Interventions to prevent clinician burnout

BURNOUT HAS dogged the medical profession for years, jeopardizing clinicians’ personal and professional lives. But the hazards and stress they’re living with now as a result of the pandemic are potentially much more dangerous and point toward the need for interventions to prevent clinician burnout.

According to an opinion piece that appeared late last year in Annals of Internal Medicine, clinicians’ exhaustion is now an existential threat to the health care workforce.

For too long, the authors say, medicine has insisted that staying sane is, somehow, clinicians’ personal responsibility, one they must attend to on their own so they can shake off any trauma they experience. The delusion that institutions, regulatory bodies and organized medicine don’t have a duty to safeguard clinicians in the workplace needs to end, and the authors propose a 10-point plan for effective change.

“(T)he entities that employ us,” they write, “must move beyond suggesting stress-reduction activities, such as yoga and meditation, to provide the tactical support clinicians need to safely care for patients and support one another.” Lead author Eileen Barrett, MD, MPH, a hospitalist in Albuquerque, spoke to Today’s Hospitalist.

What led you to write this proposal?
What drove us was seeing not only our colleagues suffer, but seeing employers—who often mean well— not realize they have to do much more to support us in our work. Even institutions that already know that may not know where to start.

“We need to treat misinformation with the same level of urgency that we treat the finances that keep the power on.”

~ Eileen Barrett, MD, MPH

You call for practice development to help clinicians manage their own anger and grief over treating unvaccinated patients. You also call for training on how to address vaccine misinformation—and for engaging all health care workers in that task so doctors don’t have to manage misinformation alone. Should hospitals appoint a misinformation czar?
I haven’t heard of any hospitals doing that, but that could be a fantastic idea. We have chief financial officers, chief informatics officers, chief experience officers. But misinformation is what our patients are dying from, and the moral injury that it is causing health care workers cannot be underestimated. We need to treat misinformation with the same level of urgency that we treat the finances that keep the power on and the IT infrastructure we all use.

Do you know of interventions that institutions are using to address misinformation?
Some institutions—including Southern Illinois University in Springfield, Ill., and Southeast Health in Dothan, Ala.—are doing community-based education about vaccines and partnering with faith leaders to answer people’s questions.

It’s also important to figure out when misinformation is willful and when it’s not. Sometimes patients have been swayed by just low-level misinformation, such as the belief that they can ride out the pandemic without needing to get vaccinated. All it may take to convince such people is to explain that everybody is either going to be vaccinated or infected—and that when those who are vaccinated become infected, they should have a less severe infection.

I recently spent close to an hour with a patient who had questions about the use of fetal cells in vaccines. I could speak to those concerns because the leader of that patient’s faith tradition has come out in favor of vaccines, and I think that was persuasive. But it depends on the person and what they have heard, and their concerns can be deeply personal.

You mention spending almost an hour discussing covid vaccines. Your piece also calls out productivity metrics as a factor that contributes to burnout and disillusionment.
The productivity treadmill has such negative consequences. Employers at times judge our professional worth on how many patients we see, not on how many complications we prevent or how many patients we persuade to get vaccinated. But those are the right things to do, and we’re put in the position of either having to act on our values or bill for more patients seen. We shouldn’t have to make those decisions.

Mental health, job satisfaction, burnout are all factors that affect physician wellness. Explore articles that focus on solutions to combat depression and lead to hospitalist career satisfaction.

You also point out the extraordinary demands the pandemic has placed on parents, and you call for flexible schedules, support groups and advocacy for infection-prevention measures in schools to help them.
For years, employers have complained that they have problems with recruitment or retention. What employers should do instead is ask, “What can we do to better support parents? How can we compete by treating people well?” I think clinicians would start breaking down doors to work for organizations that took that approach.

You also include several action items related to mental health resources, and you advocate for wellness check-ins for clinicians in areas hard-hit by covid.
The availability of mental health services depends on the institution as well as on the practice or group. We’ve seen an explosion of such services during the pandemic, and those are long overdue.

But I hear from people offering these programs that they are either totally overwhelmed by the need or that nobody is using the resources that have been put in place. In the case of the latter, support may be too difficult to access, or those services may be offered at times that hospitalists can’t use them.

And clinicians are legitimately afraid of how accessing mental health care may affect their ability to be credentialed. But every single hospital has the power to remove inappropriate questions about mental health in their credentialing applications. All of us can advocate for making such changes.

Are you encouraged by what institutions and organized medicine are trying to do to address these hazards? Or do you think it’s pretty bleak?
I think we can hold those two things at once; I know I do. The situation on the ground is bleak. But at least, people are finally talking about the challenges. Ten years ago, I don’t think our article would have been published in a prominent journal.

Why not?
Because hospital medicine—and medicine in general—had a very strong sense that physicians were supposed to just deal with work stress on their own. We didn’t place any expectations on employers or regulatory bodies as to what they should do to provide a safe workplace.

The good news is that many of the changes that can help clinicians often do not require more money. Instead, they require finding the will to do them.

Several of our recommendations are nearly free for employers to adopt: ensuring transparency about PPE, revising credentialing applications to not stigmatize mental health care, adopting robust anti-discrimination and anti-harassment policies, and more. Perhaps providing more time so clinicians can address covid misinformation isn’t free, but it will pay for itself by protecting us and our patients.

Phyllis Maguire is Executive Editor of Today’s Hospitalist.

Published in the January/February 2022 issue of Today’s Hospitalist