Physician burnout was at epidemic levels before COVID hit with a vengeance in 2020.
More than a year later, the pandemic has added to the pressures faced by a broad range
of healthcare professionals and those studying to enter the professions. What they
experience on the job and in the classroom can bring on the classic symptoms of burnout:
emotional exhaustion, a loss of identity and feelings of inadequacy related to chronic
work-related stress.
Clinicians say caregivers, who dedicate their professional lives to the service of others, often tend to forget about what they can do to care for themselves. At a time when job demands have intensified, mental health professionals and university and hospital administrators are exploring ways to address the issue.
Among those on the front lines as a health psychologist is Angela L. Kurzyna, MA, PsyD 鈥13, BCB, executive director of Moorestown Integrative Wellness in Moorestown, New Jersey, just across the Delaware River from Philadelphia. She was one of four medical professionals who spoke to Digest Magazine about what they鈥檝e seen in the field, and what interventions they have developed to address the issues.
鈥淗ealthcare workers are burned out, beyond a shadow of a doubt,鈥 says Dr. Kurzyna, who supports a range of health practitioners in the Delaware Valley: physicians, physician assistants, nurses, fellow psychologists, pharmacists. 鈥淏urnout and compassion fatigue had been increasing over the past few years, but COVID was the tipping point for so many. There was a baseline of burnout going on, and then the advent of COVID made things significantly worse. Fatigued, highly anxious, experiencing sleep disturbances鈥攕o many healthcare professionals just couldn鈥檛 turn the pandemic off.鈥
The efforts by healthcare professionals to respond to the clinical struggles of the pandemic have taken a toll, affirms Jennifer Collins, MS 鈥08, PsyD 鈥10, MSCP, clinical psychologist and chief well-being officer at Penn Medicine Lancaster General Health, in Lancaster, Pennsylvania.
She pointed to a September 2020 study by the National Institute of Health Care Management that found 71 percent of physicians were reporting burnout and exhaustion, while 8 percent of physicians had outright shuttered their offices.
鈥淭here was a higher intensity of work, a rationing of supplies, mounting death totals, and feelings of inadequacy because they couldn鈥檛 cure their patients,鈥 she says. 鈥淓ven the best of healthcare professionals were falling short of the fix-it strategy. This affected those in the wards and those on the front lines; no one was immune.鈥
Not helping were the indifferent attitudes of many Americans toward infection-control precautions such as social distancing and masking. Masking even became politicized. Then came resistance to the COVID vaccine.
鈥淪eeing those things in the media was particularly distressing,鈥 Dr. Collins says. 鈥淚t felt like the community wasn鈥檛 supporting healthcare workers by doing their part.鈥
Healthcare workers were scared, too, that they might contract the novel coronavirus.
鈥淎t the beginning there was so much fear and uncertainty,鈥 she says. 鈥淲ould they contract the virus? Would they take it home to their loved ones? There was frustration that things weren鈥檛 getting better. There was a blip of optimism when the vaccine rolled out, but that quickly halted when so many people were not accepting of the vaccine and patient cases continued to rise.鈥
Also troubling was the resistance among some fellow healthcare workers to getting vaccinated and skepticism about reaching herd immunity.
鈥淲e鈥檝e experienced that resistance and skepticism in our own health system,鈥 Dr. Collins says.
Dr. Kurzyna suggests the reaction by healthcare workers to their stressful work conditions can be better understood if viewed through the lens of researcher Hans Selye鈥檚 three-stage General Adaptation Syndrome. The first stage begins with the alarm response to stress, when one鈥檚 adrenalin kicks in. Later, the reaction turns to resistance, as one鈥檚 body remains on high alert but returns somewhat to normal. The final stage is exhaustion, in the face of unrelenting chronic stress.
Many healthcare professionals find themselves exhausted, in Selye鈥檚 final stage. For some, it has ultimately meant retirement or a career change.
鈥淚t can look like depression,鈥 says Dr. Kurzyna. 鈥淧eople can鈥檛 get out of bed. They don鈥檛 have the energy for things they used to do. There is nothing left in the tank. I see people leaving jobs, leaving their specialties. They are spent. They are done.鈥
She says programs to combat burnout need to strengthen resiliency among healthcare professionals by building a more collegial environment in the workplace. She recalls how a decade ago, physicians, PAs, nurses would gather in lounges at hospitals to talk about cases on the floor, and their lives.
鈥淭hey kept up with one another,鈥 she says. 鈥淭here was time for small talk, or case consultation. These lounges still exist, but there鈥檚 nobody in them. And if they are there, everyone is on their devices.鈥
She encourages healthcare centers to reinvigorate these spaces.
鈥淭hey need to bring back the incentive for lounges and places built in the work milieu, where professionals have the time, space and expectation to socialize,鈥 she says.
For Jerry R. Balentine, DO 鈥83, FACEP, executive vice president and chief operating officer at New York Institute of Technology, the work to address the issues of burnout must begin in medical school, where he believes students need to develop strategies that they can take with them into clinical practice.
Dr. Balentine, who was dean at NYIT鈥檚 College of Osteopathic Medicine from 2018 to 2020, says he launched a program several years ago with medical students who he observed took too little time away from the books.
鈥淚 saw them studying like crazy,鈥 he recalls. 鈥淭hey felt that if they weren鈥檛, they
were doing something wrong.鈥
Dr. Balentine鈥檚 program was a no-cost, low-pressure initiative, which took place one morning a week. He鈥檇 show up in running shoes to lead a group in a 30-minute jog around NYIT鈥檚 Old Westbury campus. When the joggers arrived back, there was another half-hour when students could ask questions unrelated to their course material: How did you pick your specialty? How did you approach the body the first time you entered the anatomy lab? Do you recommend dating during medical school? Where鈥檚 the best caf茅 to grab a sandwich?
Years later, the morning runs Dr. Balentine initiated have gained popularity. Now, several faculty members participate, and as many as 50 students show up for exercise and conversation. Guests, such as the college president and Bob Nystrom, retired right-winger of the NHL鈥檚 New York Islanders, have joined in as well.
The concept has expanded, with one faculty member leading a tennis group and another playing basketball with students, while students have gathered for cooking lessons at the college鈥檚 catering hall.
鈥淭o fight burnout, you need to include fun in your life,鈥 says Dr. Balentine. 鈥淧eople go to medical school because they want to help people. To keep that passion going, you need to keep enjoying your life, no matter where you work.鈥
He notes that may have been easier to do in earlier days when physicians left work at week鈥檚 end and were only available via pagers if an emergency arose. Today, physicians are available anytime on their smartphones, with texts and emails coming in at all hours, seeking their response. And Zoom fatigue is truly taxing.
In the past, there was much talk about creating a balance between your work and your life. Dr. Balentine says he likes to view that issue in terms of putting up barriers between your professional work and your outside personal life.
鈥淲e鈥檙e teaching our students that it鈥檚 OK to put your phone down and have some time for yourself,鈥 he says. 鈥淟isten to music, read a book, go out dancing. Don鈥檛 sit at the dinner table, checking your mail on your phone. Let there be a barrier between your work and your life.鈥
At Penn Medicine, Dr. Collins has created a work group to address burnout. At a downtown hospital and community COVID test site, the health network set up self-care locations for gentle stretching classes, meditation or instruction in self-massage. At one testing site, there was a separate room in the back鈥攁way from the testing tents鈥攚here doctors and nurses could remove their PPE and relax before heading back out to swab new patients.
鈥淲e are hoping as the COVID numbers continue to decrease that we鈥檒l be able to build support for people so they can process all that they have encountered, and find meaning and fulfillment in their work again.鈥
Deneen M. Hendrick, DO 鈥90, member of PCOM鈥檚 DO Faculty Committee on Admissions, who just finished a five-year stint as coordinator for pre-health/accelerated medical programs at Rowan University in Glassboro, New Jersey, says COVID-19 has made some students reconsider their choice of a career in the health field.
鈥淢any go into medicine with the idea that 鈥業鈥檓 going to fix it, I鈥檓 going to save the day,鈥欌夆 she explains. 鈥淏ut what if you cannot make the patient better? What is your role when you can鈥檛 save everyone? You multiply that with COVID, and everybody around you is dying, no matter what you do. You have to recognize what that means and reassess your role as a healthcare professional. That鈥檚 the challenge.鈥
Dr. Hendrick says that the COVID pandemic has highlighted the need for healthcare professionals鈥攁nd students鈥攖o give themselves time for self-care. That鈥檚 crucial, in the face of grim statistics from a range of studies that indicate that the suicide rate for physicians is far higher than it is for the general public.
She says that self-care includes being willing to acknowledge that, at times, you are overwhelmed, and that speaking with an advisor or mental health professional could help you work through those feelings. But first, you must overcome the stigma some feel to seek help.
鈥淜nowing you need help is a sign of maturity,鈥 she says. 鈥淚t鈥檚 a sign of self-awareness.鈥
Dr. Hendrick often counsels students considering a career in medicine, pharmacy or allied health. In the past year, she witnessed how COVID increased pressures in the high-stakes atmosphere involved in the process of applying for admission.
It became more difficult, as COVID caused the postponement of the MCAT and other exams, and students scrambled to reschedule their test. Dr. Hendrick told the students to realize that there are things in the world that are out of your control, and you need to figure out how to go with the flow.
鈥淲hy have stress over things you can鈥檛 control?鈥 she says. 鈥淚 tell them that the bend in the road doesn鈥檛 have to be the end of the road鈥攗nless you fail to make the turn. If you turn with the curve, you will stay on the road.鈥
The changes to life caused by COVID were also a challenge for those individuals with a Type A personality, who have a tendency to multitask, are ambitious, competitive and highly organized, and are driven to excel at school or work.
鈥淐OVID taught us that you don鈥檛 control as much as you thought you did,鈥 Dr. Hendrick says. 鈥淵ou can鈥檛 control all of the stressors around you.鈥
That lesson was highlighted early in the pandemic, when physicians scrambled to treat the flood of patients into local emergency rooms. At that time, there were protocols in place that put many patients suffering from COVID on ventilators. Protocols were later changed after so many patients failed to survive the ventilator treatment.
鈥淭he doctors would put people on respirators, and the patients would die, despite their best efforts,鈥 Dr. Hendrick says. 鈥淪ome doctors internalized that failure.鈥
She says healthcare professionals need to step back, and give themselves a break.
鈥淭hey have to realize that they don鈥檛 own all the world鈥檚 problems,鈥 she says. 鈥淭here are so many things that are so much bigger than all of us.鈥
Digest, the magazine for alumni and friends of 色中色, is published by the Office of Marketing and Communications. The magazine reports on osteopathic and other professional trends of interest to alumni of the College鈥檚 Doctor of Osteopathic Medicine (DO) and graduate programs at PCOM, PCOM Georgia and PCOM South Georgia.
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