Caregiver burnout is our biggest challenge

The following discussion is from the Notable Perspectives podcast, Episode 2, where Dr. Toby Cosgrove, the former President and Chief Executive Officer of Cleveland Clinic, sits down for an in-depth conversation with Notable CMO Dr. Muthu Alagappan, and shares his views on healthcare's most pressing issues. This transcript has been edited for clarity.

Muthu Alagappan: What do you think are the one or two biggest challenges that healthcare systems are specifically facing today? 

Toby Cosgrove: I think there's two that are just hitting us right in the nose particularly coming out of COVID. The first is the shortage of doctors and healthcare providers, particularly nurses. I was reading the other day that in order to meet the need for nurses, we're going to have to graduate 200,000 a year. That's impossible. And it's not just the United States, it's the whole world. 

The second issue is inflation has really hit healthcare providers very hard. The cost of goods, the cost of labor, and the cost of pharmaceuticals have all soared — and the payments through the providers have not kept pace. 

So we're going to have to figure out how we reduce the number of people that it takes to look after somebody. 

For example, in the hospital, 60% of the cost of running a hospital is people. And there just aren't enough people [to fill all these jobs]. So we've got to find technologies that, one, reduce the administrative work, and, two, make the clinical work more efficient by reducing the number of people that we need to take care of people who are sick.

I think those are the two screaming needs right now in healthcare delivery.

Muthu Alagappan: It's additionally worrisome that both of those feed off each other and so you've got shortages that result in existing labor being compensated at a higher rate — and then you've got this negative flywheel. 

I want to touch on one thing you mentioned, which is the administrative burden facing clinicians and staff. There’s been a lot of discussion about burnout. This may be an unconventional question, but do you think the problem of burnout is overstated or over-emphasized, or understated — do we need to make a bigger deal about it? 

Toby Cosgrove: No, I don't think it's overstated at all, and I think it's real. Stop and think about what's happened over the last 40 years in healthcare. 

First of all, it has gone from a time when the doctor used to come to your house with his bag with all the diagnostic and treatment modalities in that black bag, and now it's not possible to practice healthcare medicine by yourself. You need a tremendous amount of support expertise. 

Secondly, doctors were never checked for their quality metrics. Now they're being measured. 

The third thing is that there has been an explosion in knowledge. [Clinicians] are just overwhelmed by that. There are thousands of journals — I think around 5,000 — and the total amount of knowledge doubles every 73 days.

How the heck do you keep track of all that? It’s a tremendous challenge. 

And then, finally, now you have to have the electronic medical record, and all those things have piled on. 

There are people who are feeling like they are overwhelmed and under-supported and measured. And so the burnout is a real phenomenon. No question about it. 

We have got to figure out how we allow people to practice at the top of their license, how we reduce the manual work that they need to do, and how we get them enough support to help them manage their day-to-day practice. And these are challenges that I think are only going to be answered by technology.

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