The Impact of Pandemic Burnout on Physicians

John Whyte, MD, MPH; Peter Yellowlees, MD

Disclosures

February 17, 2021

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  • Burnout among women physicians, in particular, increased in 2020. The highest levels of burnout among all physicians were seen in critical care, rheumatology, and infectious diseases — some of the specialties affected most by the COVID-19 pandemic.

  • Physician stress also increased as hospitalized COVID-19 patients continued to deny the severity of the disease.

  • Burnout and depression can lead to increased impatience and medical errors. Physicians reported feeling frustrated by patients not listening to them.

  • Burnout is often caused by external factors. Good leadership in health systems that acknowledges the pandemic and thanks physicians is important.

  • Physicians tend to ignore their own care; exercising regularly, getting enough sleep, and nurturing relationships with others is important to cope with burnout.

This transcript has been edited for clarity.

John Whyte, MD, MPH: Welcome, everyone. I'm Dr John Whyte, chief medical officer at WebMD, and you're watching Coronavirus in Context. Today I want to talk about burnout in physicians and how it impacts them personally and professionally.

To provide some insight, I've asked Dr Peter Yellowlees to join me. He's the chief wellness officer at UC Davis Health. Dr Yellowlees, thanks for joining me.

Peter Yellowlees, MBBS, MD: It's nice to be here, John. Looking forward to the conversation.

Whyte: Medscape puts out a report every year, and this year it's titled 'Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021. One of the important findings was that burnout hasn't changed that much since last year, but it's increased slightly, particularly in women physicians. Does that surprise you?

Yellowlees: No, I don't think it does. It's very hard to know how much emphasis to put on almost any report around well-being or burnout at the moment during the pandemic. The reality of life is that all physicians have been affected by the pandemic, just as everybody else has. We're essentially going through a disaster response cycle, which we understand well and it is stressful.

Whyte: Twenty percent of physicians stated that they experienced burnout for the first time this year as a result of COVID-19. But it's interesting that burnout among specialties has changed. This year it's critical care, rheumatology, and infectious diseases that had the highest percentage of physicians with burnout. Just in case you're wondering, dermatology and plastic surgery were among the lowest. But how does this factor into burnout? Those are the specialties that we see primarily addressing the pandemic.

Yellowlees: Right. I think that's exactly the reason. These are the specialties that are particularly under fire and under pressure, where their work has changed quite dramatically in many instances. They are also increasingly concerned about the potential spread of infection to their families, other people, and obviously getting COVID themselves. So it's totally predictable, and I think it's going to be interesting in the long term as to how these specialties manage and whether people want to go into them in the same numbers as they have in the past. They've all been pretty popular specialties in the past. But whilst we know that there's an increase in medical school applicants at the moment, I wonder if they'll be going into these particular specialties.

Whyte: Some people might be thinking, so physicians are burned out; everyone's burned out. But what we also saw in this report is how burnout impacts them professionally. They talked about its impact on when they become exacerbated by patients, that they're not listening to patients, and are making some errors in their judgment when they're tired and burned out. How concerned should we be about the impact of burnout on the delivery of care?

Yellowlees: I think it's a very important issue. In fact, the issue that most of my colleagues speak about is the difficulty speaking to some patients who've actually had COVID (even patients who have been ventilated) and who refuse to admit that they've had it because they don't believe it exists. It has been extremely stressful for the physicians. There's complete denial of reality that is going around. There's essentially a mass delusion, as far as I'm concerned, and physicians are on the sharp end of that, being confronted with patients who are very sick but refuse to accept the fact.

Whyte: Burnout often leads to depression. But is depression causing physicians to make more medical errors?

Yellowlees: We know that both burnout and depression lead to increased medical errors. You should probably think of burnout as being a sort of minor variant of depression, maybe a vulnerability factor for depression. Burnout normally is a self-limiting disorder, but it can certainly move on and be a vulnerability factor so that people eventually develop depression, other psychiatric disorders, or substance use disorders. I think we should think of it as being a vulnerability factor primarily, rather than a specific disorder in its own self. And we know that burnout is primarily caused by external organizational factors or stresses, rather than by internal factors related to the physicians.

Whyte: Well, you're the chief wellness officer. If external factors are causing burnout, how do we fix it? How does the individual physician help address issues of burnout? And then more broadly, how does the healthcare system?

Yellowlees: I think the individual physician has to look at both their local organizational issues and their own personal issues. We know that local leadership and good leadership in small and large teams at organizations makes a huge difference. So simply acknowledging the great work that people are doing, thanking them, and being aware of the sorts of stresses that they're under is really important.

Educating people about the normal process of disaster recovery psychologically, and essentially, the areas around disaster mental health — what is normal, what is abnormal — [is important]. We're going through a process where most of us, quite honestly, are adversely affected by this pandemic disaster, and it's not unreasonable to acknowledge that and to then attempt to move on from that stage.

At an individual level, we know very clearly from multiple literature evidence factors that physicians as a group are highly resilient. At entry to medical school, physicians are more resilient than equivalent graduate students elsewhere, less depressed and less burned out. The problem is that physicians are generally squeezed in a really difficult system. They develop burnout because of those systemic issues. Now, what that means is that as physicians, we have to actually focus on the good resilience capacity that we have and relearn that and support that. It's not that we're not resilient, but there's no reason why you can't improve your resilience and support yourself better.

Whyte: Give us some tips on how to do that. Is it about meditation? Is it about trying to maximize sleep? We know it's about eating healthy. That's not always something that people can do without some preparation. What are your tips?

Yellowlees: It's about all of those self-maintenance things, particularly sleep; it's really important to monitor your sleep and make sure you're getting enough. Exercise — we know that exercise is good for your mental health. There's no question about that. There's a lot of evidence to support that. So, regular walking, cycling, running. You can do all of those things even while you're socially distanced.

Obviously, nurture and spend time on your relationships. I've got a number of colleagues who are very pleased that their children are being homeschooled at the moment because they're spending much more time with them than they would normally. And if a married couple are physicians, they're able to work their shifts around that. So, look at all of these self-care approaches.

Whyte: I was going to ask you about self-care because people have been talking about that. You pointed out that physicians are good at resilience. Some people would argue that physicians aren't good at self-care. There's a reason why we say the smart physician doesn't ascribe to the attitude of heal thyself. We're not so good when it comes to managing our own health, isn't that right?

Yellowlees: I think that is, unfortunately, true, and that's one of the things that physicians need to learn. We know that more than 30% of physicians don't have a primary care physician of their own. One of the things we encourage people to do is go and see your primary care physician. At least get yourself checked over. Do the maintenance that you advise your patients to have with their own physician. I think we have to have less denial about our own health and focus more on that in this situation.

Whyte: What do you find is the biggest mistake clinicians make when it comes to burnout? Is it a "pull yourself up by your own bootstraps" approach? Is it denial? Is it, I'll deal with that later; I'm too busy? From your experience, what has been the key challenge in getting people to recognize this as physicians?

Yellowlees: I think the biggest mistake that physicians make is that they continue doing what we were all taught in medical school, which is that if you want to succeed in something, you just work harder. You do more, you plow through and overcome almost anything by just working more and longer hours and harder. That's obviously not true. But it's what we're taught and trained to believe, and it's what a lot of the residency programs are based on. I think we've got to get away from that mantra. Unfortunately, that is a very common belief that physicians hold. In reality, what we need to be doing is working smarter, not harder.

Whyte: Take out your crystal ball. What will next year's report on burnout and suicide show us?

Yellowlees: I think it's probably going to show similar rates to now and not much less. I'm not expecting dramatic improvements. Obviously, I hope that we'll be through most of the pandemic by then and that our work will have returned more to what is a "new normal." There are potentially some big silver linings associated with COVID. Learning to use telemedicine-equivalent technologies for patients is going to be really good for us. There is increasing evidence to show that, despite the Zoom fatigue, using video with patients is actually good for our mental health as physicians. Certainly, we know that patients love it. I think that's important.

A lot of health systems have discovered that transparent honesty with all of their staff is a really important matter. Certainly that's coming through fairly clearly. We're going to have more communication across and within our workplaces, which I think will be helpful as a consequence of COVID. There's been an increased emphasis on the importance of healthcare workers as essential workers and as people who have a difficult, potentially dangerous, life-threatening job, and who need that validated. So, I think some positive things will come out of COVID that will help physicians. Unfortunately, I wouldn't expect an immediate improvement in burnout rates because those are very slow to change.

Whyte: I want to thank you for sharing your insights today, as well as for all that you're doing in order to help address issues of burnout.

Yellowlees: Thank you very much, indeed. It's a real pleasure to be here, and I greatly appreciate Medscape's focus on burnout because it is really important for the profession.

Whyte: And thank you for watching.

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