Are Healthcare Institutions Doing Enough for Physicians?

At the height of the COVID-19 pandemic, quarantiners around the globe made noise with bells, claps, and even saxophones to acknowledge healthcare heroes. The rhetoric deeming healthcare workers "heroes" may be intended as an expression of gratitude, but it sends another, more damaging message: that healthcare workers are impermeable, even superhuman. Unlike Bruce Wayne and Clark Kent, many physicians don't have the time or energy to lead double lives.

"As a physician, [work-life balance is] always a little bit of a challenge, and as a woman in medicine, too, I think it's always something to be mindful of," Susan Bleasdale, MD, chief quality officer for the University of Illinois Hospital & Health Sciences System and assistant vice chancellor for quality and patient safety for University of Illinois Chicago, told Medscape Medical News. During the lockdown, she and her husband — an internist — had no choice but to leave their three teenagers alone at home while they spent countless days, evenings, and weekends at work. "During the pandemic...[it] was a challenge to make sure the needs of my children were met, and [to maintain] the balance of my job and my husband's job, because we both needed to be seeing patients," she said.

Dr Susan Bleasdale

Long hours and high levels of pressure and stress leave many healthcare workers with a shortage of time and energy to maintain full, healthy personal lives. An imbalance of work and life can affect a healthcare professional's performance at work, sense of well-being within the workplace, social life outside of work, and physical and mental health. Since the onset of the pandemic, the challenges of work-life balance and burnout among healthcare professionals have intensified and lingered. The effects of COVID-19 and the "Great Resignation" have left the healthcare industry at a tipping point, and the future of the industry depends on the measures being taken to ensure a better quality of life for physicians moving forward.

Halee Fischer-Wright

Still, potential solutions to this problem remain nebulous. A May 2021 study by the Medical Group Management Association (MGMA) found that only 14% of healthcare institutions had a plan for dealing with physician burnout, while 86% do not.

"While I can say I've heard of quite a bit of creative activity," MGMA President and CEO Halee Fischer-Wright, who wrote the 2017 book "Back to Balance: The Art, Science, and Business of Medicine," told Medscape Medical News, "I would say they're dots on the map, not an overall strategy of how to address this issue."

Acknowledging and Destigmatizing the Issue

A 2022 Medscape report found that 47% of physicians reported experiencing burnout or emotional and physical exhaustion. In keeping with these findings, a research review published in the Wiley Public Health Emergency Collection in March 2021 found that 34.1% of the nurses studied reported emotional exhaustion, due in part to working in hospitals with inadequate and insufficient material and human resources.

The alarming prevalence of menta l health issues, post-traumatic stress disorder, and suicide within the healthcare industry prove that this is not just an individual issue, but one directly related to working conditions and the high stakes, high expectations, and high stress of the industry.

"To understand why so many clinicians and other healthcare workers are struggling with burnout now, it is important to understand that healthcare worker burnout was a pandemic in its own right prior to the COVID-19 pandemic," Craig Rooney, PhD, counseling psychologist and program director of the Office of Clinician Well-Being at the University of Missouri (UM) School of Medicine in Columbia, Missouri, told Medscape Medical News. "The stressors that COVID-19 put on healthcare systems [have] only exacerbated a pre-existing, underlying problem."

Craig Rooney, PhD

Each year, the UM Office of Clinician Well-Being conducts the American Medical Association's burnout survey among students and clinicians at the UM medical school. The office's leaders then collaborate with medical school leaders to develop plans to deal with the issues raised in the survey responses. A central part of their solution is providing mental health resources: Rooney provides clinicians with short-term counseling services and refers them to psychiatrists and other mental health services for support.

"In my experience, potential new hires have learned to ask about efforts in this area," Rooney said of mental health resources, "and will take note of whether or not a potential employer recognizes this problem and is taking some steps to address it."

Fischer-Wright also emphasized the importance of healthcare institutions facilitating mental health support. "We recommend mental health resources such as peer-to-peer counseling," she said. "When I was coming up, life coaching was kind of like Fight Club: You don't talk about life coaching. Now life coaching is a very important part of decreasing burnout."

Healthcare institution leaders often allocate all of their mental health resources to patients, while overlooking the needs of their own providers. But health leaders should be especially familiar with the idea that prevention — rather than treatment — is the first line of defense and can save resources and minimize risks in the long term. Making room in budgets for in-house or easily accessible mental health services is an essential first step for healthcare institutions to retain clinicians and draw new hires — and even, in some cases, to save clinicians' lives.

"It is important to understand that clinicians are the largest source of revenue in healthcare organizations," Rooney said, "so a crisis in clinician well-being will become a crisis in the financial health of our healthcare organizations."

Making Room for Autonomy, Flexibility, and Boundaries in the Postpandemic Workforce

At the height of the pandemic, an increasingly virtual reality blurred the lines between work and downtime for some University of Illinois (UI) Health staff, who Zoomed into meetings while driving into work, or even while on vacation, simply because they could.

A key criticism of remote work is that some suspect it will lead to workers engaging less in their work, but there is evidence to suggest the opposite is true. Various recent studies have found that employees work longer hours when working remotely. According to a 2020 paper by the National Bureau of Economic Research, each workday lengthened by an average of 48.5 minutes at the onset of the pandemic, and the number of meetings each person was attending increased by 13%.

UI Health leaders have taken on some of the responsibility for setting boundaries and parameters when it comes to remote work. "We've been trying to monitor what is called 'pajama time' in our electronic medical record, how much time people are spending outside of the work day doing work, because the electronic world has brought the work of a physician home," Bleasdale said. "[Remote work] creates a lot of ease [in terms of] work flexibility, but it also has a chance — if you don't make good boundaries — to encroach on your personal life."

Another piece of the autonomy puzzle is limiting the extent to which physicians get bogged down by bureaucracy and clerical burden. In addition to providing mental health services, UM's Office of Clinician Well-Being works to lower clinicians' administrative burden by decreasing the amount of time they spend filling out documentation.

"Healthcare is one of the most regulated industries in the United States, and oftentimes we add layers of administrative burden without subtracting them," Fischer-Wright said. "So [we need to take] a critical look at what can be stripped away safely. We recommend giving providers more autonomy.... So what do we mean by that? Using scribes, getting practices that have physician's assistants or nurse practitioners...more flexible work schedules and more time off."

Fostering Community and Connection Among Healthcare Professionals

UI Health has a multicategory employee appreciation program that offers employees opportunities to send shout-out cards and thank-you notes to their peers, and to nominate their peers for the CARE (Compassion, Accountability, Respect, and Excellence) Award, the Class Act Award, or the Joseph V. Abraham Leadership Award.

Bleasdale was nominated for Physician of the Year by her UI Health colleagues and for Woman Physician of the Year by her fellow northern Illinois members of the American College of Physicians (ACP), in recognition of her work throughout the pandemic. The ACP also awarded her an Advancing the Careers of Women Award in February 2022. "During the pandemic and all the time, it's important to make sure that you're creating that recognition, and highlighting the work of people," she said.

Employee appreciation can reinforce a sense of purpose and community among healthcare workers. A study published in The Lancet in May 2021 found that the likelihood of healthcare workers experiencing burnout was 40% lower among those who felt valued by their healthcare organizations.

"The first thing you need to do is have the communication, or at least have the environment where you can have that kind of transparent communication," Fischer-Wright said. "I think in a lot of ways, because healthcare has really put its nose to the grindstone, we've lost that sense of community and connectivity."

In a 2020 study published in the Kansas Journal of Medicine, 43% of the practicing physicians surveyed reported a sense of loneliness, a feeling associated with burnout.

"Healthcare is serious business, so it can be important to intentionally develop ways that physicians and other healthcare workers can have fun together, too," Rooney said, suggesting happy hours, socials, and peer mentorship programs along with employee appreciation measures.

Still, reflecting on tribulations is just as important as rewarding triumphs. Bleasdale and other leaders at UI Health acknowledged collective struggles by doing wellness rounds and sharing stories from the front lines during the pandemic. They also encouraged staff to keep their cameras on during virtual meetings to boost face-to-face connection. "When you're never seeing anyone's face, you're never having that handshake, you get very disconnected," Bleasdale said. "It really [is] disruptive for community work, engagement, alignment."

As healthcare institutions foster a sense of community in the workplace, clinicians can feel more supported by their colleagues and leaders, and less like they need to shoulder the full burden of their burnout and take on the added task of "self-care."

"What I recommend for the future is to have organizations tie the important work that care providers do back to the mission of taking care of people and taking care of communities, because I think it's that sense of validation that you're doing something greater than yourselves that can help fuel people through rough times," Fischer-Wright said. "That sense of doing something greater than yourself brings people together in community, and the community can sustain an individual if they're struggling in a way that a workplace in and of itself can't."

A Teeter-Totter of Resources

Healthcare institutions that do not create and implement plans for clinician burnout perpetuate the dangerous mythology that health practitioners are invincible. The idea that healthcare "heroes" have the Herculean power to take care of the health and well-being of themselves, their families, and their entire communities without support creates unreasonable expectations both within and beyond the industry.

There is no such thing as the perfect work-life balance, but healthcare leaders can help care for the workforce by fostering the balance of individuality, through autonomy, flexibility, and boundaries; and community, through connection, communication, and appreciation. Protecting the workforce through preventive measures against burnout — such as providing in-house counseling, hiring assistance to reduce administrative burdens, and prioritizing employee appreciation programs — also protects the industry as a whole. Managing burnout and imbalance from the top down prepares healthcare institutions for critical issues and crises, from general employee discontent and staffing shortages to physician suicide and unexpected pandemics.

"I don't think ever, at any point, that things are in perfect balance," Bleasdale said. "It's more of a teeter-totter of resources.... [It's about] highlighting the good work of people, recognizing challenges, and acknowledging that there is no perfect balance, but a give and take."

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