What are some key takeaways for physicians on how to care for themselves, advocate for change, and support colleagues going forward?

Dr Sharma: Recognizing the symptoms of burnout can help providers identify their risk early, before experiencing a large mental toll. Prioritizing self-care is essential in these challenging times, and reaching out to colleagues for wellness checks can create an environment of awareness regarding mental health. Destigmatizing burnout with frequent discussions at meetings and inviting speakers to give seminars on the topic can encourage providers to open up about their own experiences. Engaging hospital leadership to prioritize provider mental health is also essential.


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Dr Dewey: “Permission to be human!” is a quote from my colleague Bill Swiggart, a licensed professional counselor who spent 30-plus years of his career supporting physicians. Physicians must learn to acknowledge their humanness and support their individual needs.

“Place yourself at the top of the to-do list” is a relevant quote because physicians take care of everyone else very well and often fail at truly caring for themselves, and this includes their own goals and dreams.

“Remember, every ripple from you is better when you are better.” I love the analogy of a drop of water as it enters a pond – there are many ripple effects from that one drop. As physicians, if we prioritize ourselves and realize it is not selfish but necessary, then all our ripples are better, and those ripples affect our significant others, children and pets, family members, colleagues, teams, patients, and every other relationship we have no matter how brief or long. It is not selfish; it is necessary. 

“Be the change you hope to see in the world.” The quote made famous by Mahatma Gandhi reminds us if we make changes and model those behaviors for our families and future generations of physicians, we will change the culture of medicine over time.

What are other remaining needs in this area in terms of research, organizational change, or otherwise?

Dr Sharma: Most studies on provider burnout in the literature are cross-sectional surveys. More longitudinal studies are needed to follow providers over time and prospectively identify factors associated with burnout. Research is also needed to identify factors that promote emotional well-being and are protective against burnout. Large, urban teaching hospitals were overrepresented in our survey. More research is needed on the experience of providers in rural settings and smaller hospitals. Understanding the pandemic’s impact by provider race and ethnicity is important to produce equitable research findings. Continuous assessments are needed as the pandemic rapidly evolves, particularly now as cases are rising dramatically across the nation.

Dr Dewey: We still need physicians who are willing to take the time to learn and adjust their work and home lives for their individual needs. Meaning, physicians are near death before they participate in training programs, coaching, and therapy, and I ask, why? We know why – physicians are still too worried about stigma and fear of being less than perfect or human or real. This fear and, I believe, lack of knowledge, prevents physicians from seeking help. In general, physicians are not fired or released because they get coaching or therapy. They get fired and released for the behaviors that come from years of neglecting themselves, which end in distressed and disruptive behaviors, mental health conditions that are untreated, and impairment due to substance use from poor coping skills and burnout.

We still need systems and organizations that prioritize changes that support cultures of wellness and value quality of care over the monetary amount of addressing these challenges. We need organizations to support wellness officers and initiatives that support systematic change to improve workplace environment and reduce the risk of burnout.

We still need research and programs that support physician well-being in a confidential and individualized way. We do this in my center at Vanderbilt, the Center for Professional Health.6 We have developed several programs that target healthcare providers and leaders to enhance individual well-being and support organizational change.

References

1. Morgantini LA, Naha U, Wang H, et al. Factors contributing to healthcare professional burnout during the COVID-19 pandemic: a rapid turnaround global survey. PLoS One. 2020;15(9):e0238217. doi:10.1371/journal.pone.0238217

2.Sharma M, Creutzfeldt CJ, Lewis A, et al. Healthcare professionals’ perceptions of critical care resource availability and factors associated with mental well-being during COVID-19: results from a US survey. Clin Infect Dis. Published online September 2, 2020. doi:10.1093/cid/ciaa1311

3. Rodriguez RM, Medak AJ, Baumann BM, et al. Academic emergency medicine physicians’ anxiety levels, stressors, and potential stress mitigation measures during the acceleration phase of the COVID-19 pandemic. Acad Emerg Med. 2020;27(8):700-707. doi:10.1111/acem.14065

4. Cravero AL, Kim NJ, Feld LD, et al. Impact of exposure to patients with COVID-19 on residents and fellows: an international survey of 1420 trainees. Published online October 21, 2020. Postgrad Med J. doi:10.1136/postgradmedj-2020-138789

5. Dewey C, Hingle S, Goelz E, Linzer M. Supporting clinicians during the COVID-19 pandemicAnn Intern Med. 2020;172(11):752-753. doi:10.7326/M20-1033

6. Herbers K. Center for Professional Health celebrates decades of hope, healing. VUMC Reporter. March 14, 2019. Accessed December 21, 2020.

Suggestions for further reading and resources

1. Worth T. How doctors can cope with psychological distress during the pandemic. Psychiatry Advisor. October 1, 2020. Accessed December 21, 2020.

2. Walton M, Murray E, Christian MD. Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. Eur Heart J Acute Cardiovasc Care. 2020;9(3):241-247. doi:10.1177/2048872620922795

3. Kaslow NJ, White DT, Cook SC. A psychological perspective on the association between critical care resource availability and emotional wellness during the COVID-19 pandemic. Clin Infect Dis. Published online September 15, 2020. doi:10.1093/cid/ciaa1398

4. Feist J, C Feist, Cipriano P. Stigma compounds the consequences of clinician burnout during COVID-19: a call to action to break the culture of silenceNAM Perspectives. Published online August 6, 2020. doi:10.31478/202008b

5. Hartzband P, Groopman J. Physician burnout, interrupted. N Engl J Med. 2020;382(26):2485-2487. doi:10.1056/NEJMp2003149

6. Bradley M, Chahar P. Burnout of healthcare providers during COVID-19. Cleve Clin J Med. Published online July 9, 2020. doi:10.3949/ccjm.87a.ccc051