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Doctors and nurses are trained to take excellent care of other people’s health, and often don’t look after their own. Close to half the health care workforce has burnout, and it shows in rounded shoulders, lower back problems, and little time to process a patient’s death. Internal medicine and critical care physician Narinder Singh Parhar discusses his KevinMD article “The health care workforce crisis we keep ignoring.” With nearly four decades in hospital and ICU medicine, he explains why clinicians treat self-care as self-indulgence and what feeds burnout, from training culture to productivity demands. You’ll hear what you can do yourself, from exercise that strengthens your back and hips to regular meals and sleep. He makes the case for asking for protected meal time, seeking mental health support, and banding together with colleagues. Health systems have their part too: appropriate staffing, less unnecessary documentation, AI tools that save physician time, and healthy leadership role models. Stay for the whole plan, from what you can change yourself to what your health system has to do.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Narinder Parhar, internal medicine and critical care physician. Today’s KevinMD article is “The health care workforce crisis we keep ignoring.” Narinder, welcome back to the show.
Narinder Singh Parhar: Kevin, good to see you.
Kevin Pho: All right, so what’s your latest article about?
Narinder Singh Parhar: Well, it is about the need for our health care system to look at the physical, mental, and emotional health of our health care providers: physicians, nursing staff, and the other allied medical professionals.
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Kevin Pho: And why do you feel that is? I know we talk a lot about burnout. Almost 50 percent of our health care workforce is burned out. Do you feel that our health care systems are taking it seriously?
Narinder Singh Parhar: I think there is a fair effort, at least, to recognize it, and some steps have been taken, but we need to do a lot more. It’s a big, big issue. You know, I practiced medicine for almost four decades, a good part of it in hospital medicine and acute ICU care, and I spent so much time in office and hospital practice.
What I saw was a little paradox. We, especially physicians and nurses, are trained to take excellent care of other people’s health, but I often found that we do not do as fair a job of taking care of our own health, both physicians and nursing staff, and physicians in particular a little bit more. So I delved into it and tried to find out what the reasons are, what the hurdles are to fixing that problem, and how we could fix it at all levels.
Kevin Pho: All right. So you have practiced for over four decades now. Tell us about some of the stories that go beyond the statistics. What have you seen personally about how burnout has affected our clinical workforce?
Narinder Singh Parhar: Well, you know, as you mentioned, the statistics on burnout are 40 percent, 50 percent. Recently there has been some movement across the board to take care of this issue. But burnout is actually not necessarily upstream. It’s a downstream issue.
Over the years, I have found that physicians, including myself at that time, have been committed to sacrificing our time, our sleep hours, time with our families, and eating at appropriate times to take care of others. We take pride in it. That’s how physicians are programmed, from even before they enter medical school. We are programmed to excel, to delay gratification, and to avoid taking care of ourselves, which we think could be self-indulgence, which it’s not.
So I find that on the hospital grounds, we see physicians with rounded shoulders and slouched backs, and nursing staff with lower back issues who are unable to sit up or stand up from a chair without taking support from the chair or the desk. Those are all signs that we are not taking good care of our physical health. The nursing staff, of course, are at an extra disadvantage, because most of that staff is female, and they are taking care of their households and their children more than, you know, the other gender does. So they keep their emotions and needs kind of neglected. Physicians do the same. We spend a lot more time in our practices and in our hospitals than I think is healthful, and we should be making more time for ourselves.
Kevin Pho: Now, from your time in practice, in your article you talk about several stories about colleagues who entered the profession full of motivation and excitement, and gradually that motivation wore down the longer they practiced, right?
Narinder Singh Parhar: That is correct. You know, I mentioned a story about one of my gastroenterologist colleagues. We were both at the end of our weekend call, around 5 or 6 p.m. on a Sunday, carrying a load of about forty-plus patients for our partners. He saw me slouching over, walking slowly. I saw him, and his comment was, “Narinder, we must win a lottery.” That is the story I remember.
I remember another story, of one of our ICU patients, a middle-aged lady who had a sudden cardiac event. We did everything. There was an interventional cardiology procedure, and an embolectomy was done. Unfortunately, despite all the heroics that we could have done, she did not survive. Instances like that do bear upon us, physicians and nursing staff. I remember gathering with the staff and the family to explain to them what happened, and fortunately, they were understanding. However, what I found was that there’s little time for us to process the emotion that we all go through, the emotion of failure. And then, of course, the next patient is waiting. We all need to go to that one.
Why does it happen to the most dedicated, hardworking people? I came across some reasons, which could be at the personal level, the individual level, the family level, the cultural level, and of course the health care system itself: the medical education, the nursing education, and the structural level of the health care system. Then there are the expectations of society from our profession. So all these factors are playing a part.
At the individual level, we are all dedicated. We want to work hard, be punctual, persevere, and delay our gratification. These are good for achieving a goal, but at the cost of our own health. Many of us come from families where we see our parents or our siblings having done the same thing.
And from the medical education and postgraduate training perspective, we have grown up, at least in our generation, and maybe it’s getting a little bit better, with our seniors boasting that taking a day off was a guilt. I remember one of our attendings saying, “Oh, in our old days, we had to drop dead before we could get a Sunday off.”
Then, of course, society depends on us. Many times they forget that doctors and nurses are biological human beings first. They need to be taken care of, too, and they need time off, too. They cannot answer the phone call right away.
At the system level, the corporate structure has in a way also contributed to it, because there are more demands to produce, to see a patient every ten minutes, fifteen minutes. There is so much load for documentation, and some of it is just unnecessary, or at least it could be reduced. Fortunately, AI is coming to help in that area, so that physician time can be saved for clinical needs, and some of these jobs can be taken up by technology.
There is always a staffing issue, especially in the hospitals, and the physicians who are employees of the hospital systems now are bearing this extra burden. I was reading an article yesterday where a physician was saying, “I have to put in orders which normally a clerk would have done. I had to make calls to confirm appointments, all because of the staffing issues.” We as physicians have learned to do more than our share of work, and sometimes we take on the guilt that if this work is not done, I’m responsible for the whole team. So that’s another factor.
Kevin Pho: So it sounds like, in terms of a path forward, there are system solutions that we need to implement, but there are also some things that individual physicians can do as well. So let’s talk from the perspective of the individual physicians. What are some of the things that we can do to push back, to help prevent some of this burnout? What have you seen over the years that you’ve been practicing?
Narinder Singh Parhar: What I think is that as individuals, number one, we should take care of our own physical health. We should find time to exercise on a daily basis, especially strengthening the spinal extensors and the hip adductors, taking appropriate time for meals at the right time, and sleep. Sleep well. Those are our responsibility. Nobody else will do it for us.
As far as our efforts to counter the external pressures, I think physicians need to stand up for our health rights. We should demand that there be time slots for our meals, for our time, and time to absorb a sudden loss when a patient expires, either in the ICU or on the floor. We should also not hesitate to ask for some mental health help to respond to those scenarios. So those are the steps that we could take at the individual level. And at the system level, again, appropriate staffing and healthy leadership role models will go a long way.
Kevin Pho: Now, do you ever feel that as individual physicians, we are a little bit hesitant to ask for the things that you’re advocating for, like mental health days, pushing for protected lunchtime hours, or just having debrief sessions after a patient expires? Sometimes it’s harder to speak up against the system for these things if you’re doing it as an individual.
Narinder Singh Parhar: You’re right. We have been trained that way, that we are the captain of the ship and we should absorb everything. So we do take our responsibilities a little bit too seriously, for that matter, at the cost of our own health.
Kevin Pho: So what are some ways that physicians can band together? Because it is difficult as an individual to sometimes ask for these provisions. So what are some recommendations you have for physicians to band together and maybe ask for these as a group?
Narinder Singh Parhar: One is, of course, awareness. We should share our stories honestly and frankly, and we should be empathetic to other colleagues as well. Two, I think as physicians, we need to get into management. We do need to get that training, and training in communication, other than the medical literature or sharing medical knowledge only. Because these days, the medical profession is not what it used to be in our parents’ times. Now it’s significantly corporate-involved. So we need to learn those skills as well, and of course, we need to be better communicators. We should not hesitate to explain or share where we need help.
Kevin Pho: Now, you’ve practiced for over forty years. During that time, do you feel like we’re moving in the right direction? Do you feel that things have gotten better, just a little bit?
Narinder Singh Parhar: I think awareness is definitely better, and people are talking about it. As corporations and hospital systems have taken over private practices, there’s a good side to it. Now physicians don’t necessarily have to carry their administrative work home, like private practitioners used to do. And so now there’s at least a time when a person could say, “Now I’m off. I have done my eight hours, I have finished my inbox, and I have checked my labs. I’m done.” So that is definitely an improvement.
Kevin Pho: We’re talking to Narinder Parhar, internal medicine and critical care physician. Today’s KevinMD article is “The health care workforce crisis we keep ignoring.” We had internet problems on this episode, so I am going to summarize Narinder’s take-home messages for the KevinMD audience.
First, take care of your own health, because no one else will do it for you. Physicians and nurses are trained to delay gratification and to see self-care as self-indulgence. It isn’t. Exercise daily, including strengthening your back and hips, eat at the right times, and get enough sleep.
Second, speak up for your health rights. We’re trained to be the captain of the ship and absorb everything, but we should ask for protected time for meals and time to process a patient death before moving on to the next patient. And don’t hesitate to seek mental health support when you need it.
Third, band together with colleagues. Share your stories honestly and frankly, and be empathetic toward one another. Physicians also need to step into management and build communication skills, because medicine today is far more corporate than it was in our parents’ time, and we need a voice in how it’s run.
Finally, health systems have to do their part. That means appropriate staffing, cutting unnecessary documentation, using technology like AI to give physicians back time for patient care, and healthy leadership role models. Awareness of burnout has improved, and that’s a start, but we need to do a lot more to protect the people who take care of everyone else.
I want to thank Narinder for coming on the show and sharing his time and insights.
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