Bridging the Gap: Physician Shortages and Burnout in the Post-COVID-19 Era
Introduction
The COVID-19 Pandemic has been an unprecedented challenge for U.S. hospitals and the healthcare industry. While the heroic efforts of healthcare's essential workers were widely celebrated, the pandemic also revealed the profound toll it took, manifesting as burnout and exposing significant flaws within the US healthcare system. While burnout was already a pervasive problem before the pandemic in the healthcare industry, COVID-19 made this a crisis, leading to widespread rates of physicians quitting their jobs and leaving U.S. hospitals understaffed across the country. This article will explore strategies that hospitals are implementing to address physician burnout while ensuring financial sustainability.
Understanding Burnout
Burnout is defined as a mental or physical collapse due to prolonged or high levels of stress. It is a “syndrome consisting of three stages: emotional exhaustion, depersonalization, and reduced feelings of personal accomplishment…caused by overwork. Employees have a limited capacity for information absorption…and reach states of fatigue and exhaustion that result in diminished work performance”(Claponea et al). Burnout holds substantial importance in the healthcare field, as physicians with impaired performance directly impact patient lives and health outcomes. This negative impact on the clinical relationship leaves both patients and physicians dissatisfied. The emotional exhaustion and depersonalization that are the key elements of burnout can trigger health professional feelings of exhaustion and cynicism and they can become distant and cold when facing the patients' needs, all of which compromises the quality of care (“Burnout”...).
Existing research suggests that burnout during the COVID-19 pandemic can be attributed to various factors. Witnessing the widespread loss of life and the rapid spread of illness, compounded by insufficient support, including shortages of Personal Protective Equipment, extended working hours, and a lack of ventilators, generated a sense of hopelessness. Over 1 million people in the US have died as a result of the pandemic (CDC…). For numerous healthcare workers, these death rates were a career first, leaving many of them devastated and with severe mental trauma. "One study from the national center for biotechnology, indicated that of 1833 healthcare workers, 39.9% met the criteria for PTSD (Bayazit et al).
Additionally, the healthcare industry has seen a prioritization with meeting quantitative objectives, leaving some physicians with the feeling that hospitals prioritize metrics and data analysis over meaningful patient interaction. Compounding the issue further, the widespread adoption of Electronic Health Records (EHRs) has shifted the dynamics of healthcare delivery, demanding a substantial commitment of physicians’ time and contributing to a noticeable decrease in the amount of direct interaction between physicians and their patients. Physicians find themselves devoting approximately half of their working hours, with an additional 28 hours each month during nights and weekends, to complete these records (Changes…). This shift in focus has led to a change in how many healthcare organizations gauge the effectiveness of a "good doctor," with an emphasis on metrics related to administrative efficiency, such as promptness of message responses and swift completion of patient charts for billing purposes. Physicians who reported higher percentages of time spent on administrative duties had lower levels of career satisfaction, higher levels of burnout, and were more likely to be considering seeing fewer patients in the future (Rao SK et al).
The increased focus on administrative work coupled with the trauma from COVID cases has created a severe and documented problem of increased burnout in the healthcare industry as a result of the pandemic. As the healthcare industry grapples with the ramifications of burnout, another critical challenge emerges in the form of a looming physician shortage, exacerbating the strain on an already overburdened system.
The Physician Shortage Dilemma
The consequences of burnout are severe and far-reaching: decreased job satisfaction, lower quality patient care, and, alarmingly, an exodus of doctors from the profession. The Bureau of Labor Statistics estimates that the health-care sector has lost nearly half a million workers since February 2020 (The Employment…). According to a 2021 Association of American Medical Colleges study, America could see a shortage of between 37,800 and 124,000 physicians by 2034 (AAMC…). One in four Massachusetts physicians plans to leave medicine in the next two years (Massachusetts Medical Society). Over 230,000 physicians, nurse practitioners, physician assistants and other clinicians had quit their jobs as of August last year (Addressing…).
The shortage creates a vicious cycle, as physicians and healthcare workers who do not leave the profession have to compensate by working in an environment that is understaffed, with undue pressures to work overtime. This can worsen their burnout. Physician shortages are not a mere inconvenience; they can have dire consequences for public health in the United States. Patients might experience delayed diagnoses, receive suboptimal care, and in some cases, be unable to access healthcare altogether. For example, the average patient appointment wait time is up 8 percent since 2017 and 24 percent since 2004, with the latest data from [AMN Healthcare] showing it takes around 26 days for a new patient to get an appointment with a provider in 2022 (PatientEngagement…). Physicians whose surveys revealed signs of burnout were 2.2 times as likely to report a perceived medical error, a statistic that can mean life or death for patients (Motluk).
Implementable Strategies
Now, in order to combat the physician burnout crisis, while also maintaining a hospital’s financial viability, healthcare facilities across the U.S. have begun implementing a variety of these measures in order to strategically address these issues. Psychological interventions like providing access to social workers and clinically trained therapists to healthcare providers, surveys to analyze levels of stress and anxiety, providing articles on self-care, yoga and meditation workshops have been found to be relatively successful in burnout reduction (Aryankhesal et al). Additionally, continuing to expand healthcare teams and build a community-focused environment of nurse practitioners, doctors, physician associates, and administrative employees will alleviate the burden on physicians. Finally, financial incentives like loan forgiveness models may allow physicians to remove financial strain from medical school loans and place more focus on their own mental well-being and providing a high level of patient care.
The first few steps towards managing physician burnout are recognizing and measuring it through proactive administrative work reduction and timely surveys. These steps are implemented at Mayo clinic, which annually measures and compares their data with the national data enabling them to assess the workload and satisfaction levels of their physicians. There are plans to extend the survey to further assess which departments have physicians experiencing the most burnout and mitigating accordingly (Patel et al). Additionally, a family medicine program at Colorado University started, “APEX,” Ambulatory Excellence Program, in which medical assistants performed the initial workup including history taking, reconciling medications, scheduling visits, administering vaccinations, and providing information regarding health education and preventive care. Though this method requires extensive training for medical assistants to work semi-independently following protocols, it turned out to be cost-neutral for the management and allowed physicians to concentrate on examination and diagnosis. Burnout rates decreased from 53% to 13% in six months (IT et al).
Conclusion
Addressing the dual challenge of physician burnout and shortages in the post-COVID era is a critical task for the healthcare industry. The relentless demand placed on healthcare professionals has exacerbated this mental health crisis, while the global health crisis has simultaneously highlighted the urgent need for an expanded and resilient healthcare workforce. By implementing effective strategies and providing needed support, we can ensure a healthier future for both patients and physicians.
From: Northeastern University
By: Sreya Ravi
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