The Latest on Physician Burnout in the Time of COVID-19

By Clive Riddle, May 29, 2020

After COVID-19 fully assaulted the United States in March, an article appeared in the April 9^th Harvard Medical School’s Lean Forward: A Double Whammy: The COVID-19 Pandemic and Burnout in Medical Professionals, sharing that “leaders are advising health care workers to think of the pandemic as a marathon, not a sprint. But how long can health care workers hold up in these challenging conditions?” They cited a recent study on China’s physician COVID-19 experience: “researchers in China conducted a cross-sectional study published in JAMA Network Open Journal in March 2020. The study involved 1257 health care workers in China during the coronavirus pandemic and reported troubling results; 50.4% had symptoms of depression, 34.0% reported insomnia, 44.6% reported symptoms of anxiety and 71.5% reported distress.”

A May 17^th Forbes article,  Doctor, Heal Thyself: Physician Burnout In The Wake Of Covid-19 quotes Nisha Mehta, MD, radiologist, physician advocate and keynote speaker: “For many physicians, Covid-19 may be the proverbial straw that breaks the camel’s back as they isolate themselves physically from their family and friends while encountering a surge of sickness and death.” They cite that “physician burnout was an epidemic BEFORE the Covid-19 pandemic. According to a 2018 study, 400 physicians die by suicide each year – double that of the general population. In addition, doctors have the highest suicide rate of any profession in the U.S including combat veterans. From an economic standpoint, studies estimate that physician burnout is costing the health care system approximately $4.6 billion per year.”

An example of a growing trend, at the start of this month Charlotte, N.C.-based Novant Health established a new task force that will screen front-line healthcare workers for burnout.

Without focusing on just COVID-19, The May issue of The Journal of the American Board of Family Medicine featured are series of studies on physician burnout. In Joy in Work for Clinicians and Staff: Identifying Remedial Predictors of Burnout from the Mini Z Survey, Niharika Khanna, Russ Montgomery and Elena Klyushnenkova remind us that “Joy in medical practice is an important marker of clinician satisfaction related to structural and cultural aspects of the practice.”

Their study involved the CMS Transforming Clinical Practice Initiative (TCPI), which provided coaching and learning support to practices during transition to new models of value-based care. Specifically, Maryland practices participated in the Garden Practice Transformation Network (GPTN) as a part of the TCPI. During practices assessment, the authors measured prevalence of burnout and identified its remediable predictors among GPTN-Maryland practices.

 They found “prevalence of burnout symptoms was 22%, with 35% enjoying their work. A 100-point Time Constraints/Teamwork (T/T) score was constructed using factors significantly associated with burnout symptoms. T/T score increase by 1 unit was associated with 10% increase in the odds of moving from the group experiencing burnout or stress to the group who found ‘joy in work’.”

In Indicators of Workplace Burnout Among Physicians, Advanced Practice Clinicians, and Staff in Small to Medium-Sized Primary Care Practices, Debora Goetz Goldberg, Tulay G. Soylu, Victoria M. Grady, Panagiota Kitsantas, James D. Grady and Len M. Nichols remind us that “burnout is defined as a ‘syndrome of emotional exhaustion, depersonalization, and a sense of low personal accomplishment that results in decreased effectiveness at work.’ Numerous studies have concluded that burnout is a serious problem for physicians, advanced practice clinicians, nurses, and other health care professionals. Recent research indicates that primary care physicians experience a higher rate of burnout than most other physician specialties.”

Their study analyzed survey responses from 1273 healthcare professionals from 154 small to medium-sized primary care practices participating in the EvidenceNOW initiative in Virginia. They found “workplace burnout was reported by 31.6% of the physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff. Regardless of burnout status, results show all healthcare professional groups had high levels of anxiety. Providers had significantly higher scores for anxiety than all other healthcare professionals. Providers who experienced higher levels of anxiety and withdrawal were more than three times as likely to report burnout compared to those who experienced low levels in these domains.”

They recommend that “programs should focus on strengthening the work environment of small to medium-sized practices to improve organizational capacity for change and address high levels of anxiety experienced by physicians, advanced practice clinicians and staff.”

Here’s hoping our healthcare heroes can somehow find joy in work, and a strengthened work environment in these COVID-19 times.