incident Commander for the University of Maryland Medical System, framed the moment in terms of what the industry learned from COVID-19 and risks losing.
“We came together and figured it out, and let’s not let those lessons learned fade away,” he said. “We need to accelerate the pace of change and speed of decision, so healthcare can keep up and be ready for the next response.”
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