The COVID-19 pandemic has been likened to a war, with new battles and strategies constantly arising. Among the staggering casualties brought on by this pandemic —deaths, disability, mental health, and economic insecurity, to name a few — the count must include medical professionals. They are unintended victims who suffered just the same.
What Clinicians Are Feeling
Before the pandemic, clinicians were already dealing with issues like lower reimbursement rates, higher incidence of acute on chronic conditions, and greater patient census numbers with less load protection due to staffing shortages.
Additionally, physicians saw increasing acuity in an aging population, more complex medical problems, and an exploding opioid crisis containing chronic issues associated with addictive susceptibilities.
Research shows that pre-pandemic, physicians were at twice the risk for burnout compared to the general population. Now, with COVID-19-induced pressures at such critical levels, clinicians struggle to practice optimally.
Becker’s Hospital Review reports that 52 percent of health care workers feel “burned out,” 43 percent are “anxious,” and 21 percent are “angry.” Of even greater concern, 23 percent say they are likely to leave the health care field soon.
It has become overwhelming, resulting in what Dr. Annamarie Lim, SCP Health Group Medical Officer, calls “moral injury,” suffering that comes from breaking one’s moral code. The term was first used to describe soldiers with PTSD and with the collective trauma of the health care community, now applies to them as well.
“What is often termed burnout is in actuality moral injury, the result of preventing physicians from completing their duty to help patients,” said Dr. Lim in an interview.
She added that most medical schools codify this not in the Hippocratic Oath, but the Declaration of Geneva, which says:
“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard; I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat; I MAKE THESE PROMISES solemnly, freely, and upon my honour.”
“When supply chains are taxed, medicine is not available, and ventilators are in short supply, there is a psychological trauma that leaves an indelible mark upon the soul of any person, let alone someone pushing for the highest standards of care,” Dr. Lim said.
Health Care System Support
Hospital-based care (and by extension its clinicians) continues to feel more stress as primary preventative care service lines are over capacity or underutilized by patients due to accessibility.
When clinicians are overworked, enduring longer hours than usual, and face different capacities to account for shortages, they are more tired, get less rest, and spend less time enjoying outside hobbies and passions. Studies show that patients of clinicians who are “depleted” are less satisfied, less likely to follow instructions, and experience poorer outcomes.
Clinicians need extra support in order to carry the weight of their responsibilities. Supporting the bereaved loved ones of patients is a tall order, especially while also processing their own grief for patients they lost, suffering colleagues, and the community at large—along with the routine stresses of life, both personal and professional, that they continue to face as well.
Without assistance, medical professionals can experience a loss of passion. They may no longer remember why they chose medicine or connect with patients, both essential components to continuing to follow their medical vocation.
We Need Our Clinicians
Medical professionals of all specialties comprise a significant segment of the “Great Resignation.” The sad truth is that when clinicians leave medicine, we lose both the healers they are and those they would have become.
The professional lifespan of a clinician is waning, particularly in certain specialties. For example, the average lifespan of a hospitalist is around five years before they move on to something else. That is concerning considering the length of time spent in education. Hospitals and patients also lose out on the benefits of having more experienced clinicians.
How to Help
Hospitals and health systems, along with clinicians and patients, all have a responsibility to help combat this fallout.
Watch for the Signs
We must be vigilant and watch for signs of physician burnout. The more apparent symptoms include physicians who:
- Are late for work;
- Seem more disconnected;
- Are always exhausted;
- Begin expressing interest in other avenues or careers;
- No longer volunteer or delve deeply into their profession.
While we all watch for signs, clinicians who are struggling and concerned can use self-assessment resources such as the PROQOL scoring system to get a measure of professional quality of life. Such assessments help to identify feelings and can help you take action.
Take Action
Hospital and medical leadership must do everything possible to protect clinicians. Steps include:
- Providing adequate coverage to lighten the load, especially for daytime staff;
- Leveraging AI technology to use predictive staffing forecasting and creating flexible scheduling models may help;
- Ensuring physicians have adequate time to care for patients;
- Offering support, understanding, and a safe place. That includes confidential access to mental health resources, places where clinicians can connect with others, and acknowledgment that times are hard.
“Admitting that things are hard is not a sign of weakness,” Dr. Lim said. “Instead, it implies strength of character and knowledge of oneself in a way that provides control. As Teddy Roosevelt put it, ‘Do the best that you can with what you’ve got where you are.’”
Clinical staff needs support, but so much is beyond our control. Dr. Lim advises leaders to focus on doing what you can and look to the future to shore up prevention.
“Knowing that what we do now in terms of quality will be the foundation of medicine in the post-pandemic world makes all of our efforts for ourselves and our communities worthwhile,” she concluded.
It is imperative to provide clinicians with the support and resources needed to deal with personal and professional challenges. SCP Health has a dedicated clinician support program to confidentially assess concerns and connect clinicians with the appropriate resources.
