Physician stress and burnout: Finding help during the COVID-19 pandemic
As we are more than 18 months into the COVID-19 pandemic, physicians and other health care professionals are finding themselves feeling emotionally, physically, and spiritually drained. A combination of intense workloads, disruptive patients, punishing schedules, limited personal protection equipment (PPE), and devastating patient outcomes have created a work environment that many have come to dread. And with the rise of the Delta variant, these overwhelming conditions could intensify in the weeks and months to come.
According to a new study by the Washington Post and Kaiser Family Foundation, approximately 29 percent of health care workers have considered leaving their profession. The reasons behind these decisions include a jumble of emotions caused by the pressure and chaos of the pandemic. Mounting personal fears of infection, illness, and exposing COVID-19 to loved ones and family members, and frustrations with insufficient PPE are just some of the contributors. 1, 2
The study also found that more than half of the respondents consider themselves victims of “burn out” while approximately 62 percent report that stress has impacted their mental health. 1, 2
While these numbers point to a potential mental health crisis among health care workers, the study also shows that 87 percent of respondents have not sought or received mental health care services or medication during the COVID-19 crisis. Among those respondents who reported stress and burnout, the main reason given for not seeking mental health care or services was they were “too busy.” 2
But there are other factors keeping physicians from seeking care. One is the stigma many physicians feel they will take on by admitting a need for mental health services, and the potential consequences for a physician who admits to such a vulnerability. According to a recent study published by the Mayo Clinic, nearly 40 percent of physicians reported they “would be reluctant to seek medical care for treatment of a mental health condition because of concerns about repercussions to their medical licensure.” 3
In July 2020, a study of physician license applications across the United States revealed that the Texas Medical Board (TMB) was one of 17 states that did not ask intrusive questions that would require disclosure of mental health conditions. 4 Instead, the TMB asks follow-up questions on mental health only if the applicant reports they have an untreated condition that could impair their judgment or ability to safely practice medicine, such as a mental health or substance abuse issue. However, in dozens of other states, medical boards ask physicians extensive questions about their health histories including a requirement to disclose any diagnosis or treatment for mental illness.
These types of questions can also occur when applying for hospital credentials or insurance reimbursements. “Disclosure can trigger a call to appear before the state board, a demand for medical records, or even a psychiatric evaluation. In the worst cases, doctors may be restricted in how they practice medicine or even lose their licenses.” 5
This type of questioning often leads physicians and other health care professionals to pay “out of pocket” for mental health services or not seek care at all. Unfortunately, in today’s COVID-19 pandemic environment, those top contributing factors to physician stress and burnout — increased work demands, social isolation during “lockdown,” increased exposure to traumatic events at work — have remained high, accelerating physician stress and burnout.
Untreated, increased stress and burnout can lead to deepening depression, anxiety, substance abuse, and even suicide. In health care settings, the consequences of stress and burnout have been consistently linked to increased risk of medical errors and poor patient safety.
Recognizing the warning signs of stress and burnout can help an at-risk individual take appropriate steps toward self-care. Therefore, when a physician takes decisive action toward self-care, not only does the physician benefit, but also his or her patients, colleagues, and loved ones.
Knowing the difference between stress and burnout
So, what is the difference between “stress” and “burnout” and when is it time to seek help? In simple terms, feelings of stress are the result of “too much”— too many daily pressures, responsibilities, tasks, activities, or meetings. People who are under stress usually feel that they are still in control of their situation, and reducing stress is well within the realm of possibility.
Stress is often relatively short-term; however, prolonged stress can lead to several ailments ranging from loss of energy and headaches to high blood pressure and anxiety disorders.
Stress can also lead to burnout. While stress comes from feelings of “too much to handle,” burnout can come from feelings of “not enough to give.” Being burned out means feeling empty, unmotivated, and uncaring. People who feel burned out feel like they don’t have any control, and they feel little hope that they can change the sources of their burnout.
Burnout often takes place over a long period and can be characterized by feelings of hopelessness, detachment, and depression. And while one is usually aware of being under a lot of stress, recognizing burnout may not be as obvious. 6
During the current COVID-19 pandemic, stress and burnout among physicians is at a unique and unprecedented high.
The Physician Support Line
In March 2020, Mona Masood, a Doctor of Osteopathic Medicine and psychiatrist, launched the Physician Support Line as a national, free, and confidential phone hotline to provide physicians with counseling during the COVID-19 pandemic. No appointments are necessary for callers.
The hotline — 1-888-409-0141 — is “made up of 600+ volunteer psychiatrists, joined together in the determined hope to provide peer support for our physician colleagues and American medical students as we all navigate the COVID-19 epidemic.” 7
“[P]hysicians are running on empty. They have not had time to process grief or loss like they would have before the pandemic. They just have to keep going. It looks similar to war,” says Masood in an interview with HealthLeaders. 8
She continues that the pandemic has brought out a “deep-seated vulnerability” among physicians. She describes how many physician callers have expressed feelings of regret and shame for even making the call. “The physicians are feeling like they should not be calling and talking about their challenges. Physicians have an expectation that they have internalized—they are not supposed to be taking care of themselves, they are supposed to be taking care of other people. There is a lot of guilt that is associated with that. We have to remind physicians that we created this resource for them.” 8
The website also offers articles, podcasts, and materials on such topics as anxiety, sleep and insomnia, supporting children at home, fitness, and coping with quarantine.
The Physician Support Line is available at 1-888-409-0141 every day from 8 a.m. to 12 a.m. Eastern Standard Time/7 a.m. to 11 a.m. Central Standard Time. Learn more at their website: https://www.physiciansupportline.com/.
The Emotional PPE Project
The Emotional PPE Project is a non-profit organization that offers an online directory of licensed mental health practitioners who provide free therapy services to physicians and other health care workers. This website, also launched in March 2020 to help physicians during the COVID-19 pandemic, was started by Ariel Brown, a Boston medical scientist, and her friend, Dan Saddawi-Konefka, the anesthesia residency program director at Massachusetts General Hospital. 9
In an interview with the Boston Globe, Brown stated, “PPE (personal protective equipment) is getting thrown around a lot. People in hospitals need masks and equipment to protect them from the virus and keep them safe and healthy. We feel there is a gap in [safeguarding] people’s mental health, and we’re providing that protection.” 10
The Emotional PPE Project was created to bypass the hurdles many physicians cite when contemplating mental health services, including stigma, career repercussions, and being too busy. “We started The Emotional PPE Project with these barriers in mind. Any worker in a healthcare related field that is impacted by the COVID-19 crisis is welcome to contact any of the volunteer licensed mental health practitioners in our directory. Each of these experienced therapists is dedicated to providing free sessions. No insurance. No cost. Just a trained professional to talk to.” 9
The Emotional PPE Project website is found at https://www.emotionalppe.org/.
Self-help strategies
If seeking professional help is not yet necessary, there are several meaningful strategies anyone can use to increase well-being through self-care and compassion.
“Having compassion for oneself is really no different than having compassion for others,” writes Kristin Neff, PhD on her website Self-Compassion.org. When you see a person struggling — emotionally, financially, physically — you may feel a need to help them, to take away their pain or difficulty. Struggle is human, and we are all human. To care for oneself is to recognize your own humanity, and your own need for help. 11
Self-compassion involves responding the same way to yourself in times of difficulty as you would to a patient under your care. Dr. Neff continues, “Instead of mercilessly judging and criticizing yourself for various [perceived] inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings — after all, who ever said you were supposed to be perfect?” 11
Dr. Neff includes a variety of exercises and tips for practicing self-compassion on her website. One exercise, called “How would you treat a friend?,” asks you to think of a time when a friend was struggling in some way and to write down a description of your response, what you might have said, and in what tone.
Next, think of a time when you were personally struggling or having negative feelings; write down how you responded, including what you may have said to yourself and in what tone. Then compare your responses — to your friend and to yourself. What are the differences? Did you treat your friend with more kindness or compassion?
The last portion of the exercise is to describe how your actions, attitude, and results may have differed if you had responded to yourself in the same way that you would have typically responded to a struggling friend. 12
Other ways to ensure you are taking care of yourself in your professional life and personal life include:
- Identify the people, places, and activities in your life that you enjoy. Stay away from people or relationships that drain you.
- Take breaks throughout the day, even if you must schedule them. Use a quick 10-minute break to step outside and get some fresh air.
- Set boundaries. Do not overcommit yourself at work or in your personal life. If possible, cut activities out of your schedule that cause you added stress, such as attending unnecessary meetings. Learn to say, “No.”
- Do something for yourself each day. Try to eat well and get enough sleep and exercise.
- Gain control where you can. This can mean keeping simple goals, such as being on time to work, taking the stairs at work, or maintaining a weekly “standing date” with a friend or partner. For example, have dinner every Friday with your best friend.
Practicing self-compassion isn’t self-indulgent, it’s a way to remind yourself there will be times that you will need to take care of yourself to avoid stress and burnout and maintain a high level of patient care. 6
Sources
1. Wan, W. Burned out by the pandemic, 3 in 10 health-care workers consider leaving the profession. Washington Post. April 22, 2021. Available at https://www.washingtonpost.com/health/2021/04/22/health-workers-covid-quit/. Accessed June 28, 2021.
2. KFF and Washington Post Frontline Health Care Workers Survey, March 2021. Kaiser Family Foundation. February 11 – March 7, 2021. Available at https://context-cdn.washingtonpost.com/notes/prod/default/documents/4d8d1ddf-c192-40f9-9e3a-7a3fefa0d928/note/91e5f1ac-2cc5-41bb-b164-ecb4d77ed0b5.#page=1. Accessed June 28, 2021.
3. Dyrbye, LN; West, CP; Sinsky, CA; et. al. Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clinic Proceedings. Volume 92, Issue 10. October 2017. Available at https://www.mayoclinicproceedings.org/article/S0025-6196(17)30522-0/fulltext. Accessed June 28, 2021.
4. Saddawi-Konefka, D; Brown, A; Eisenhart, I; et. al. Consistency Between State Medical License Applications and Recommendations Regarding Physician Mental Health. JAMA.
5. Belluz, J. The doctors are not all right. Vox Media. June 23, 2021. Available at https://www.vox.com/22439911/doctors-mental-health-suicide-coronavirus-pandemic. Accessed June 28, 2021.
6. Wenske, W. Combating physician stress and burnout. The Reporter. Texas Medical Liability Trust. Quarter 1 edition, 2017. Available at https://hub.tmlt.org/reporter/the-reporter-quarter-1-2017. Accessed June 29, 2021.
7. Physician Support Line website. Available at https://www.physiciansupportline.com/. Accessed June 29, 2021.
8. Cheney, C. Coronavirus: Help Line Launched to Support Mental Health of Physicians. Healthleaders. April 24, 2020. Available at https://www.healthleadersmedia.com/clinical-care/coronavirus-help-line-launched-support-mental-health-physicians. Accessed June 29, 2021.
9. The Emotional PPE Project. Available at https://www.emotionalppe.org/. Accessed June 29, 2021.
10. Sances, MK. Through a new site, health care workers can find mental health counseling for free. Boston Globe website. April 16, 2020. Available at https://www.bostonglobe.com/2020/04/16/lifestyle/through-new-site-health-care-workers-can-find-mental-health-counseling-free/. Accessed June 29, 2021.
11. Neff, K. Definition of self-compassion. Self-compassion.org. Available at https://self-compassion.org/the-three-elements-of-self-compassion-2/. Accessed June 29, 2021.
12. Neff, K. Exercise 1: How would you treat a friend? Self-compassion guided meditations and exercise. Self-compassion.org. Available at https://self-compassion.org/category/exercises/#exercises. Accessed June 29, 2021.