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The Keckley Report

2024 is a Make-or-Break Year for Physicians

By November 13, 2023No Comments

At the interim meeting of the American Medical Association House of Delegates Saturday in National Harbor, MD, President Jesse Ehrenfeld, MD, MPH, urged physicians to take action: “Medicine is not just at a crossroads…it’s at a crisis.” He’s right: 2024 is a make-or-break year for the profession.

His remarks came on the heels of the November 2 issuance of the Calendar Year (CY) 2024 Physician Fee Schedule Final Rule by the Center for Medicare and Medicaid Services which cut its conversion factor (which is used to calculate payments to physicians) by 3.4% to $32.74 from $33.89 in CY 2023. Its calculus was based on 4 factors:  1- expiration of the 2.5% statutory payment increase in CY 2023, 2- a 1.25% statutory increase for CY 2024, 3-a 0.0% conversion factor update for the Medicaid and Children’s Health Insurance Program Reauthorization Act and 4-the budget neutrality adjustment. But the rule also included changes that signal a sea-change in how Medicare thinks about physician compensation:

  • Provisions to address “whole person care” vis a vis telemental health coverage and reimbursement for mid-level mental health providers and counselors.
  • The addition of 5 new, optional Merit-based Incentive Payment System Pathways in 2024 to facilitate participation and broaden its value-initiatives.
  • Coverage for dental services associated with cancer treatments.
  • A 4-year extension for the Medicare Diabetes Prevention Program Expanded Model.
  • Payment increases for “primary and longitudinal care by implementing payment and coding more accurately…” which would be offset by cuts to specialists.

Ehrenfeld, a Medical College of Wisconsin anesthesiologist, called out mounting mental health, political pressures, and financial issues facing on physicians. “Adjusted for inflation, physician payment under Medicare has dropped 26% since 2001…with more cuts planned next year. When a system becomes so broken that, year after year, it places greater financial pressure on physicians — in fact, penalizing them for providing care to Medicare patients — we cannot simply shrug our shoulders…we must keep the pressure on and we will.”

The AMA called the rule “an unfortunate continuation of a two-decade march in making Medicare unsustainable for patients and physicians” and the Senate Finance Committee unanimously advanced a bill to the Senate floor that would reduce the conversion-factor rate cut from 3.4% to 2.15%.

My take

The issues for the medical profession go well-beyond burnout and finances. Though pushback against the Final Rule is understandable, it must be considered in a broader context. Medicare funding is in the cross hairs of budget hawks in Congress and rating agencies (Moody’s November 13, 2023) have downgraded the nation’s debt citing deficits, spending (including Medicare) and political polarization as root causes. And 2024 is an election year in which the economy is the key issue topping the domestic agenda and healthcare affordability a key focus along with access to abortion services. 

This rule is a departure from the health system’s past when times were simpler and arguably more satisfying to physicians: physicians treated patients, physicians and nurses stayed in their swim lanes and physician employment by hospitals, plans or private equity were exceptions, and notions of self-care, AI-driven clinical decision support and consumer engagement were not on the radar. But over the past two decades, practice administrative costs doubled, adjustments for inflation by Medicare were lower than actual costs, payer intrusion increased (network design, prior authorization et al), hospital consolidation reduced physician referral leverage, employers refused to pay 200% of what Medicare pays for the same services and physicians and public satisfaction with the health system eroded.

Today, half of America’s physicians work as employees of hospitals, another 30% work as employees in private-equity backed practices, and the rest are either competing as independents and/or pursuing entrepreneurial exits. The vast majority of physicians are concerned about the future of the profession and frustrated by red tape and administrative hassles that infringe on their clinical autonomy. The vast majority believe the care they provide is necessary, evidence-based and in the best interest of their patients. The vast majority resent the notion of transparency sweeping the industry hoping requirements like those facing insurers, hospitals and drug companies are not applied to their work. The vast majority think Big Hospital Systems, Big Pharma, Big Insurers and Corporatization are not good for the system. And the vast majority think quality of care is compromised and affordability unreachable if the status quo continues.

In response, trade groups including AMA, AAMC, AAPL, APG and others have adapted: medical education has modernized its MCAT and curricular focus adding people skills to the mix. Competency requirements have expanded to include leadership, interpersonal communication and emotional intelligence. At least 80 medical schools now offer an MD-MBA training option and financial management 101 is a staple in offerings by medical societies. And some have embraced alternative payment models to enable physicians to tackle issues of affordability. But their responses have been slow or otherwise complicated by federal/state policies that limit changes.

Example: the 2024 Rule calls for a shift of funding by Medicare from specialists to primary care providers beginning January 1, 2024. Multi-specialty groups, teaching hospitals and private equity-backed single specialty carve-outs will see financial impact immediately as lenders and investors assess impact. And the maturity cliff for private equity investments in medical practices—500 deals/year between 2017 and 2021—will put pressure on physicians to optimize practice EBITDA as General Partners pursue a sale.

So, the 2024 Medicare Physician Pay Rule is in the books and market adjustments are underway. The AMA will double-down on its Recovery Plan for Physicians (Fixing prior authorization, Reforming Medicare payment, Fighting scope creep, Supporting telehealth, Reducing physician burnout) protecting the interests of physicians. Insurers will adjust fee schedules and bulk up their primary care gatekeeping activities in Medicare and private coverage. Hospitals will attempt to pass thru cuts to employed physician income through efficiency improvements and revisit their compensation plans. And retail juggernauts like Amazon, Best Buy, CVS, Apple, Walmart et al will exploit these conditions to attract physicians to an alternative “future state” in which their income appears more secure.

Its implementation in 2024 is a turning point for physicians not just because Medicare is cutting reimbursement to some; it’s because a perfect storm hangs over the U.S. system and the role of the profession will be re-examined–how it addresses cost-effectiveness, equitable access and consumer-empowerment among others. Most of the major players will resort to old playbooks: the profession of medicine is inclined to the same unless and until its leaders embrace new assumptions about its value proposition and performance in the future.


PS: Several citations below expand on key points in this Report—physician shortages, pharmacists in primary care and others.  As I share with groups, the Big Bet in U.S. healthcare is whether its future is a repeat of its past. Thanks for reading. I welcome your comments.


MONETIZING MEDICINE: PRIVATE EQUITY AND COMPETITION IN PHYSICIAN PRACTICE MARKETS American Antitrust Institute July 10, 2023  AAI-UCB-EG_Private-Equity-I-Physician-Practice-Report_FINAL.pdf (


Re: Amazon Prime- One Med partnership: “Taking care of your health should be easy, but the current U.S. health care experience is often hard to navigate, frustrating, and dissatisfying… helps remove the frustration and inconvenience of having to wait weeks for a basic check-up or to discuss an urgent health need, and they’re committed to providing an experience that never feels rushed.”

Amazon CEO Andy Jassy on X November 8, 2023.

Re: integrating health and social services: “We have come to appreciate that achieving healthier communities requires a larger focus on social factors contributing to ill health. For that to happen, we need to design better SROI techniques and ways in which community savings are distributed. Health systems need to deploy investment resources in ways that prevent illness as well as treat it. Their levels and type of investment should also reflect the broad economic value of prevention and better health. And they must appreciate the importance of sharing control of decision-making over the use of their own investments.”

Suart Butler “How Health Care Organizations Should Support Social Services” JAMA Health Forum November 9, 2023;4(11):e234569. doi:10.1001/jamahealthforum.2023.4569

Re: consumerism in healthcare: “Despite years of management attention on the disruptive potential of consumerism, the health system operating model remains provider-centric, with performance metrics focused on transactions rather than the strength and durability of consumer relationships. At the same time, many organizations are hesitant to make investments in consumer-focused solutions for which the return on investment (ROI) is unclear…

The imperative for health systems to directly address consumer needs and preferences in core operations and in the design and implementation of strategies is well documented. Consumers now have plenty of incentives, information, choices, and digital tools that enable activation. These dynamics all point to the need to abandon the traditional operating model and become more consumer-centric. However, acknowledging the need to be consumer-centric and becoming so are two different things.”

Dan Clarin “2023 State of the Healthcare Consumer Report: Measuring What Matters” Kaufman Hall NOVEMBER 7, 2023

Re: physician shortages: American healthcare reputedly confronts a monumental physician shortage. A highly publicized 2021 report by the Association of American Medical Colleges (AAMC) forecasts that shortage to be as high as 180,000 physicians by 2034. [1] That’s out of a total population of roughly one million physicians.

A breathless commentary on the AAMC report by the American Medical Association (AMA) called for immediate action to forestall the crisis. [2] “The AMA, like most incumbent healthcare organizations, does a good job of “admiring” the industry’s problems and offering solutions that double down on existing business practices. In Steve Jobs’ vernacular, they certainly don’t think “different.”

Regarding physician shortages, the AMA wants more funding for Graduate Medical Education (GME) funding, more residency slots, greater use of technology for expanding physicians’ reach and more investment in physician-led, team-based care. No surprises here. Physicians are still captains of the ship within a hierarchical care delivery system.

The AMA’s “solutions” are based more on preserving the status quo than on finding ways to deliver better outcomes at lower costs with great customer service. Focusing on outcomes —what disruptive innovation guru Clay Christensen described as “jobs to be done” — liberates the mind. Innovative solutions emerge that challenge conventional wisdom and practices…There is not a shortage of surgeons in American healthcare. There is, however, a remarkable shortage of imagination. America still trains physicians in largely the same way it did a century ago when the Johns Hopkins medical education model was proliferating throughout the nation.

Healthcare’s presumed staffing shortages create an opportunity for system redesign and innovation centered on desired outcomes, not pre-established protocols. Necessity can and should be the mother of invention. Why not lower costs and improve outcomes?”

David Johnson “Circumcising Physician Training the Case for Surgical Mechanics” 4Sight Health November 7, 2023

Re: healthcare PE deal activity: “During most of 2023, we, along with much of the industry, were predicting a mild H2 rebound. Although we hold out hope for a few platform exits to be announced before the end of the year, it now seems that recovery at the top end of the market will have to wait until 2024. Geopolitical volatility and persistent financing difficulties are contributing to a risk-off attitude among both buyers and sellers.

As we have pointed out, the fundraising environment for healthcare-focused PE firms is remarkably positive, and this means that firms should eventually be pushed to exit substantial portions of their portfolios in order to return capital to LPs, enabling subsequent fundraises. To be sure, these managers will also want to avoid taking an unnecessary performance hit by exiting into a less favorable pricing environment. Part of the problem here is the economic ambiguity: The possibility of a soft landing prolongs the hope of a more stable dealmaking environment, while a clear recession trajectory might prompt sponsors to cut their losses and sell. With this in mind, we expect dealmaking to remain roughly flat—and similar in nature, with small buyouts and minority stakes dominating—in Q4.”

Pitchbook Healthcare Services Report November 7, 2023

Re: consumer credit card debt: “Credit card balances have reached an all-time high just shy of $1 trillion and represent the fastest growing loan type. Bankcard balances and originations are up 15.4% and 5.9%, respectively, over the past year as individuals have increasingly turned to new credit card debt in the face of higher prices. Households also remain on a historically strong financial footing, giving them more room to borrow to satiate elevated demand…The economy is being supported primarily by consumers. Consumer spending was responsible for more than half of the 4.9% annualized real GDP growth in the third quarter. But this cannot last forever. Higher interest rates will derail loan demand and slow the economy. Moreover, lenders will continue to tap the brakes as delinquency rates tick up alongside slower real income growth.

Moody’s Market Analytics November 9, 2023

Re: CMMI financial impact: “Looking ahead, CBO currently projects that CMMI’s activities will increase net federal spending by $1.3 billion, or 0.01% of net spending on Medicare, over the center’s second decade, which extends from 2021 to 2030. If CBO used its 2010 approach instead, it would estimate net savings of $77.5 billion, or 0.8% of net spending on Medicare, in the second decade of the center’s operation. The difference between CBO’s current projections for the second decade and projections using its 2010 approach largely reflects an update in the agency’s expectation about the rate at which CMMI will identify and expand models that reduce spending. For the period spanned by CBO’s current baseline projections, 2024 to 2033, CBO projects that CMMI will increase net federal spending by less than $50 million.”

Federal Budgetary Effects of the Activities of the Center for Medicare & Medicaid Innovation (

Re: Retail Pharmacy desserts: As pharmacies shutter stores across the U.S., people in low-income and predominantly Black, Latino, and Indigenous neighborhoods are increasingly left in pharmacy deserts, without easy access to medications and other essentials. In November 2021, CVS announced that it would be closing 300 stores a year across the country in the next three years, and Rite Aid, which filed for bankruptcy in October, plans to close at least 150 stores in the next several months.

A 2021 study co-authored by Qato, published in Health Affairs, examined disparities in pharmacy access in major cities such as Los Angeles, Chicago, Houston and Memphis. In Los Angeles, one-third of all Black and Latino neighborhoods were pharmacy deserts — meaning that the average distance to the nearest pharmacy was 1 mile or more. The biggest racial gap in pharmacy access was in Chicago, where only 1% of white neighborhoods were pharmacy deserts, compared to 33% of Black neighborhoods in the South Side.

In an earlier study of 3 million adults, published in JAMA Network Open, Qato and her colleagues found that when pharmacies close in a community, older adults are more likely to stop getting their prescriptions filled for vital heart medications such as statins, beta-blockers, or oral anticoagulants.

The problem of closures isn’t just limited to major retail pharmacy chains. A JAMA Internal Medicine study published by Qato and her colleagues found that one in eight pharmacies closed during the six-year period between 2009 and 2015. According to their analyses, independent pharmacies in both urban and rural areas were three times more likely to close than chain pharmacies.”

How pharmacy deserts are putting the health of Black and Latino Americans at risk November 10, 2023


AMA Study: physician payment sources: Per the AMA’s latest data:

  • “In 2022, over a third of physicians (34.4%) were in a practice that was accredited or recognized as “a medical home. 45% of physicians indicated their practice belonged to a commercial ACO, 38. % to a Medicare ACO, and 30.0% to a Medicaid ACO.
  • Participation in care delivery models has been on an upswing, increasing since 2014 by 11% points for medical homes and 10 percentage points for Medicare ACOs, and increasing since 2016 by 9 percentage points for Medicaid ACOs and 13% points for commercial ACOs. Furthermore, while only 44.0% of physicians in 2016 indicated their practice belonged to at least one ACO type, this has increased to 57.8 % in 2022.
  • For payment methods, FFS was the most prevalent method, as 86.4% of physicians were in a practice that received at least some payment based on FFS for care that they provided (stable since 2012). The data also show that 64.3% of physicians worked in practices that received at least some revenue from an APM for care they provided, down from 66. % in 2020 although still up from 57.6% in 2012. More specifically, in 2022, 41.4% of physicians were in a practice that received at least some payment based on pay-for-performance, 39.6% received bundled payments, 25.5% received capitation, and 22.2% received shared savings.
  • Despite the majority of physicians indicating they received at least some revenue from APMs, the data suggest the reliance of practice revenue on FFS has remained consistent. An average of 69.1% of practice revenue came from FFS and 30.9% from APMs in 2022, similar to the shares in previous years.”

Payment and Delivery in 2022: Continued Growth in Accountable Care Organization While Alternative Payment Methods Stagnate AMA Research Perspectives

Study: Pharmacists as primary care providers: In this VCU-led trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023.

“Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 additional life years and 0.62 additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years.”

Dixon et al Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States JAMA Network Open November 3, 2023;6(11): e2341408. doi:10.1001/jamanetworkopen.2023.41408


McKinsey-ANA Nurses study: As part of an ongoing, collaborative research effort, the American Nurses Foundation (the Foundation) and McKinsey surveyed more than 7,000 nurses in April and May 2023 to better understand mental health and well-being in the nursing workforce. Findings

  • Intent to leave also remains high: about 20% of surveyed nurses indicated they had changed positions in the past six months, and about 39% indicated they were likely to leave their current position in the next six months. Intent to leave was roughly 41% among nurses who provide direct care to patients, compared with 30% for nurses not in direct-patient-care roles.
  • Surveyed nurses who indicated they were likely to leave cited not feeling valued by their organizations, insufficient staffing, and inadequate compensation as the top three factors influencing their decisions. Insufficient staffing was especially important to respondents with less than ten years of experience6—a population that will be critical to retain to ensure future workforce stability.

Understanding and prioritizing nurses’ mental health and well-being McKinsey November 6, 2023


Hospital finances deteriorating: “Each year there are over 34 million admissions across the more than 6,100 hospitals in the United States. Never before has this critical healthcare infrastructure been so needed, and yet, never before has it been under such duress. The convergence of deep and profound financial pressures is crashing into workforce issues, with one exacerbating the other…

Municipal Market Analytics estimates that nearly 4% of the approximately $300 billion of hospital bonds outstanding are experiencing payment difficulties (the hospital sector is roughly 13% of the total municipal bond market). A recent Fitch Ratings analysis calculated that the median debt-to-EBITDA ratio for U.S. hospitals is approximately 3.9x, up from 2.5x in 2021, with a 33% debt to total capitalization ratio. Definitive Healthcare concluded that there is now $50 billion of bad debt held by hospitals with the top five systems accounting for $7.4 billion. The bad debt to patient revenue ratio is now closing in on 47%. Through August this year, 60 hospitals and health systems have seen their debt ratings downgraded. The looming debt restructuring negotiations will be dramatic – and painful…

Over the last 30 years consistently less than one-third of all hospitals operated with negative operating margins; that changed markedly with the pandemic, when more than half of all hospitals were not profitable…

The operating and staffing issues are also showing up in emergency room wait times, which reached a median time of 2 hours 40 minutes in 2022, an increase of five minutes from the prior year. Hospitals along both coasts comfortably exceed three hours in median wait time, which only adds to operational complexity and patient dissatisfaction. Notwithstanding that, October healthcare payrolls increased 3.1% year-over-year, trending at 14k new job adds per month in 2023, and yet this is still 1.5% below pre-pandemic employment levels.

Over an extended period of time, it is well understood that healthcare cost increases have meaningfully outpaced increases in general inflation. Of the “medical care” index below, hospital and physician services account for 47% of the total. The escalating cost of healthcare is what has made care so unaffordable for so many, increasing the reliance of government safety net programs for an increasing segment of the population.”

Hospital Sector is Under Siege” November 5, 2023

Kaufman Hall Consumer Report: Performance measures related to consumer expectations inadequate: Per its 2023 State of the Healthcare Consumer report based on its survey of 59 hospitals & health systems:

  • “Progress toward consumer-centric care is stalled due to how hospitals and health systems measure performance. Only half of 59 respondents said their institution tracked at least one consumer-focused measure like the cost of care to patients. Instead, most hospitals and health systems use traditional, transaction-focused business metrics to gauge success, like the volume of patient visits, the unique patient count, and inpatient market share. “
  • Health systems that have adopted more patient-centric measures use them to increase patient access (72% of respondents), improve patient satisfaction (67%), and enhance their marketing strategies (72%). In addition to making these strategic shifts, organizations must also measure and track the corresponding return on investment.
  • The most-cited barrier to tracking consumer-centric metrics is the lack of available data or technology (69% of respondents). Respondents noted that data such as outpatient data or measuring share of wallet is typically fragmented, and integrating data can be complex.
  • Other barriers include uncertainty about how to define and prioritize consumer-centric metrics (40% of respondents) and a lack of staff or staff role to own metrics management (34%).

2023 State of the Healthcare Consumer Report: Measuring What Matters Kaufman Hall November 7, 2023


CMS issues proposed changes to Medicare Advantage plans: Monday, CMS announced major changes to Medicare Advantage regulatory oversight to address what it perceives as flaws in the marketing and administration of the program:

  • Supplemental benefits: Extra benefits such as eye exams, dental and fitness benefits offered at no additional cost to seniors because the insurance companies receive a bump up from their estimated cost of providing Medicare-covered services but enrollees use of those benefits is low. Also requires insurers to design supplemental benefits using clinical evidence and to notify members who haven’t utilized these benefits by mid-year.
  • Broker incentives: Because many seniors use agents or brokers to help them find a Medicare Advantage plan, the administration argues better guardrails are needed to ensure agents are acting in the best interest of seniors. The proposed changes would broaden the definition of broker compensation so limits on compensation and health insurance company payments to brokers and independent agents would be capped at $632 per Medicare Advantage enrollment starting in 2025. CMS also proposed all but banning volume-based bonuses insurers pay marketing companies for steering customers to specific plans.
  • Provider network adequacy: Under the proposed changes, Medicare Advantage carriers must include marriage and family therapists, mental health counselors, addiction medicine clinicians, and opioid-use disorder providers in their networks. An estimated 400,000 of such therapists and counselors will be able to bill Medicare for services next year under recently passed legislation intended to expand access to mental health services.
  • Prior authorization: Ordering Medicare Advantage carriers to conduct and publicly report how their prior authorization policies impact people with disabilities, members in special needs plans and low-income enrollees who receive Medicare Part D subsidies.
  • Nursing home adjudication: Puts independent contractors—not the insurers themselves, as is the current practice—in charge of reviewing members’ appeals for longer nursing home, outpatient or home health care.
  • Biosimilar access: Lifts a rule that carriers must notify regulators about changes to coverage of biosimilar drugs when the medicines are interchangeable and gives Medicare drug plans more flexibility to substitute a biosimilar for the more expensive original.

Note: CMS reduced the base rate paid to Medicare Advantage carriers by 1.1% for 2024, introduced a risk-adjustment model that excludes 2,000 diagnoses that insurers and risk-bearing providers used to catalog members’ illnesses, tightened audits, and made star ratings quality bonuses harder to earn.

Some Medicare Advantage carriers have responded to these policy changes by laying off workers and curtailing extra benefits. Humana sued to stop CMS from recouping an estimated $4.7 billion the agency determined Medicare overpaid.

CMS proposes stricter Medicare Advantage marketing rules

Population Health

Study: semaglutide efficacy:  “In a multicenter, double-blind, randomized, placebo-controlled, event-driven superiority trial, we enrolled patients 45 years of age or older who had preexisted cardiovascular disease and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 27 or greater but no history of diabetes…

In patients with preexisting cardiovascular disease and overweight or obesity but without diabetes, weekly subcutaneous semaglutide at a dose of 2.4 mg was superior to placebo in reducing the incidence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke at a mean follow-up of 39.8 months.“

Lincoff et al “Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes” NEJM November 11, 2023 Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes | NEJM


Polling: Public Perspectives on Boarding in Emergency Departments 

  • 80% of surveyed adults are concerned about the boarding crisis and 43% would delay or avoid going to the Emergency Department (ED) if they knew that they, or a loved one, could face a long wait in an ED before being admitted to the hospital or transferred to another facility.
  • 44% said that they, or a loved one, experienced a long wait time after receiving care in an ED. Of those, 16% indicated that they, or a loved one, waited 13 or more hours after being seen in the ED but before being admitted to another part of the hospital or transferred to another facility.
  • 93% say emergency medical services, such as emergency departments, paramedics, and emergency medical treatment are essential.
  • 89% believe additional or supplemental government funding for these essential services should be a priority.

.Morning Consult, Public Perspectives on Boarding in the Emergency Department, October 2023

Public Health

Study: health worker health status: Data from the General Social Survey Quality of Worklife Module were analyzed to compare self-reported mental health symptoms among U.S. adult workers from 2018 (1,443 respondents, including 226 health workers) and 2022 (1,952, including 325 health workers). Findings:

“From 2018 to 2022, health workers reported an increase of 1.2 days of poor mental health during the previous 30 days (from 3.3 days to 4.5 days); the percentage who reported feeling burnout very often (11.6% to 19.0%) increased. In 2022, health workers experienced a decrease in odds of burnout if they trusted management (odds ratio [OR] = 0.40), had supervisor help (OR = 0.26), had enough time to complete work (OR = 0.33), and felt that their workplace supported productivity (OR = 0.38), compared with those who did not. Harassment at work was associated with increased odds of anxiety (OR = 5.01), depression (OR = 3.38), and burnout (OR = 5.83).”

CDC: Health Worker–Perceived Working Conditions and Symptoms of Poor Mental Health — Quality of Worklife Survey, United States, 2018–2022 November 3, 2023 / 72(44);1197–1205