By Melina Davis
CEO & EVP, Medical Society of Virginia

In the ever-evolving landscape of healthcare, the demand for quality patient care has never been higher. However, this heightened demand comes at an unexpected cost – the mental and emotional well-being of our healthcare providers.  

Many of us know the leading factors contributing to burnout include administrative burdens, lack of work-life balance, and the emotional toll of caring for patients in their hardest moments. On top of facing extreme burnout, our healthcare professionals are also experiencing moral injury from a healthcare system that puts profits ahead of patients and the healthcare workforce. 

Are you dealing with burnout symptoms in your healthcare profession? See how SafeHaven can help support you.

The pressure to meet performance metrics and the careful mental vigilance required to avoid making medical errors contribute to an extremely arduous work environment that damages the resilience of these necessary professionals and causes traumatic stress. 

Psychological Safety: A Key Pillar of Well-being 

Psychological safety within the healthcare workplace is essential for addressing burnout, moral injury and promoting overall well-being. Psychological safety refers to an environment where individuals feel comfortable speaking up, expressing their thoughts, and seeking support without fear of reprisal or judgment. 

Creating a culture of psychological safety involves fostering open communication, empathy, and mutual respect among healthcare team members. When healthcare professionals feel secure seeking help and admitting vulnerability, a more supportive and collaborative work environment is reinforced. 

Many healthcare professionals do not feel psychologically safe and, as a result, consciously avoid seeking mental health support when they need it, leading to the Burnout Loss Spiral.  

The Burnout Loss Spiral and its Stages 

The healthcare profession is a noble calling, but the constant pressure, high stakes, administrative burdens, loss of autonomy and moral injury can sometimes lead to a downward or loss spiral in the mental health of physicians, PAs, NPs, nurses, and the entire healthcare team.  

This article breaks down and addresses the stages of the burnout loss spiral: thriving, reduced activity, distress, and despair.


Many healthcare professionals enter with positivity, passion, and an enthusiasm for the healthcare profession. The initial years are marked by fervor, long hours, and an unwavering dedication to patients. 

When a provider is thriving, they can take things in stride: they are physically well, socially active, and are driving positive change in the healthcare system. Although they are dealing with stress, they use healthy coping mechanisms, set effective boundaries, and manage their time well for the most part. 

As patients, this is the stage we want our healthcare heroes to experience throughout their career. 

Reduced Activity 

The weight of responsibility may take its toll. Despite best efforts, many healthcare providers find themselves spending more time at work, sacrificing personal and family time to meet the demands of the healthcare profession. 

As healthcare professionals move into the reduced activity stage, they work more than they are home, they experience noticeable effects on their interpersonal relationships, they take less initiative in their day to day, they may experience less interest in connecting with patients, and other early signs of burnout.  

When the healthcare community and others notice these signs, we have an obligation and an opportunity to step in to help prevent these professionals from moving into the next phases of the spiral.  


The emotional toll of dealing with patients’ suffering, tough decisions, and the constant vigilance given to avoid making mistakes in the face of increasing patient loads and increased administrative requirements becomes overwhelming. Resilience begins to wane, affecting the ability to provide compassionate care at the same level as when they were thriving. 

When in the distress stage, family, friends, and colleagues may notice the provider has increased anxiety, negative interpersonal relationships, lack of initiative to solve problems, loss of productivity, and absenteeism or tardiness.  

Healthcare providers in this stage are struggling and moving into crisis level. They need care like peer support and counseling to navigate back up and reverse their path on the loss spiral. 


At this point in the spiral, it is likely that a healthcare provider has hit their breaking point. They may decide to leave the profession altogether. This stage can manifest itself with mental and physical illness, substance use, suicidal ideation, or even death by suicide.  

Employer-based intervention programs and professional monitoring programs, typically managed under the auspices of licensing boards, exist and may be required for providers at this stage. Providers that successfully recover in these programs are usually subject to years of monitoring, reporting and oversight by an employer or a licensing board, such as the boards of nursing, pharmacy, dentistry, or medicine. This process has lasting effects on the rest of their career.  

To ensure our healthcare heroes never reach the bottom of the loss spiral, we must make a systemic change in the way we offer mental healthcare services to these professionals.  

Steps Toward Change 

To address healthcare provider burnout and promote psychological safety, a multi-faceted approach is needed: 

  1. Policy Changes: Healthcare institutions must implement policies that prioritize work-life balance, limit excessive administrative burdens, and provide adequate staffing to prevent overwork. 
  2. Legislative Changes: Healthcare provider advocates and legislators need to enact the Safehaven legislation across the country to ensure that healthcare providers can seek confidential mental health services. This is a cornerstone to building psychological safety for providers. 
  3. Mental Health & Well-being Resources: Employers and organizations need to invest in and partner with a trusted third party, such as a state medical society, to offer protected and confidential mental health programs like SafeHaven for their healthcare providers. 
  4. Training and Education: Healthcare providers need to be given time and opportunities to participate in training and education that encourage innovation and growth. Teams and individuals also need time for personal breaks and social interaction at work. 
  5. Leadership Involvement: Leaders within healthcare organizations must actively champion a culture of psychological safety, modeling open communication, and prioritizing the well-being of their teams. 

Addressing healthcare provider burnout and fostering psychological safety is not only a moral imperative but a necessity for maintaining a resilient and effective healthcare workforce. By acknowledging the challenges faced by healthcare professionals, providing mental healthcare support, and cultivating a culture of psychological safety, we can work towards creating an environment that prioritizes the well-being of those who dedicate their lives to caring for others.  

Our communities and organizations must prioritize investments in the humanness of the healthcare workforce over institutional profit and liability protections. Through this, we will see an improvement in quality, safety, and turnover.  

It is time to nurture the healers so they can continue providing the best possible care for their patients.