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Overworked Healthcare Systems: The Case of the US and Canada

Introduction

In the 21st century, the world’s healthcare systems have been undergoing major transformations that stem from a variety of factors. First of all, the very understanding of medical care providers as a one-way avenue has been rendered obsolete. Today, this process is a dialogue between clinical experts and patients, who seek the most fitting solution that would satisfy both sides with maximum efficiency. In addition to that, the external environment in which medical professionals operate has been subject to change. There have been serious budget reconsiderations and so-called optimizations initiatives that have altered the proportion of workers and communities assigned to them. As a result, the issues of overworking and burnout have emerged on the agenda of the global healthcare system.

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With the higher pressure of the work environment, combined with budgets allocated differently, medical practitioners are forced to operate under difficult circumstances. Moreover, as global crises in the form of pandemics arise, the pressure is multiplied, creating a state of emergency for the system. While the U.S. is commonly considered one of the most overworked health systems, it is wise to consider the experience of other nations. This paper explores the case of Canada as an overworked healthcare system in today’s environment.

Overview of the Problem

Overworked healthcare systems have become a subject of intense interest for experts and researchers across the globe. According to Sfeir (2021), this problem has reached a new level of importance amid the COVID-19 pandemic. In its general sense, the issue at hand consists of the extreme workload placed upon healthcare professionals within the system. This includes prolonged working hours beyond reasonable shift limits, an excessive number of patients per nurse or physician, and a shortage of equipment and facilities (Grima et al., 2019). As a result, overworked medical professionals develop a series of mental and physical complications that result in stress, anxiety, and depression. In most cases, this condition is also referred to as professional burnout, affecting millions of medical workers across the globe.

From one perspective, this issue is central to healthcare-related discussions in the U.S. For example, Reith (2018) states that approximately one-half of all medical professionals in the United States have experienced burnout as a result of being overworked. In this regard, the U.S. is deemed as one of the territories with an extremely overworked health system. On the other hand, the widespread of the issue is not limited to this country, as the underlying issues causing it are global in nature. In fact, the case of Canada presents increased interest within the framework of the discussed problem. This country is in geographical proximity to the United States, possessing similar social and economic characteristics.

In other words, Canada is the nearest neighbor of the U.S., operating on similar political and social grounds. According to Duong (2021), by October 2021, Canada’s healthcare system had reached a breaking point due to the extremely stressful working conditions. The country’s medical leaders report unprecedented levels of staff shortage, workload, and professional burnout, especially on the front line of the system. As mentioned by Pelley (2021), 78% of Canadian nurses report signs of overworking, stress, and burnout, which exceeds the aforementioned 50% threshold observed in the U.S. Under these circumstances, Canada’s healthcare framework is on the verge of collapse, making it extremely overworked to the point of concern.

Causes of the Problem

The identified problem has not appeared spontaneously, as it stems from a series of systemic issues that have undermined the preparedness of the system for major challenges. The investigation of the causes is an essential step toward a quicker recovery. More specifically, understanding the roots of the problem allows decision-makers to address them with a higher degree of efficiency, potentially eradicating the issue in the long term.

Administrative Issues

In the contemporary healthcare environment, the resilience of the system remains highly dependant on budgetary matters. For example, Ellen et al. (2018) address the problem of health service overuse in Canada, which may be deemed one of the problem’s determinants. According to them, the distribution of resources within the country’s healthcare system has not been optimal for the past decade. From one perspective, it is a natural obligation of medical workers to provide high-quality care to their communities, thus promoting higher standards of living. On the other hand, the issue of service overuse implies that some parts of the population utilize excessive procedures that are neither necessary nor timely for them. At the same time, the resources of the system are finite, and completing unnecessary procedures means that other, more pressing concerns may pass unnoticed. As a result, workers are initially engaged in less productive activities, spending their time and energy in vain. The uneven distribution of resources is a major problem that undermines the Canadian healthcare system’s ability to withstand the emerging challenges of today.

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COVID-19 Pandemic

While administrative issues of resource distribution are a complex set of problems on their own, the recent outbreak of the COVID-19 pandemic has taken overworking to a previously unseen level. O’Donnovan (2021) refers to the case of a healthcare union in Saskatchewan that suffers from chronic understaffing. Amid this struggle, the workers were hit by the emergence of COVID-19, forcing them to work beyond reasonable limits. According to O’Donnovan (2021), some members of the Saskatchewan union have reached 80 hours of overtime within a single month. While the problem started long before COVID-19, the pandemic multiplied the damage inflicted on the system by it. Pelley (2021) concurs, adding that burnout and anxiety were already prevalent before the 2020 crisis. Now, however, the issue has reached historically high levels, with 78% of nurses and 73% of allied health professionals reporting burnout (Pelley, 2021). In a way, the pandemic has become a vicious circle for Canada’s healthcare, highlighting the profound issues within it.

Implications of the Problem

Professional Burnout

Professional burnout is the primary, direct implication of the overworked healthcare system. It has long become a common occurrence among health workers who perform under increasing amounts of stress within their daily duties. In fact, burnout is present outside the domain of medicine and is prevalent in most industries today. However, in the case of healthcare workers, its implications are particularly serious. Grow et al. (2019) have investigated the problem in the context of medical workers, namely physicians, and confirmed the suspicions regarding the profound physical and mental impact of burnout. The professionals who encounter it experience chronic anxiety and depression, often resulting in suicidal behavior. In other words, occupational stress is accumulated, becoming a self-propelling condition that affects all aspects of a medical professional’s life. In most cases, this results in the worker’s withdrawal from their occupation, but the implications may include severe mental issues and even death.

Shortage of Medical Professionals

The next implication is closely related to the concept of professional burnout as the primary consequence of overworked medical systems. As described above, extreme levels of occupational stress have a profound negative effect on the worker’s well-being. Hence, it is only natural for them to make attempts to evade the cause of the problem. If milder measures fail to yield the desired effect, medical professionals often opt for quitting the field and pursuing other opportunities, mostly in the private sector. As a result, the number of experienced workers engaged in the healthcare system’s operations remains on a stable decrease (Pelley, 2021). Moreover, the influx of new practitioners is impeded by the same issue.

In the age of globalization and instant communication, major systemic issues are highlighted and discussed at length. Thus, the public shortly becomes aware of the burnout prevalence in contemporary healthcare. This actively hinders young specialists from pursuing medical careers at earlier stages, limiting the number of new workers in the field. As a result, the combination of these issues creates one of the most serious problems encountered by today’s healthcare systems, which is the shortage of trained professionals. Ultimately, the workload is distributed among the few that remain.

Implications for Communities

The implications described above mainly concern healthcare professionals who experience a direct impact of the system’s overworked nature. Nevertheless, the consequences of the problem extend beyond that, affecting the communities as well. More specifically, modern institutions lack physicians, nurses, and other team members who work with the population. Furthermore, those who remain are often overworked and stressed, becoming less focused or productive as a result of burnout (MacNeil et al., 2019). Under these circumstances, residents of the communities have fewer options in terms of health services. With fewer practitioners available, they are forced to wait longer, even for vital procedures. As Warburton (2021) states, Canadian patients now have to wait for months for their surgeries simply because there are no available surgeons. In addition, the lack of proper structuring increases the cost of healthcare, thus affecting its affordability. This may also occur as a result of medical errors that become more likely with stressed, overworked teams.

Potential Solutions to the Problem

Legislative Initiatives

While the problem can be addressed at all levels, the focus should be on legislative initiatives aiming at alleviating the burden of healthcare workers. Among the immediate measures, medical professionals call for immediate relief efforts on behalf of the government. According to Duong (2021), one of the key measures could be lifting the jurisdictional limit that restricts the workers’ areas of operation to specific provinces. Furthermore, the government is reluctant to acknowledge the very presence of burnout and overworking within the system. Duong (2021) insists on adding these topics to the national agenda, preparing legislative measures that would limit overtime and create new opportunities to promote well-being among doctors and nurses. Overall, a consolidated governmental approach is required to address the profound issues that are rooted deep in the system.

Medical Personnel Training

Amid the increasing rates of burnout and fatigue, the system continues to suffer from a shortage of professionals who could be added to existing teams for a more even distribution of the workload. Thus, if the legislative initiatives address the systemic level of the problem, educational opportunities exist on the institutional one. More attention should be paid to the formation of competent and resilient workers who are aware of all sides of the field. The existence of burnout and overworking should be acknowledged by the domain as a pressing concern to be resolved. This way, new professionals will operate with facts instead of rumors, becoming better prepared for the future. Considerable attention should be paid to training effective techniques against stress, fatigue, and anxiety. In other words, nurses, doctors, and other professionals should be informed of what burnout is and how it can be prevented.

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Community Efforts

Finally, on the level of individuals and communities, personal efforts can make a strong contribution to resolving the problem at hand. First, communities should be informed of the present state of the system, including its persistent issue of service overuse. This implies that the implication of wasteful resource use should be clearly presented to the population, along with advice on how to avoid it. Second, communities and healthcare systems should build mutual understanding, acknowledging each other’s issues and concerns. This way, they can make combined efforts to alleviate the stress for both sides. Third, the ongoing pandemic is the largest stressor for healthcare today. As members of communities, people are to do everything in their power to impede the further spread of COVID-19 by universally appraised measures. This includes following medical experts’ guidelines on hygiene, social distancing, protective equipment use, and vaccination. Through these measures, society can revert back to normal more quickly, mitigating the stressful effects.

Conclusion

Overall, most healthcare systems of the world remain overworked today because of a combination of factors. Administrative and organizational flaws, COVID-19, and overall stress place heavy burdens on medical workers, causing anxiety and burnout. While the U.S. system is generally perceived as the most overworked one, Canada sees major difficulties in this regard, as well. With most workers being overworked and many of them quitting the field, Canada faces serious implications that endanger its entire society. A combination of legislative, institutional, and individual actions is required to counteract this tendency, allowing healthcare to fulfill its ultimate purpose in bearable conditions.

References

Duong, D. (2021). Canada’s health system is at a breaking point, say medical leaders. CMAJ News. Web.

Ellen, M. E., Wilson, M. E., Velez, M., Shach, R., Lavis, J. N., Grimshaw, J. M., Moat, K. A., & Synthesis Working Group. (2018). Addressing overuse of health services in health systems: A critical interpretive synthesis. Health Research Policy and Systems, 16, 48. Web.

Grima, F., Georgescu, I., & Prud’Homme, L. (2020). How physicians cope with extreme overwork: An exploratory study of French public-sector healthcare professionals. Public Management Review, 22(1), 27–47. Web.

Grow, H. M., McPhillips, H. A., & Batra, M. (2019). Understanding physician burnout. Current Problems in Pediatric and Adolescent Health Care, 49(11), 100656. Web.

MacNeil, M., Koch, M., Kuspinar, A., Juzwishin, D., Lehoux, P., & Stolee, P. (2019). Enabling health technology innovation in Canada: Barriers and facilitators in policy and regulatory processes. Health Policy, 123(2), 203-214. Web.

O’Donnovan, C. (2021). Saskatchewan healthcare workers are overworked and ‘drowning’, union says. Global News. Web.

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Pelley, L. (2021). Health-care workers battled burnout before COVID-19 — now it’s even worse, experts warn. CBC. Web.

Reith, T. P. (2018). Burnout in United States healthcare professionals: A narrative review. Cureus, 10(12). Web.

Sfeir, M. M. (2021). Frontline workers sound the alarm: Be always sure you’re right, then go ahead. Journal of Public Health, 43(4), 899–901. Web.

Warburton, M. (2021) Canada’s overworked healthcare sector braces for staff shortages as vaccine mandates loom. Reuters. Web.

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