A number of studies have documented a rise in burnout among health care professionals related to the COVID-19 pandemic. For example, in a recent study involving focus groups of oncologists published on JCO Oncology Practice, Fay J. Hlubocky, PhD, MA, of University of Chicago Medicine in Chicago, Illinois, and colleagues found that oncologists “reported that the undesirable, harmful personal effects of COVID-19 exacerbated underlying prepandemic oncologist burnout and increased new stress.”
In an accompanying editorial, Ronald M. Epstein, MD, and Michael R. Privitera, MD, of the University of Rochester Medical Center in Rochester, New York, wrote, “The nature of work has changed. Many colleagues approaching retirement age are now exhausted and are moving more quickly toward reduced hours than they had anticipated prior to the pandemic. Who can blame them?”
Drs Epstein and Privitera suggested measures to ease the underlying causes of burnout. “Flexibility in work hours and assignments and coaching and communication skills programs can enhance teamwork, sense of purpose, collective resilience, and alignment of clinicians toward common goals,” Drs Epstein and Privitera wrote.
In addition, health care systems should avoid having clinicians spend time performing meaningless tasks, “manifest as a torrent of mandatory training modules, administrative work, note bloat, documentation whose sole purpose is to increase billing revenues, and dysfunctional computer systems.”
Physicians commonly resist seeking mental health services because of the possible professional consequences, such as losing their licenses, Dr Epstein said in an interview. “Some states even ask, ‘Have you ever been diagnosed or treated for a mental illness?’” said Dr Epstein, who is a professor of family medicine, psychiatry, oncology, and medicine.
He also observed, “If physicians did not have to report any mental health issues, they would more likely seek care. A more intelligent approach adopted by some states is to ask physicians, ‘Do you currently have any physical or mental impairments that might affect your ability to practice medicine?’”
Dr Epstein said there is a need for behavioral health and peer support programs that respond quickly and effectively to clinicians in difficulty, indicated by bad outcomes, medical errors, or moral distress or conflict. Addressing burnout will require systemic changes in the work culture and stronger leadership involvement at medical facilities.
In an Annals of Internal Medicine article about the mental health effects of the pandemic on physicians, Warren D. Taylor, MD, MHSc, and Jennifer Urbano Blackford, PhD, of Vanderbilt University Medical Center in Nashville, Tennessee, offered advice for lowering burnout risk. Physicians should practice self-care “by taking time to eat, sleep, and rejuvenate. Intentionally creating even brief moments of lower stress through mindfulness meditation can reduce both physiologic stress markers and depressive and anxiety symptoms.” To carve out the necessary time to recover, Drs Taylor and Blackford stated, physicians need to lean on their social supports, including family, friends, teammates, and colleagues.
Physicians who are struggling should ask for help early, they advised. “Psychiatrists and psychologists have a range of effective treatments, including brief, focused psychotherapy; group therapy; and, if needed, prescription medication,” they wrote.
Reidar Tyssen, MD, PhD, a psychiatrist and professor of behavioral medicine at the University of Oslo in Norway, said physicians should focus on the foundations of their wellbeing. They need to ask themselves if the time spent in these areas fit with their importance. He recommends drawing a cake diagram, with the size of each slice reflecting the importance of various aspects of their work and personal lives. “Do not skip mental relaxation or leisure activities that really make you reboot,” Dr Tyssen said. “Reading a novel, listening to music, just doing nothing, all are important.”
Rahman Mohammed, MD, a Dallas-based emergency medicine physician and CEO and founder of VivoDoc, a company aimed at helping doctors better handle the business of medicine, said physician burnout can be the result of too much work, having dashed expectations, and insufficient compensation. Clinicians can take steps to prevent burnout by achieving a healthy balance between work and life. Better time management is one such step. For example, physicians should delegate non-clinical responsibilities to support staff and have medical assistants handle patient follow-ups and prioritize clinical tasks based on urgency.