Industry Voices—Combating physician burnout in the post-COVID-19 future

It may be a while before the medical field can fully reflect upon and appreciate the psychological costs of the COVID-19 crisis on our physician workforce.

Vivid accounts of grief, loss, and helplessness on the frontlines have permeated national headlines while reinforcing the superhero, serve-others-first mentality that physicians are grounded in from their early medical school years. 

Having partnered with physicians for 20 years to shape comprehensive treatment programs for prevalent and serious chronic diseases, I have seen burnout with my own eyes. The fact that 42% of physicians experience burnout never surprised me before COVID-19 and still doesn’t today.

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The pandemic has only magnified the problem’s scope, and now our industry needs to join arms to accept burnout exists and continue to articulate its consequences as we look ahead to the post-COVID-19 future.

We must evolve the dialogue of burnout beyond individual coping skills. 

The depersonalization that results from long-term job stress inevitably trickles down to patients. Depersonalization creates the paralyzing feeling of watching yourself from outside yourself—a byproduct of trauma. Beyond sheer exhaustion, this sensation leads to compassion fatigue, which increases attachment with the treatment while decreasing connection with the person being treated. 

With the ever-changing nature of COVID-19, physicians simply do not have all the answers that patients depend on for comfort and a sense of control. Physicians may also be simultaneously overwhelmed with efforts to ensure their patients’ safety while protecting their own health and the health of their loved ones.

The accomplishments that cement physicians’ purpose and confidence leading up to this point may suddenly pale in comparison to the mounting numbers of patients who cannot be helped.

I lead a national network of social workers at Fresenius Medical Care North America, one of the country’s largest providers of life-sustaining dialysis to patients with kidney failure. The role of a social worker on our patients’ core treatment team means we are helping them maintain their emotional health while also witnessing firsthand the psychological health of physicians and care teams.

At one point during my time working at a dialysis facility, I observed the frustration of our physicians who had concerns about the unchanging, non-adherent behavior of our patients. We were trying out a variety of interventions that would temporarily improve treatment adherence, but they were not sustainable. As a result, I noticed some nephrologists appearing more dismissive with certain patients. Impatience and intolerance became a norm, not an exception. This emotional climate began to impact the full interdisciplinary team, and soon everyone shared the same perceptions of those patients, who were still refusing to make changes. It wasn’t until we all encouraged one another to start taking self-care seriously and explore ways to partner with, and better understand, our patients that we started to see real results.

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There are a few “ways of knowing” that have created more stability for my team, and that I hope can help others as we all become more comfortable with our collective burnout.

  • We cannot be afraid of our emotions or others’—especially those that may come on without warning or hold more power over us than we would like.
  • While we are not all on the frontlines, we are all exposed in some capacity to the pandemic—and grieving our circumstances in our own ways is critically important.
  • Peer support means sharing our fears in real time, which may otherwise go unnoticed when we are not seeing each other in person.
  • Get off your own island. Conferences and meetings can refresh our minds and create needed separation with our day-to-day commitments. While many of these events are being held virtually, the inspiration and integrity of a community of minds reuniting is not lost. 
  • Turn your “fear zone” into your “learning zone.” Fear happens when you dwell on what you cannot control, and your daily conversations are rooted in anger and helplessness. Learning happens when you start accepting what is beyond control and cannot be solved with preparation and practice (the antithesis of how we have been trained). 

Addressing burnout starts with confronting it directly, especially from leaders at the top, who can help recognize its pervasiveness and acknowledge the many ways it manifests.

There is much more to be revealed about the long-term solutions that can address burnout in a compassionate, sustainable way. We can help by building a roadmap that validates burnout, customized for an organization’s culture and needs, at every rank of experience.

When we think about providers across the full healthcare spectrum, they are contributing to and absorbing a particular “care culture.”

How company leaders approach invisible threats to their livelihood can either perpetuate a lasting, silent pain or transform a culture and identity of a work environment for the better. Establishing this foundation now can help set the stage for new medical school graduates entering the clinical workforce in the throes of an unrelenting pandemic.  

Felicia Speed is the senior director of social work services at Fresenius Medical Care North America.