A Healthcare Crisis: The Burden of Operating Room Travelers Contributes to Surgeon Burnout

The COVID-19 pandemic has stressed healthcare systems worldwide significantly and revealed flaws in the medical supply chain, facility utilization, and human resources. This has further burdened physicians who were already susceptible to high rates of burnout. Surgeons have been greatly affected, with over half reporting burnout due to inadequate equipment, higher clinical responsibilities with decreased reimbursement, and mandatory furloughs, thus leading to dissatisfied employees and higher turnover.1 In response, many hospitals have resorted to increased use of traveling healthcare workers. This option is very desirable to nurses and scrub technologists in the operating room (OR) because traveling work gives the benefits of drastically increased wages and the ability to choose their workplace. According to data from Vivian Health and the US Bureau of Labor Statistics, traveling nurses with the same skills and credentials as permanent staff nurses earn, on average, an additional $16 more per hour.2 This is causing permanent staff to switch to traveling and use various methods to stay local despite having a traveling contract. The expected number of travelers in large hospitals before the pandemic ranged between 10% and 20%. Since the pandemic, the US healthcare system has been paying an additional $24 billion per year for clinical labor, and the demand for travelers has increased by 40%.3,4 Above a critical threshold, this shift in workforce negatively impacts institutions with significant costs and the liability of having unfamiliar employees in the OR. ORs require specific topographical knowledge for efficiently retrieving necessary equipment and have unique workflows specific to the culture of the institution. Local staff receive increased and more disruptive workloads to accommodate traveling professionals and experience resentment toward wage differences. The shift from full-time circulating nurses to traveling circulating nurses may lead to increased operative time, waste, and loss of expensive equipment. A key factor in surgeon burnout is relational coordination within the OR, so breakdowns caused by the lack of experience of some members of the team further exacerbate burnout.5 With traveling nurse rates exponentially increasing, improper utilization may worsen burnout within the existing system and can directly impact patient outcomes and quality of care.4 A viable solution to the crisis of healthcare work staff is not readily apparent. Many institutions are relying on the hope that it will fix itself or that falling hourly rates will disincentivize travelers, but this growing issue will likely need more proactive attention. A disconnect between hospital administration and the OR experience exacerbates these issues, as an added burden is applied to full-time workers. Adequate staffing levels should not merely be determined by the number of workers present but should consider the institution-specific experience to minimize the burden on surgeons and allow them to focus on their core responsibilities. Adding onto the steadily increasing responsibilities placed on surgeons, the shift from full-time workers to traveling healthcare workers may be more detrimental than beneficial by further destabilizing the OR structure and placing the long-term financial sustainability of healthcare institutions at risk. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.