Q&A: ACP leaders call on health care employers to better support clinicians

Several ACP leaders have outlined 10 actions that health care employers can take to ensure the safety and wellbeing of clinicians during and after the COVID-19 pandemic.

In an opinion piece published in Annals of Internal Medicine, Eileen Barrett, MD, MPH, an associate professor of internal medicine and director of continuing medical education at the University of New Mexico, and colleagues addressed the mounting challenges that clinicians face while providing safe, high-quality health care to patients.

As burnout increases and more clinicians pursue different career paths, “the entities that employ us 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,” Barrett and colleagues wrote.

Their guidelines were communicated specifically to health systems, hospitals and clinical practices. They recommended the following actions:

1. Ensure the physical safety of clinicians by reducing their risk for COVID-19 through vaccine mandates and policies that guarantee universal masking, proper ventilation and access to personal protective equipment.
2. Offer “practical support” to clinicians in the areas that cause emotional stress or moral injury.
3. Allow enough time during clinical encounters for health care workers to address COVID-19 and vaccine misinformation.
4. Offer flexible work schedules and support groups to clinicians who are parents and advocate for policies to reduce SARS-CoV-2 transmission in school settings.
5. Cut back on administrative tasks that are not “mission-critical,” including unnecessary meetings and trainings that have not been proven to improve patient outcomes.
6. Implement antidiscrimination and antiharassment policies “to acknowledge and mitigate harm, particularly against minoritized persons.”
7. Offer free and confidential mental health resources for clinicians.
8. Remove unnecessary questions on credentialing and employment applications about mental and physical health diagnoses “that may deter care-seeking, violate the Americans With Disabilities Act and stigmatize clinicians.”
9. Encourage clinicians to use vacation and professional development days.
10. Adopt suicide prevention strategies.

Barrett and colleagues emphasized that these actions are feasible and affordable to implement and that sharing best practices between systems and centers “can provide incentives to reluctant adopters.”

“The adage that no crisis should go to waste presents us with many opportunities to do better — and the ongoing waves of the pandemic create a new urgency to do so,” they wrote.

Healio Primary Care spoke with Barrett to learn more about these actions and her message to physicians.

Healio Primary Care: What prompted you and your coauthors to write this opinion piece?

Barrett: We were reflecting on how long and hard this time has been, and how many of our peers have reached out to us as individuals in all different dimensions of our lives to say how difficult it has been for them seeing patients suffer, and also how difficult it has been when there are initiatives in our health care institutions that want to value our wellbeing, but they put the responsibility on clinicians to create their own wellbeing. Words like resilience have in some ways become a dirty word because, to some people, it can feel as though they themselves should be fixing their fatigue, disillusionment and burnout rather than their employer addressing this.

We wanted to capture some actionable, achievable and, in many cases, really low hanging fruit that are tactical steps that employers can do to say, “We see you. We care about you. We want to listen to you to find out what we can do better, because we don’t ever want to imply that the problem is you. We want to demonstrate that it’s not just words; it’s about our deeds.”

Healio Primary Care: Were these stress reduction strategies warranted before the pandemic?

Barrett: They certainly applied before the pandemic. And they certainly apply now, and I think they can be a foundation for things that we can build upon moving forward. The actions that we suggest should be considered standards.

Healio Primary Care: You set out 10 recommendations. What is the top priority organizations should be focusing on?

Barrett: The challenges are local because some employers are already doing some of the things that we recommend. So, I would suggest that institutions start by asking frontline clinicians what they need, what they want, and ask them to choose what they would prioritize among these actions and what is missing from this list. Start by asking the people who are affected what they need and move on from there.

Healio Primary Care: What is the key takeaway for physicians?

Barrett: There are institutional and organizational obligations to each of us. When we acknowledge this, we can shift the narrative and highlight actions that are “big enough to matter but small enough to win.” That could be as small as sharing this article and asking if this is something we can work on, or what is the timeline in which we can start to work to achieve these things. We may find that just having a small victory will lead to greater victories because it helps reinforce our sense of agency.

We are highlighting steps that literally every institution can do — regardless of their finances and regardless of their bandwidth — to help clinicians know that they’re not alone, there are resources available to them and their institutions should show that they are supported.

Lastly, this is a checklist that will need to evolve and grow as needs change. So, when an institution accomplishes all of these steps, it’s time for a new checklist to emerge. I’m looking forward to finding out what those next steps are so that all of us can learn from the experience of people who have taken this work further.

Reference:

Barrett E, et al. Ann Intern Med. 2021;doi:10.7326/M21-3381.