Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / Zombie Burnout: Why Low Turnover Isn't What It Seems
Transcript
- Santina Wheat: Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. Since we are in the middle of Halloween season, I want to ask you a provocative question. What is the absolute scariest costume in healthcare this year? It's probably not the bloodstained scrubs from a movie set. It is certainly not a fake skeleton or a ghost costume hanging in a store aisle. In my opinion, the scariest costume in healthcare this year is walking down the hall of your clinic, your hospital, or your department every single day. The scariest costume is the individual who is looking fine. It's the polished Composed mask we put on over our faces before we step into an exam room or a faculty or leadership meeting. It is the rehearsed, automatic answer we give when a colleague asks, How are you doing today? And we smile, nod, and say with incomplete sincerity, doing great, just busy. All while our internal battery is sitting at a lowly two percent. Recently, a new healthcare workforce report came out from Bamboo HR featuring a phrase that I haven't been able to stop thinking about. And that is zombie burnout. Now, if you look at national numbers from the American Medical Association, There is some genuinely encouraging news. Physician burnout rates have actually steadily fallen from their post-pandemic peak of nearly 63% down to under 42%. That means that something's working. Systemic interventions around inbox management and administrative workflows are starting to move the needle. We're talking a drop of 21%. And yet, When you look at the broader healthcare workforce data, sixty-five percent of all healthcare workers still report active burnout, compassion fatigue, moral distress, or secondary traumatic stress. Meanwhile, resignations have fallen every single year since 2022. That is down to 55.9% of departures this year. But I want you to think about what those two realities mean when you put them side by side. It means resignations keep falling, nobody is leaving, but nobody is fully well. Even as macro burnout numbers slowly improve, nearly two-thirds of our workforce is still navigating moral distress and secondary trauma. And despite that, nobody is quitting. There are no jump scares here. There are no dramatic masks. There are just good, dedicated, highly trained human beings who are quietly walking the halls on empty. They keep showing up, they keep signing the charts, they keep seeing the patients, and attending the meetings, not because they are fully restored, but because they are caught in a sort of suspended animation. As a physician leader, an educator, and a director, that disconnect between the turnover numbers and human well being is the single metric that haunts me the most. For decades, healthcare administrators, C suites, and department heads have been conditioned to read low turnover as a massive victory. That means retention is great. We open our dashboards, look at the retention graphs. And see that resignations are down. And we pat ourselves on the back because it means things are working. We tell ourselves: look at our retention metrics. Burnout numbers are coming off their peak. Resignations are down. Our culture must be healthy. Our team is loyal. And importantly, people are staying. But I don't think that's the full story. In fact, I want to offer you a hard diagnostic truth today. Retention without wellness is not loyalty. It is hostage taking. Even with national burnout averages improving, when over 40% of physicians and two-thirds of clinical staff remain in distress, low turnover is certainly not proof that your culture is thriving. It is proof that your people are too depleted to imagine leaving. They don't have the cognitive bandwidth to update their CV, to schedule job interviews, or even navigate a career transition. So they stay. They stand in front of patients, they precept the residents, they teach the medical students, and they complete charting while feeling completely hollowed out on the inside. If nobody is quitting, but nobody is well, then your organizational culture is not healthy. It is undead, like a zombie. Let that sink in. A system that measures its health strictly by whether or not people are quitting is a system that is completely blind to human suffering. You are measuring physical presence while ignoring psychological absence. Let's talk about loyalty versus undead retention. Real loyalty is a healthy culture where staff stay because they feel valued, supported, and psychologically safe. There's high energy, active engagement, clear boundaries, and importantly, deep purpose. Contrast that with undead retention. Or zombie culture. In this scenario, staff stay because they are too exhausted to construct an exit plan. There is depleted morale, quiet compliance, mechanical output, and a significant amount of burnout. So let's talk about why burnout is a leadership issue, not just a personal failure. How did we get here? How did we create an environment where two-thirds of healthcare workers are operating like zombies? Well, we got here because for 20 years, healthcare leadership has treated burnout as an individual resilience problem rather than a structural operational problem. When staff report compassion fatigue or moral distress, what is the standard institutional response? Many offer a mandatory 15-minute mindfulness module, or hand out free coffee vouchers, or bring pizza to the break room. We tell our doctors and our nurses, you just need to practice better self-care and work to build your emotional resilience. That framing is toxic. Although some may need to work on their self-care and build emotional resilience, healthcare workers are already the most resilient population on the planet. You don't survive medical school, residency, nursing school, and decades of high-stakes clinical practice without immense internal resilience. The multi-year drop in physician burnout we have seen recently. didn't happen because doctors suddenly took more mindfulness classes. It happened because institutions finally started addressing structural frictions. Many streamlined EHR and templates, they automated inbox routing, and increased team-based documentation support. Burnout is not something that is occurring because clinicians lack resilience. Burnout occurs when we ask resilient human beings to function inside systems that are structurally designed to consume them. So there are some chronic reasons why we have moral distress. There is the chronic inbox bloat and prior authorization barriers. There are the short-staffed shifts and unrealistic slot templates. There is subverting clinical judgment for financial metrics. And then there are the reformative wellness initiatives that really just add on to the administrative tasks. All of us are familiar with these, and all of us are frustrated by them. When a physician or nurse experiences moral distress, it is not because they are tired. it is because they are forced to participate in a system that has significant friction, like wrestling with the insurance, like rushing through those 15-minute visits, or charting until midnight that directly prevent them from giving patients the care they deserve. When you tell a clinician in moral distress that they simply need more resilience, you are gaslighting them. Burnout is a leadership and system design problem. And fixing it starts with leaders who are willing to look past the dashboard numbers. Now, don't get me wrong, individuals need to take care of themselves as well. Individuals need to have self care. and need to hold on to their boundaries. But individuals need the system to support them more as well. So, how do we break the zombie spell? How do we move from undead retention to authentic healthy engagement? Well, it starts with leaders who have the courage to model the exit ramp. If you lead a department, direct a residency, or manage a clinical team, your team is watching your relationship with work. If you are an administrator or an attending who answers emails at 11 p.m., Works through every vacation and brags about never taking a break, then all you are doing is reinforcing the zombie culture. You are signaling to your team that to stay employed here, they must forfeit their humanity. Instead, we have to model fierce excellence on the clock and then the engine completely off when we step off the clock. And then as a leader, we have to change what questions we are asking when we look at our dashboards. So the old dashboard question is Is anyone quitting? This measures our physical retention, looking at the clinician turnover. But instead, we should be asking a better question, a more truthful leadership question. And that is, is anyone well? This measures human sustainability and their ability to thrive. To ask, is anyone well? You have to look for real signals, not just the spreadsheet data. So what does a real signal look like on a clinical team? It might be, is there laughter in the break room? Or is there a heavy oppressive silence? Are people speaking up in meetings with fresh ideas? Or are they just nodding passively to get out of the room? Are your junior faculty and residents taking their earned CE and vacation days? Or are they hoarding them out of guilt because they don't trust anybody to cover them while they're gone and they can't imagine the immense backup that they would have if they left? Do team members feel safe saying, I am maxed out on this project? Or do they smile, take on the extra load, and collapse privately? When you audit real signals instead of turnover graphs, you stop managing a zombie workforce and start building a sustainable culture. This Halloween, let's take off the mask of looking fine and consider your Monday morning challenge for this week. If you are a clinician, an educator, or a leader who has been white knuckling through zombie burnout, showing up on empty, smiling through the fog, and pretending you're fine, I want you to give yourself permission to drop the mask. I want you to identify. One boundary you need to draw this week, whether that's locking your inbox at 6 p.m. or asking for help with a clinical task. If you lead people, I want you to pick one person on your team this week. Sit down with them, look past their productivity metrics, and ask them directly. I know your charts are done and you're showing up every day, but I want to know. Are you actually well? And most importantly, listen to their answer without judgment, without offering a quick fix, and without defending the system. Validate their reality, help them find an exit ramp off the treadmill, and let them know that they don't have to carry the load alone. I want to thank you for joining me on this episode of the Hidden Load. If this conversation about zombie burnout and true culture metrics spoke to you today, please share it with a colleague or a leader who needs to hear it. Let's lighten the load together. I'm Dr. Santina Wheat and I look forward to seeing you next week. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode ⁓ and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up too. And I'll see you next time.