During the pandemic, Amarilis Martin, MD, was working in a hospital where some nurses and doctors were growing increasingly frustrated with the administration’s policies.

Some of the younger nurses had left the hospital to pursue the generally more lucrative field of travel nursing. Other nurses left because they refused a mandated COVID vaccine, she said. Then, some of the older, more experienced nurses who stayed on became increasingly frustrated with stagnating salaries and increased work demands.

“Somehow, I kind of heard about all this and you could see it in their faces,” said Martin, who now works as a pediatric intensive care provider at Stonybrook Children’s Hospital in Stony Brook, New York, but was at a different institution during the pandemic when these events took place.

Overall, burnout among hospital clinicians is still a problem.

“Many people are still feeling distressed about their work, and I think there’s still a lot of work that needs to be done,” Martin said.

‘The Biggest Thing is Frustration’

Forty-five percent of hospitalists nationwide are experiencing burnout according to the 2024 Society of Hospital Medicine Workforce Report.

“Burnout is a major issue for hospitalists around the country,” Michelle Knees, DO, a hospitalist, said in an email.

“That takes a toll not only on hospitalists’ mental health, relationships, and career longevity but also on the care patients receive, where it can manifest as compassion fatigue or even lapses in safety,” wrote Knees, an assistant professor at the University of Colorado, Aurora, Colorado.

“I have seen a lot of it, unfortunately,” Martin told Medscape Medical News. “The biggest thing is that frustration. You can feel it. You can see it.”

The Root of Burnout Among Hospitalists

Burnout is not only about individual resilience, Knees said in an email. It’s driven mostly by systemic issues such as high workloads, limited autonomy, and the challenges of “working in a complex, and sometimes dysfunctional, healthcare setting,” she said.

A major source of frustration is the extensive documentation insurance companies require to cover the cost of certain medications and medical supplies, Martin said. “That just takes a lot of work,” Martin said. “So we are in constant need of using a care manager, or even trainees, who just devote a chunk of time trying to discharge one patient.”

Another issue is that physicians are working “very demanding” long hours, and they do not always have enough time to recover, Martin said. “That just adds to the whole problem, and then, they really have a harder time coping” she said. That can push some doctors to leave.

As profiled in a 2024 editorial written by Knees and Marisha Burden, MD, one 2024 study in the Journal of Hospital Medicine that surveyed 88 hospitalists across the country found that an unsafe clinical workload was “the only factor linked with all measured outcome variables such as higher burnout, lower work well-being, depersonalization, emotional exhaustion, and decreased personal accomplishment,” Knees and Burden wrote in their editorial.

“That study provided additional compelling survey evidence to support a strong relationship between unsafe clinical workloads, low hospitalist well-being, and high burnout,” Knees and Burden wrote. They added: “Targeting this area of hospitalist work is likely to be particularly beneficial to decreasing hospitalist burnout, while also creating safer care systems for patients.”

Martin recalls that burnout was happening before the pandemic, too, but the pandemic just “brought it to light a lot more.”

“There’s still underlying burnout — many people just having some psychological distress from medicine,” Martin said. At the end of a shift, the hospitalist still needs to write notes before they can come in the next day and handle new admissions, discharges, and taking care of patients; this can make it hard to rest and fully allow yourself to disconnect from work.

Possible Solutions

In May 2024, Martin cowrote a letter to the editor, “Mitigating Burnout Imperative for Retention of Hospitalists” for the Wisconsin Medical Journal in response to the article “Perception of Burnout and Its Impact on Academic Hospitalists During COVID-19 and Institutional Strategies to Combat Burnout and Improve Wellness.” In the letter, she and coauthors highlighted the importance of hospitalists having or developing a sense of belonging.

“If creating a work environment that fosters belonging increases physician retention, then hospitals and other healthcare organizations have a compelling reason to invest in efforts that improve physician belonging,” they wrote.

“For academic hospitalists, this may include streamlined clinical care, support for career advancement, and promoting open, effective, and safe communication,” they said in the editorial.

Martin told Medscape Medical News that she co-wrote the piece in part to prioritize the importance of communication between physicians and hospital administrators.

“It has become almost like isolated; the administrators are in one part, and then the work, the physicians, the clinicians are in a different section, and there’s not good communication,” Martin said.

“There’s quite a lot of things that administrators can do to prevent people from leaving,” Martin said. Attrition is expensive, she added.

When administrators listen to clinicians, they can be more open to possible solutions. “I think that might not only save the hospital a lot of money but they also can improve the well-being of the people taking care of patients,” Martin said.

Another important factor to tackle burnout is ensuring clinicians feel like they have opportunities for growth, which may look different for different individuals, according to Martin. “That can make the clinician feel like, ‘Oh yeah, I’m enjoying my job despite all these issues,’” she said.

“So there’s many things that leaders can do to make somebody feel like they matter in their workspace,” Martin said.

Early in her career as a hospitalist, Knees realized “I couldn’t keep up a full-time clinical schedule and still be present for my family in the way I wanted,” she said in an email. “Hospitalist work, by necessity, requires 24/7 coverage for highly medically and socially complicated patients, and this means working odd hours, weekends, and holidays.”

Her division and department are supportive, and she has been able to secure funding for research, education, and quality improvement work.

“They helped me build a more balanced schedule,” Knees said. “That mix has really sustained me in this field, and it shows why structured solutions — like flexibility, balanced workloads, and support for different careers paths — are so important for hospitalist medicine more broadly.”

Everyday things matter, too. For example, in her current hospital, Martin is part of a physician well-being committee that develops different surveys for hospital clinicians to help gauge their well-being and monitor them for burnout. A separate group offers activities like yoga, Pilates, and other relaxation techniques.

“It gives you a moment to step away from all the clinical roles, all the other stuff that you need to do, and then when you come back, you feel refreshed, and you’re like ‘ok I can keep going,’” Martin said.

Her hospital has also implemented a “code lavender,” designed for hospital staff to debrief or decompress after a difficult situation. Staff are encouraged to call a code lavender if they think any staff member needs it, Martin said.

Separately, every week, a cart full of snacks and water is available to various hospital units for the staff, nurses, and physicians. “The simple act brings a smile to the unit and is greatly appreciated, particularly by those having a busy or stressful day,” Martin said in an email.

Some other hospital systems offer coaching opportunities for clinicians struggling with work-life balance, Martin said. “A lot of people have enjoyed that and felt like it has been very helpful for them,” she said.

One study published in BMC Psychology in 2024 found that physician-led virtual coaching “can decrease burnout, improve professional fulfillment, and increase self-compassion,” the authors wrote.

Where We Are at Today

There is currently growing recognition that clinician well-being is vital not just for the workforce but also for patient care, according to Knees. “We’re seeing more initiatives like wellness committees, chief well-being officers, and peer support programs,” she said.

But burnout often comes from system-level issues “that go beyond any one division or department, so addressing it really requires commitment and resources at an organizational level,” Knees said.

“We need a national movement toward better work for better care,” she said. “That means treating workload and work design as patient safety issues, not just physician wellness concerns. We also need professional societies to help set standards and share best practices, and national health system leaders to be engaged in the solutions.”