Systemic and cultural change is needed to combat the burgeoning clinician burnout crisis in health care, which has been further exacerbated by the COVID-19 pandemic, according to expert panelists who participated in “Healing the Healers,” a webinar hosted by SmartBrief.
Clinician burnout was a serious and growing concern before the pandemic. According to a National Academy of Medicine study conducted in 2019, 35% to 54% of doctors and nurses were experiencing considerable burnout symptoms, along with 45% to 60% of medical students and residents. COVID-19 added to a potent mix of traditional drivers that have gotten worse during the pandemic, which detract from patient care and interaction.
Burnout is a form of distress caused by a mismatch between clinicians’ job resources and the realities of their everyday working environment, said Anh Tran, director of the National Academy of Medicine Action Collaborative on Clinician Well-Being.
“Burnout is not a mental condition. It’s a result of these workplace factors,” said Tran, who added that sources of burnout vary, so causes will look different for each health care organization.
Dr. Jessi Gold, an assistant professor of psychiatry at the Washington University in Saint Louis School of Medicine and an outpatient psychiatrist, said burnout leads to mistakes in the workplace and hurts patient outcomes and satisfaction. Burnout can also cause clinicians to leave their jobs, as well as depression and, in some cases, suicide, Gold said.
Burnout drivers and causes
Challenges such as grappling with EHRs and patient charting, along with changes in outcomes measurement and health care delivery, were among the drivers of clinician burnout before the onset of the pandemic, said Sophia Thomas, president of the American Association of Nurse Practitioners and a family and pediatric nurse practitioner. “The business of health care can be very challenging and stressful,” Thomas said.
Dr. Catherine Florio Pipas, a professor in community and family medicine at Dartmouth University’s Geisel School of Medicine who also runs a clinical practice, said health system inefficiencies and payment models that don’t prioritize primary and preventive care, patient relationships or care continuity also contribute to burnout.
The culture of medicine, which sometimes puts patients and work ahead of clinician self-care and mental health, also plays a significant role, Pipas said.
“The idea of prioritizing our patients is a good thing. It’s a strength,” Pipas said. “But when we do it at our own expense, we see the impact not only affects us but our patients as well.”
Gold said the culture perpetuates the idea that clinicians should be stoic and are “not allowed to have feelings.”
“Our baseline is so off that we have normalized bad,” Gold said. “We’re at this place where what we think is OK is so far from OK. We have to throw the culture out the window and start over.”
Physicians who experience burnout are significantly more likely to not only leave their jobs, but medicine altogether, which limits access to health care and exacerbates workforce shortages, Tran said.
“If we allow burnout to be pervasive and normalized,” Tran said, ”there will continue to be profound consequences for the health care workforce.”
Effect of COVID-19
The pandemic has amplified traditional burnout factors and added new stressors to the mix. Patients have increased anxiety and are seeking advice from clinicians on life decisions such as sending their children back to school. As case numbers skyrocket again and health systems become further strained, it is clear these challenges will remain for the foreseeable future.
COVID-19 has become a “chronic crisis” for health systems and clinicians, Tran said.
“They’re feeling like this is a marathon, but now it feels like a marathon without a finish line in sight,” Tran said. “The fatigue is very real and is not sustainable.”
The politization of the virus and public health has compounded the stress clinicians feel as providers and individuals, Thomas said.
“This virus isn’t partisan,” Thomas said. “It’s our job as health care providers to educate patients on the dangers of [COVID-19].”
Gold added that clinicians “have struggled a lot lately with the change from [people] clapping to screaming at us. It’s hard not to feel drained by it.”
Making matters worse, some clinicians are isolating from family to keep them safe, which removes a critical support system and fuels feelings of isolation, Gold said.
“Health care workers would like to go back to their normal jobs and just breathe,” Gold said.
There have been some positives amid the challenges, though. The pandemic has prompted meaningful discussion about clinician burnout, led to expanded patient care through telehealth and highlighted problems with health disparities in minority, rural and underserved communities.
“There are ways of framing this that allow us to look at what’s working well so that we don’t get more negative about the situation and we can continue to rise and work well with what’s happening,” Pipas said.
“It’s OK to not be OK”
Addressing clinician burnout can start simply by focusing on basic needs such as ensuring that workers are taking breaks and allowed to recharge, Tran said. Buy-in from leadership is also vital.
“What we are looking for from our leaders is clear communication and to be able to hear in no uncertain terms that well-being matters to them,” Tran said. “The crucial first step is to acknowledge well-being and that we all have to do the work for it.”
Collaboration and creating a clear and comprehensive plan – and following through with implementing it – are crucial to success, Pipas said.
“It’s necessary to have a vision, but it’s not sufficient,” Pipas said. “Because if our vision sits on a shelf, and is not integrated, and is not a lived vision on an everyday basis, then all we have is a wonderful vision about taking care of the health of health professionals, and we continue to do the same things that burn them out.”
Burnout leads to workforce turnover and disruptions in the health care system, so system-level changes are necessary to mitigate contributing factors, Thomas said.
“We need to take of ourselves physically, emotionally and spiritually,” Thomas said. “Health care systems’ greatest asset is the people who work in it.”
Institutions must make financial and resource investments to address burnout, or nothing will change, Gold said. “If [COVID-19] hasn’t made them realize that this is worth the investment, I honestly don’t know what will.
“We need a culture where it’s OK to not be OK,” Gold said. “And we don’t have that right now.”
Doug Harris is custom content editor for health care and life sciences content at SmartBrief. He edits health IT, medical imaging and provider-focused newsletters and oversees development of content marketing pieces for SmartBrief’s health care and life sciences clients.