Currently, one of the biggest problems our hospitals face is loss of expertise. With the length of the pandemic and increased burnout among health care workers, nurses and doctors are leaving at a dangerous rate. I've already blogged about a lot of the reasons for burnout (or what people are calling moral injury). In the beginning, we feared for our own safety and those of our families and lamented lack of personal protective equipment. We struggled with the distress of having few tools against the virus, ethical dilemmas of rationing care, and the consequences of seeing so much death especially in young patients. Then we struggled with misinformation, conspiracy theories, disregard for public health guidance, variants and mutations, and resulting surges. Early on, there was an outpouring of support, encouragement, and gratitude for our work, but now, we see people engaging in higher risk activities, refusing to get vaccinated, and fighting public health mandates. No wonder we are ready to leave medicine.

Through this entire pandemic, hospitals have struggled to staff enough nurses, but recently, I've noticed that this problem is escalating with a departing workforce. Even at my hospital, many nurses who worked through the initial waves have decided to transfer to other units or retire. We're leaning on traveler nurses and ramping up programs to train nurses from other parts of the hospital, but there's no question that we're losing expertise. The nurses who are leaving are some of our best, who have cared for ICU patients for decades, who bring a lot of value to our institution.

Likewise, we've had a few doctors leave, including critical care specialists like me. The training pipeline for ICU doctors is at least five years (and often more) after medical school. And though the pandemic has inspired more people to go into health care, these new doctors and nurses won't join the workforce for years. Furthermore, even the best-trained new graduates have a lot to learn. Expertise is built over years and decades of practice. Even though COVID is a new entity, we draw upon a wealth of accumulated knowledge and experience, and when our physicians leave early, that void is difficult to fill.

Obviously, it's not new for physicians, nurses, and other health care workers to retire, leave for a different career, or move on to another job. But the pandemic and its physical, emotional, financial, and social harm on our lives has accelerated this process, and I worry it will have a long-lasting negative impact on healthcare. We need to create systems that incentivize the retention of expertise, mitigate the burnout we're suffering, and predict, train, and distribute our workforce in a more even and equitable fashion.