Pandemic-era burnout: How physicians manage crushing workloads and IT demands
In the third feature story in our burnout series, physicians discuss the stressors of 2020 and offer helpful tips on how their peers can combat burnout.
October 12, 2020
To see all of the feature stories in the Burnout in the Age of COVID-19 series, click here.
When the subject of burnout in healthcare is raised, perhaps the highest profile victim is the physician. Without doubt, they are under a lot of stress – especially during a pandemic where they are regularly making life and death decisions.
But it’s not just the huge workload that COVID-19 has brought with it, and the sometimes terrible decisions that must be made. It’s also routine stressors like administrative work and the IT used to do it. IT can add stress, and it can also alleviate stress. It just depends on the application, how well it has been crafted to meet clinician needs, and whether physicians like it. Electronic health record systems are a usual suspect for stress, though they can help, too.
This is the third feature story in Healthcare IT News’ Burnout in Healthcare During the Age of COVID-19 series. It focuses on what causes physician burnout and how successful doctors are in fighting the stress that leads to burnout. This feature follows the first two, one on healthcare consumer burnout and the other on healthcare CIO burnout.
Following are the experiences and opinions of six medical doctors from various backgrounds and healthcare provider organizations, including Atrium Health, Compass Medical, Garza Medical Group, Orlando Internal Medicine and Saint Peter’s University Hospital. The physicians discuss the stressors of 2020 and tips for their peers throughout the industry to help avoid burnout.
The stress of patient workload during the pandemic
Healthcare IT has played a huge part in medical care during the pandemic in the form of telemedicine. This virtual care took off as states went into lockdown and people wanted to avoid being near other, potentially infected people.
“Our health system largely was designed to operate under the circumstances where patients were expected to physically travel to us and receive healthcare, or in rare instances healthcare physically would go to a patient’s home through visiting nurses and house calls,” said Dr. Dhrumil Shah, a family physician and chief medical information officer at Compass Medical, an ambulatory primary care practice in East Bridgewater, Massachusetts. “Delivering 20-40% of care virtually as part of nationwide change is something none of us expected to happen this rapidly.”
Patient workload stress has been affected largely from three aspects: when, how and where to receive or provide care, he added.
“Being an ambulatory primary care practice, we realized the impact of these stress vectors immediately as we physically closed some of our departments, virtually closed all waiting rooms and applied administrative controls at all front doors of our buildings,” he explained. “The number of physical appointments reduced drastically, and telephonic triage exploded well before telemedicine regulations were made available to facilitate reimbursements and before mechanics of telemedicine were in place.”
Immediate impact of this pandemic on pre-existing burnout largely was felt as a shock and as uncertainty around the lack of scientific guidance available to carry out duties as a provider of care, he said.
“One way we mitigated this at Compass Medical was by creating a pool of administrative clinical leaders to provide 24/7 support for all of our physicians and clinical team members on rapidly evolving COVID-19 protocols as point-of-care practices were changing,” Shah explained.
“Our case medical management team, under the leadership of our chief medical officer, became a rapid response team that all clinicians relied on in the beginning, which tremendously helped us reduce burnout and allowed point-of-care teams to focus on redesigning patient workload from physical to virtual models of care and from reactive to proactive by applying population health insights.”
Proactively changing appointments to virtual visits when appropriate and rescheduling preventive visits when feasible allowed physicians’ schedules to accommodate the rapidly increasing demand of telephonic triage-based same-day appointments, he added.
“My burnout as a physician is partly measured in response to my professional satisfaction achieved via practicing good medicine at the end of my daily routine,” Shah stated. “During this pandemic, having a team around me making sure we get back to what matters the most – practicing good medicine – was crucial to avoid what could have been an exercise of emotional exhaustion if done in isolation.”
Bottom line: A team is what helps physicians avoid burnout and bring joy to the practice of medicine, he said. If a physician did not have a team before the pandemic, they certainly have one now if they still are practicing, he added. “Perhaps it just needed to be realized through this crisis,” he said. “Balance of life, support of professional teams and practice of self-awareness is the key to preventing burnout.”
Ever-changing information
There are many unknowns related to COVID-19, and over the course of the pandemic, information has been fluid. As physicians provide care for large volumes of patients across ambulatory, acute-care, long-term acute care and skilled nursing facilities, staying on top of ever-changing details that need to be communicated to patients, colleagues and peers about care and treatment has been very important, said Dr. Pradeep Vangala of Florida’s Orlando Internal Medicine.
“We deal with the stress brought on by the workload in a number of ways, all of them supported by technology in some way, from staying informed, collaborating with teams and the community, and sharing information with patients,” he said.
Another point of stress is ensuring that patients have detailed instructions when they leave the hospital, he said.
“Due to non-compliance or misunderstanding care instructions, patients are being put back on the schedule to be seen in a very short amount of time,” he said. “To ease this challenge, patients should be properly advised during their visits. New technologies integrated with our communications tools are making coping with this focus area at scale easier and helps relieve the associated stress.”
Optimizing workflow, reducing burden
Clinician burnout is real: It’s critical for healthcare organization leadership to call it out and acknowledge it; only then can it be addressed with measures that not just deal with the issues but creatively reduce and prevent factors that contribute to burnout, said Dr. Rasu Shrestha, executive vice president and chief strategy and transformation officer at Atrium Health, which has 39 locations in its health system, anticipating approval for a deal in October that will bring that number up to 55 hospitals.
“I am a firm believer that you cannot yoga your way out of burnout,” said Shrestha. “While it is critical to focus on clinician wellness, I spend a good bit of my energy trying to address the factors that contribute to the burnout in the first place. These include optimizing workflow challenges, reducing administrative burden, and formulating creative care models that emphasize care team coordination and person-centered care.”
Additionally, it’s important for clinicians to be self-aware and mindful, he said.
“I find new strength every time I think about our mission to improve health, elevate hope and advance healing for all,” he explained. “I am at one with this mission, and that provides me the resilience and vigor needed to work with my teammates to truly address the core issues of clinician burnout head-on. It has been said that you should allow your passion to become your purpose, and it will one day become your profession. Aligning the passion, the purpose and the profession, hence, is critical.”Read More in Original Post Here
