For years, the American Medical Association (AMA) and other organizations have fought against the rising tide of physician and clinician burnout in medicine. A survey in the Annals of Internal Medicine in June of 2019 estimated that burnout costs the U.S. health care industry $4.6 billion every year.
For the first time in nearly a decade, however, the AMA’s triennial survey of physicians showed a decline in physician burnout rate when it was published in February of this year. And then came COVID-19.
“Physicians, we go into this profession accepting some level of risk with our own health, but frontline providers are worried about being infected and perhaps passing that infection back to family and friends. We heard early that physicians on the frontlines were rewriting their wills and living apart from their families. That’s even more stress on top of the stress of facing the unending stream patients that are very ill,” Patrice Harris, MD, President of the AMA, told Health Evolution in an exclusive interview.
AMA has released a “Caring for Caregivers” guide, a resource health care CEOs and leaders can use to reduce the mental stress for those on the frontlines. Harris talked with Health Evolution about how health care CEOs can address this issue. Below are excerpts from this conversation.
Join Patrice Harris, MD and others for upcoming executive briefing: “Impact of COVID-19 on Physician Practice Economics: Collaboration to Maintain the Health Ecosystem.”
Health Evolution: Physician burnout has been a widely addressed issue – what kind of impact could COVID-19 have on burnout?
Harris: It has the potential to worsen the already existing crisis. We have to make sure physicians and other health care professionals have the resources that they need. If we are proactive in addressing stress and increased levels of anxiety, increased levels of depression, if we address those now, there’s an opportunity to mitigate later negative impact.
Health Evolution: What tools and resources can heath care leaders use to address burnout?
Harris: We’ve been listening to the needs and concerns of our colleagues. At the beginning, the lack of personal protective equipment (PPE) was a significant stressor. Physicians accept a level of risk, but we want to make sure we are protecting them. That was an area that needed addressing and it was addressed.
We are offering on a survey for health care leaders to use to monitor the impact of COVID-19 on frontline clinicians. That is a good tool to track trends and identify specific drivers of stress. Most importantly, they can develop tools and resources specific to their organization based on that data. Self-care is important, but the AMA believes institutions and organizations need to put systematic solutions in place
COVID is happening on top of a crisis we had pre COVID-19 regarding physician burnout and an increasing number of physician suicides. Of course, we are active addressing in those issues. If you have pandemic, which is a crisis, on top of a pre-existing crisis, it exacerbates the issue. We want to make physicians and all frontline professionals feel supported in their institutions. We’re a self-reliant group and it’s sometimes difficult to ask for help. There are a few institutions, such as Henry Ford Health System, that are doing routine wellness rounds and other mechanisms to make sure physicians and other health professionals had resources they need.
Health Evolution: Why is it important to build a resilient organization in the face of this crisis?
Harris: It points out the need to take a systematic approach to the health, safety and wellbeing of physicians. It doesn’t put the onus on individuals. The AMA, through a lot of surveys, found out that many of the issues involving physician burnout were larger systematic issues. Before COVID-19 there was a lot of regulatory burden that interfered with our ability to take care of patients: pre-authorization, the burden of electronic health records and more. These issues were drivers of physician dissatisfaction. So if you have an organization building capacity for resilience and supporting physicians, and each institution will need to do its own self-assessment and find their own drivers of dissatisfaction, you can use that data to develop resources for physicians. The leaders of health care organizations, when they understand the sources of anxiety, they can ensure these concerns are recognized and develop an approach to mitigate the concerns.
Health Evolution: What are some important elements CEOs should consider when caring for caregivers?
Harris: We recommend appointing a point person. Some organizations have a chief wellness officer. It doesn’t matter the title, but you need someone in leadership—a point person that will coordinate and drive any change that’s needed. You may need to appoint a team of people, with input from the frontlines on potential solutions.
After you get this input, you need to have a plan of action. In some organizations, you have people developing wellness rounds. Even meeting basic needs is important. Some physicians didn’t want to take mask off to eat…and then there’s a question of what food was available for meals. You really want a comprehensive plan that addresses issues both inside and outside the walls of the organization. Childcare is critical. Organizations can support things like transportation and parking. Lodging is one. Some physicians don’t want to go home because they don’t want to pass the infection onto family members. Support for alternate lodging is important.
The other issue is transparency and communication. This is critical in a public health crisis and critical in a hospital, so everyone knows the plan. If there as a lack of PPE, what’s the plan to get more and make sure workers are safe?
Health Evolution: How does trauma potentially impact performance?
Harris: In general, we’re learning it would be an acute stress disorder from those that may develop the symptoms. Of course, we have to differentiate that from [overall] increased levels of anxiety and stress. After exposure to trauma, there is acute stress disorder and lingering effects—post-traumatic stress disorder. We can’t say how it will impact performance, but we worry how it will impact mental health. We want the caregivers to be healthy, we want physicians and other health professionals to mitigate these long-term effects. That’s why we have to act now. We won’t be able to eliminate but we can mitigate.
We will have to make a commitment to the mental health of everyone in this country, but particularly our health care workers. This can’t stop. Our support can’t stop. These wellness rounds. When we get through crisis of COVID-19, we will certainly have to continue to monitor the mental health of frontline clinicians over the long term.