Anyone who practiced medicine in the past decade will be well acquainted with the myriad discussions about epidemic of burnout and the eroding of well-being among health care providers that has accelerated with the pandemic. With 63 percent of physicians having at least one symptom of burnout and professional fulfillment dropping from 40 to 20 percent in 2021, there are no shortage of culprits. Increased workload, documentation, and administrative burdens, mistreatment of health professionals, staffing shortages, politicization of vaccination, and anti-science attitudes all contribute to these concerning trends.
A hidden factor that has been given minimal attention is the impact of the climate crisis on physicians. There is greater recognition that the health sector itself has a huge environmental footprint, as it is responsible for 8.5 percent of U.S. greenhouse gas emissions (GHG). Increasingly, physicians are beginning to hear the message that pollution attributable to U.S. health care has public health harms commensurate with the harms of preventable medical errors. When we talk about the moral injury that occurs when physicians cannot deliver the quality of care they want, health care sustainability and climate health need to rise to the top.
I have spoken to many physicians who are downright angry at health system waste. Surgeons have told me how frustrated they are with single-use disposables and all the wasted instruments on their trays, resulting from “tray bloat” over the years. Hospitalists complain about the waste that accumulates daily on each inpatient. Physicians have even come up to me saying that, while they aren’t “environmentalists,” they are disgusted with the level of waste health care generates.
We have nascent terms like eco-anxiety and solastalgia, which the health care profession is comfortable applying to patients. We recognize that changes in the world around us can have a direct effect on an individual’s mental health and well-being. Why have we not looked inward and applied these concepts to ourselves?
Physicians understand science and see the climate health impacts firsthand. The scope of effects from fossil fuel pollution range from cardiovascular disease to respiratory conditions, from cancer to pneumonia. Obstetric complications result, affecting the most vulnerable patient populations. Pollution is associated with increased hospitalizations and at least 8.7 million premature deaths annually. Research has shown that the environmental impacts of the care we deliver cause 388,000 disability-adjusted life years lost. With all of these serious outcomes, effects on mental health and cognition could be overlooked but these too are byproducts of the climate crisis that need to be addressed.
Major medical societies such as the American College of Physicians (ACP) and the American Medical Association (AMA) are focusing on climate health. The subject is being integrated into medical schools across the country. With all this knowledge, how can physicians not be frustrated when the systems in which they deliver care contribute to their patients’ health problems?
An important aspect of physician engagement and well-being involves having autonomy and control over one’s environment, feeling that our voices are being heard. Allowing paths for physicians to practice sustainably can support this independence in our practice. Engagement and ownership can be cultivated by knowing that we are able to raise concerns in a culture of safety and do the right thing for our health systems and our patients, understanding that the goals for each are aligned.
Incorporating physician preferences not only benefits those professionals but the whole systems, since a strategic approach to sustainability can help hospitals save resources and become more efficient. Recruiting and retaining new physicians, especially younger physicians, can be enhanced when organizations espouse strong environment, social, and governance (ESG) goals. Yet, creating streamlined, environmentally conscious health systems often seem to be an uphill battle where the clinician is at a disadvantage, not having the time, connections, systems-based knowledge, or support.
Organizations such as the National Academy of Medicine (NAM) have published joint reports on Clinician Well-Being and Resilience and Decarbonizing the U.S. Health Sector – National Academy of Medicine (nam.edu), both of which call for immediate action from the health care system on both fronts. The Joint Commission, a body that accredits more than 22,000 U.S. health care organizations, had previously announced that sustainability metrics would be included in their accreditation process. However, the group was met with immediate, negative feedback from industry, prompting a shift from required to optional measures.
Nonetheless, many in health care acknowledge the importance of this work and are fully engaged in sustainability efforts. England’s National Health Service is already on track to net zero by 2040. The Joint Commission will be creating a repository of resources to support systems as they lean in to environmentally sound practices. Many resources already exist such as the AHRQ Primer, Health Care Without Harm, and My Green Doctor among others.
Incorporating principles of sustainability will not be a panacea for all that ails health care. But recognizing the positive impact that we as clinicians can have on our patients outside the walls of the health system can be a motivating and galvanizing reminder that we are first called upon to “do no harm.”
Elizabeth Cerceo is an internal medicine physician. Her views do not necessarily reflect those of her employer.