The coronavirus pandemic, brought under control in so many other parts of the world, surged anew in the U.S. when summer arrived. By mid-July, cases were spiking in several states, the numbers offering grim testament to the toll the virus was taking. A full 90 percent of the ICU beds were occupied in Arizona, four straight days of 10,000 or more new cases in Florida, and four consecutive days of 100-plus COVID-19-related deaths in Texas.
And on and on it went. Healthcare professionals — already besieged by a flood of patients, already working long hours, already facing equipment shortages — were pushed to the breaking point.
One study, released in June, showed that 45 percent of the responding physicians believed their psychological well-being had been adversely affected by the pandemic, and 36 percent believed their physical well-being had suffered. Moreover, 44 percent believed their burnout was at an all-time high, and 48 percent believed their offices had reached that point.
Even before the pandemic, burnout had long been a concern in the healthcare sector, impacting over half the nation’s doctors, and nearly as many nurses. While one study showed that it waned slightly in 2019, the onset of the pandemic brought the issue into sharper focus. And there are those who have concluded that while self-care on the part of the medical professionals themselves is a key to curtailing the problem, certain systemic changes are also in order — things like reducing the administrative burden they carry, giving them greater schedule flexibility and providing greater mental-health support.
Susan Hingle, past chair of the American College of Physicians (ACP), told Medical Economics that doctors are finding themselves “running a sprint and a marathon at the same time,” in that they are dealing with the short-term impact of the virus, but must also be wary of the long-term implications.
“One of the biggest drivers of burnout is control — physicians feeling like they don’t have control,” she said. “Talk about the perfect storm for that, with physicians taking care of patients with a very contagious, deadly virus, often without appropriate personal protective equipment (PPE) and being asked to work longer hours than typical with less ability to really provide the care that they want (to provide).”
She added that there were no previous guidelines as to how one might deal with such a crisis, no experience to draw upon. It is a new normal, with new procedures, new approaches and great uncertainty. There are fears over contracting the virus oneself, and possibly infecting others. There are concerns about shortfalls not only in PPE, as she mentioned, but in testing. There are added burdens, like comforting patients who are unable to receive visitors because of government-imposed restrictions.
Hingle further pointed out that while burnout has long been driven by the fact that many physicians don’t feel they are valued by their organizations, recent social distancing measures have made their support systems more rickety than usual.
It’s important to understand, too, that burnout impacts not just the healthcare professionals but also patients, as the likelihood of errors and negative outcomes has been shown to increase right along with it. And as in other professions, it is a major factor in turnover and absenteeism as well.
Solving the burnout problem therefore requires striking at the heart of the matter. Dr. Lili Roy, writing for Forbes, suggested that an important first step is taking certain duties off the plates of physicians, such as the time-consuming task of inputting data into Electronic Medical Records (EMRs). She also believes that they should have more input into determining their schedules, as was reflected in a 2017 study, and that mental-health support is critical.
Hingle agrees on the latter point, noting that a few years ago the ACP began a program that established “well-being champions” — i.e., doctors trained to help others in their profession combat burnout. And they have remained available throughout the pandemic, via webinar.
Psychologist and leadership coach Jacinta Jimenez is another who believes in the value of peer coaching, pointing out the need for HR professionals to keep their fingers on the pulse of employees — that they must have a firm understanding of such matters as workload, inclusion and support. And of course engagement has always been a key to worker satisfaction.
Certainly in stressful times like these, self-care is more important than ever. The Centers for Disease Control and Prevention (CDC) lists proper diet, exercise, sleep and mindfulness as important steps toward mitigating burnout. Dr. Amy Sullivan of the Cleveland Clinic took it a few steps further, stressing the importance of mindset — staying in the moment, expressing gratitude and maintaining one’s connection to others, while acknowledging that the latter step is significantly more difficult at present than usual.
But it is not enough to simply encourage self-care. While burnout has long been an issue for healthcare professionals, the unique challenges presented by the pandemic have made its systemic nature clearer than ever.
We must address the root causes of burnout, like physicians lacking control over their environments or feelings that they are not valued by their facilities. It is important that their administrative burdens be lightened. It is critical that their schedules be made more flexible.
Above all, they need more resources and support to deal with the crushing burdens they have had to carry during this crisis. It is high time we change the stigmas around discussions of mental health in the workplace, for it is just as much a part of our frontline workers’ health as any other.