Physician Burnout in the Face of COVID-19

By Dr. Claire Neely, ICSI President & CEO

In the past few years, our healthcare industry has done a better job of addressing issues around mental health for our healthcare professionals, such as physician burnout, with new programs to help promote the wellbeing and emotional resiliency. Some medical schools are trying to reduce the impacts of physician burnout with training that teaches a more balanced, therapeutic relationship between doctor and patient, as opposed to the more traditional, hierarchical experience most of us were shown.

Although progress has been made, nothing can prepare our caregivers for the impact of the COVID-19 crisis on their mental health. Our physicians and nurses are laser focused on providing care for their patients, and adrenaline is surely helping them to keep going despite the conditions we’ve all read about, particularly in the hardest hit areas like New York City and New Orleans. But at some point, this curve will flatten.  Once our healthcare workers have time to stop and think, that’s when more problems may start.

Whether it’s caretaker fatigue or severe PTSD, or something in between, we must be ready to support our heroes on the frontlines from an emotional standpoint, not just a physical one.

To plan solutions for this inevitable problem, it’s important to understand why physician burnout has been such a struggle in the first place. My generation of doctors were trained to have a kind of “emotional disconnect” when dealing with patients. We are supposed to be the objective person in the room, which creates a mental “split” as we attempt to separate ourselves emotionally from the patient experience. The high rates of divorce, drug and alcohol abuse, and even suicides among physicians attest to the challenge with maintaining this distance.

There are impacts to mental health when keeping all these feelings inside, and this goes for nurses and other healthcare professionals as well. The tradition of being the person who is supposed to provide the help, not the one the needs it, has contributed to an entire sector of workers who simply do not ask for help.

With COVID-19, our healthcare workers are facing extraordinary conditions that frankly we’ve never seen before. For example, healthcare workers may normally view their home environment as one that is a respite from the stress of their daily work. Yet now workers are concerned about bringing the virus home to their families, and/or have the added complexity of children schooling at home, so what used to be a place that provided some peace is now just another source of anxiety. What was once a safe, re-energizing space is simply no longer there.

In addition, this group of trained, intelligent workers no longer has many of the answers, or if they do have the answers, they may not have the tools (like PPE) to execute proper supports. Having to reuse equipment and perform other tasks in a way that would not be their first (or tenth) choice causes more stress as well as extreme anxiety about not doing it “right.” Each day on the frontlines of COVID-19 healthcare workers are being asked to make do, if not become creative when treating patients due to a lack of resources and knowledge.  Obviously, this compounds stress in a way that’s unimaginable for many.

While this is cause for great concern, there are also reasons for great hope. I am gladdened by the work health care has done over the past 15 years to help not only doctors, but other healthcare workers handle stress and anxiety in a healthier way. Programs that promote mindfulness practices, or providing supportive, therapeutic venues to discuss the emotional impacts of tough cases are two examples of ways in which providers and others can support our workers.

Based on this pre-existing work, many organizations have already activated to create mental health support to help our COVID-19 caregivers. ICSI, for example, has been holding conversations across the state to spread supportive practices, creating a new Mental Health Support website to provide the latest tools and resources for healthcare workers. Within ICSI’s newly formed Mental Health Support for Healthcare series, we’re hearing about new programs like internal warmlines, and buddy systems to provide peer emotional support. Some mental health professionals and others have created basic supports like food delivery systems for frontline workers, and finding ways to provide services they may not necessarily have the time or energy to complete.

Overall, I’m hopeful that our industry will meet the challenge of better supporting the emotional needs of physicians, nurses and other workers. Efforts to do so would create a permanent change in how we approach caring for patients, and the wellbeing of our healthcare workers will be stronger for it.