Commentary: Systemic trauma, not burnout, drives healthcare’s workforce crisis

Editor's Note

Healthcare’s workforce crisis stems from systemic trauma—not individual burnout.

That’s the central argument of a commentary published April 30 in MedPage Today, in which Taylor Nichols, MD, a board-certified physician in emergency medicine and addiction medicine, calls for a sweeping shift in how healthcare-associated stress is understood and addressed. Specifically, Dr Nichols advocates for leveraging the Health Care Associated Traumatic Stress (HCATS) model as a more inclusive framework for identifying the systemic harms contributing to the mass exodus of health professionals across disciplines.

As detailed in the commentary, conventional approaches often attribute clinician distress to “burnout,” a term defined by Christina Maslach in the 1980s to encompass emotional exhaustion, depersonalization, and reduced personal accomplishment. While the term has evolved, critics argue it continues to suggest that individual resilience or wellness initiatives can resolve issues rooted in poor staffing, corporate efficiency mandates, and reduced clinical autonomy. Dr Nichols notes that suicide rates among physicians—twice the national average—underscore the inadequacy of the burnout paradigm.

Some have advocated for “moral injury” as a more fitting concept. As described by Dr Nichols, moral injury refers to the anguish experienced when clinicians are unable to act in accordance with their values—such as when they witness, enable, or are powerless to prevent harm. The organization Fix Moral Injury differentiates burnout as operational in nature, while moral injury involves a relational rupture. Still, the article contends this framing doesn’t go far enough to capture the full range of harms experienced by clinicians.

Instead, HCATS broadens the lens to include administrative harm, a term coined in a 2022 New England Journal of Medicine article to describe how conflicting, opaque, or punitive bureaucratic metrics directly contribute to provider distress. According to Dr Nichols, healthcare professionals are routinely held to standards of productivity, satisfaction, and outcomes that often contradict each other—and suffer professionally when they fall short. Administrators, by contrast, rarely face accountability for the policies they design.

HCATS also integrates both primary and secondary trauma into its model. The commentary explains that primary trauma includes physical and emotional harm tied to inadequate staffing, unsafe working conditions, and leadership failure. Secondary trauma encompasses the psychological toll of repeatedly witnessing patient suffering, especially in acute and critical care. Both forms are endemic to healthcare but often ignored in institutional responses to distress.

The current focus on resilience training and individual coping mechanisms misses the point, Nichols concludes. Systemic stressors are driving people out of healthcare—and unless those root causes are addressed, potentially by HCATS, staffing shortages will continue to accelerate.