‘We’re not surprised’: Physician burnout continues into third year of pandemic
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On Sept. 15, the AMA released a statement saying that the burnout rate among United States physicians spiked during the first 2 years of the COVID-19 pandemic, citing research published in Mayo Clinic Proceedings.
The study, led by Tait D. Shanafelt, MD, the director of Stanford WellMD Center in California, found that 62.8% of physicians reported at least one manifestation of burnout in 2021, compared with 38.2% in 2020 and 43.9% in 2017.
According to the report, due to pandemic-related stress, one in five physicians intend to leave their current practice within 2 years, as well as two in five nurses.
“[This is] at a time when we're already facing a workforce shortage and lengthening wait times for patients [and having] difficulty getting into see physicians,” AMA President Jack Resneck Jr., MD, told Healio. “So we're really worried seeing all those data. But in some ways, we're not surprised, given the difficult last 3 years that physicians have lived through.”
As the U.S. continues into the winter months of the COVID-19 pandemic, physicians are continuously reporting increased rates of stress and burnout that not only affect clinicians, personally, but health care systems across the nation.
Staff shortages
According to data published in the 2022 Apollo Healthcare Predictions Report, an annual barometer of global physician sentiments from Apollo Intelligence, 62% of U.S. doctors, as well as 49% of European physicians say they are concerned about staff shortages in their hospitals or clinics. Apollo President and CEO Daniel S. Fitzgerald credits the shortages to the “prolonged pandemic” and clinicians’ frustration with their fading influence in public health.
“Burnout levels and staffing concerns overshadow other, more optimistic findings this year,” Fitzgerald said in a March 2022 company press release. “Our annual report provides a window into physicians' sentiments and views on the year ahead, and this year's report highlights the strain the pandemic is continuing to put on them.”
Laura Jefferson, PhD, MSc, BSc, a research fellow at the University of York in England, and colleagues conducted an international review of six bibliographic databases to parse evidence that explored the impact of the pandemic on primary care physicians.
“While physicians globally were experiencing burnout before COVID-19, the pandemic presented additional challenges that may have exacerbated these difficulties, with research showing primary care doctors experienced stress, burnout, anxiety and depression to varying degrees across settings,” Jefferson told Healio. “This has implications clinically, both in terms of health care infrastructure as more clinicians take time off or consider leaving their roles, and in terms of patient care, as evidence shows that patient safety and quality of care are worsened when doctors experience stress and burnout.”
Jefferson said it is possible to speculate that there could have been fewer incidents of burnout if health care systems had been better prepared for the pandemic.
“Evidence from some settings, such as Singapore [Lau et al], suggests that national preparedness for the pandemic may have influenced doctors’ wellbeing; their scores for stress and anxiety were lower than other settings,” she said. “Some of our qualitative evidence also suggests frustrations around lack of (personal protective equipment) may have led to heightened anxiety among primary care doctors facing infection risk without the necessary protection.”
Differences in rates by gender
A cross-sectional study of physicians in 2017 by Lotte N. Dyrbye, MD, MHPE, professor of medicine and associate director of the program on physician wellbeing at the Mayo Clinic, and colleagues reported that female physicians have a 30% to 60% increase in odds of physician burnout compared with male physicians. In addition, female physicians are more likely to experience depressive symptoms.
Sarah R. Ahmad, MD, of the department of neurology at the University of California, San Francisco, and colleagues conducted a mixed-method survey-based study that found that female physicians experience a significantly higher frequency of gendered microaggressions compared with male physicians, which may be a factor contributing to burnout rates.
“Physicians who are burned out because of these microaggressions may not be able to provide the same level of patient care; they may leave the workforce,” Ahmad told Healio. “Attrition for women in academic medicine is a lot higher than for men. There may be a lot of reasons for [burnout] outside of microaggressions or gender issues. It's not the whole story, but it may be a contributor.”
Plans for improvement
On Oct. 20, 2022, U.S. Surgeon General Vivek Murthy released a new framework that outlines the foundational role employers should play in promoting mental health and wellbeing within the workplace.
Citing the Mind Share Partners’ 2021 Mental Health at Work Report, the framework said that 76% of U.S. workers reported at least one symptom of a mental health condition in 2021. This was an increase of 17 percentage points in the last 2 years.
In addition, the survey found that 84% of respondents reported at least one workplace factor that had a negative impact on their mental health. Moreover, 81% of workers said they would be looking for workplaces that support mental health in the future.
“As we recover from the worst of the pandemic, we have an opportunity and the power to make workplaces engines for mental health and wellbeing, and this Surgeon General’s framework shows us how we can start,” Murthy said in the report from HHS. “It will require organizations to rethink how they protect workers from harm, foster a sense of connection among workers, show workers that they matter, make space for their lives outside work and support their growth.”
The framework consists of 48 pages, broken up into five sections, dubbed “essentials,” which aim to help workplaces develop, institutionalize, and update policies and practices that best support mental health.
At the same time in October, the AMA released its own plan to address issues in the workplace, specifically focusing on physicians: the Recovery Plan for America’s Physicians. Like HHS’ plan, AMA’s also focuses on five segments that aim to strengthen workplace conditions for clinicians. Focusing not only on issues such as prior authorization and reforming Medicare, one of the plan’s “pillars” specifically focuses on burnout rates among physicians.
“[The plan is] largely focused on making sure that, after physicians have really spent the last 3 years holding together a health care system that has been stretched way too thin, we make sure we take care of physicians and protect our ability to take care of patients,” Resneck said. “It's really all it is about — making sure we can take care of patients at the end of the day.”
Resneck said AMA’s recovery plan specifically addresses the growing rate of depression and suicide among physicians and medical students. The goal of the plan is to ensure physicians have access to mental and behavioral health resources in the workplace that also aim to deter the stigma surrounding mental health, he said.
“We’ve now got substantial data that shows that physicians who are happy in their work and are well-supported actually have better patient outcomes and are able to take better care of patients,” Resneck said.
By removing specific burdens in the workplace, it will contribute to “restoring joy in the practice of mental health,” he said.
References:
Ahmad S. Are you really the doctor? Physician experiences with gendered microaggressions from patients. Presented at: Women in Medicine Summit; Sept. 16-17, 2022; Chicago.
Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/. Published July 5, 2017. Accessed Jan. 10, 2023.
Jefferson J, et al. Br J Gen Pract. 2022;doi:10.3399/BJGP.2021.0680.
Lau J, et al. BMC Fam Pract. 2022;doi:10.1186/s12875-021-01370-7.
Physician burnout rate spikes to new height. https://www.ama-assn.org/press-center/press-releases/physician-burnout-rate-spikes-new-height. Published Sept. 15, 2022. Accessed Jan. 10, 2023.
Shanafelt TD, et al. Mayo Clin Proc. 2022;doi:10.1016/j.mayocp.2022.09.002.
Sinsky CA, et al. Mayo Clin Proc. 2022;doi:10.1016/j.mayocpiqo.2021.08.007.
U.S. Surgeon General releases new framework for mental health & well-being in the workplace. https://www.hhs.gov/about/news/2022/10/20/us-surgeon-general-releases-new-framework-mental-health-well-being-workplace.html. Published Oct. 20, 2022. Accessed Jan. 11, 2023.
What physicians want: Address burnout, staffing concerns, says 2022 Apollo Intelligence global healthcare report. https://www.businesswire.com/news/home/20220328005164/en. Published March 28, 2022. Accessed Jan. 10, 2023.
2022 Apollo Healthcare Predictions. https://apollointelligence.net/2022/02/24/2022-apollo-healthcare-predictions/?utm_source=pressrelease&utm_medium=pressrelease&utm_campaign=pressrelease. Published Feb. 24, 2022. Accessed Jan. 10, 2023.