Physician burnout amid COVID-19 pandemic a growing concern
Nobody knows how physicians will handle anxiety from being on the front lines of the COVID-19 pandemic for months on end.
But mental health experts say a toll is inevitable. Fallout to patients is possible.
The COVID-19 pandemic is one stress factor piling on another and another for physicians and nurses in hospitals here in Southwest Florida and across the nation. There is no end in sight as communities start to reopen and there are warnings of a second wave of the pandemic to hit late summer or fall, experts say.
Numerous organizations at national, state and local levels are beefing up resources to physicians and other frontline medical professionals to address stress and burnout that was problematic even before the COVID-19 pandemic hit.
More than 600 psychiatrists nationwide are staffing a physician support line on a volunteer basis to provide counseling services during the pandemic. The number is 888-409-0141.
In the three weeks since launching March 30, more than 3,000 minutes were logged, according to the group’s website, physiciansupportline.com.
In Southwest Florida, confidential psychological services that previously were available only to physician members of the Collier County Medical Society are now available to any Collier doctor and their spouses. The sessions are operating through telehealth video calls.
There are roughly 900 actively practicing physicians in Collier and 1,400 actively practicing physicians in Lee, according to April Donahue, executive director of the Collier medical society. There is concern how physicians in the region are holding up.
"There is a lot of fatigue among health care workers right now, particularly hospital-based, and there could be lasting effects, even PTSD," Dr. David Wilkinson, president of the Collier medical society, said. "Physicians are not expecting this to go away in the next few months and are trying to continue preparing for how this changes their practices and lives."
Healthcare Network, which provides medical and behavioral health services in Collier, is offering a series of free virtual conversations for health care workers statewide to discuss the impacts of COVID-19. The series will begin May 19.
A Facebook page for physicians in Collier and Lee counties is gaining popularity for networking during the pandemic.
Physicians’ fears about their safety early when COVID-19 cases were diagnosed in Florida has somewhat subsided but they need support and encouragement to seek support, said Dr. Amaryllis Sanchez-Wohlever, a wellness coach to physicians in Central Florida.
“Working daily while fearing for your own safety can fog the intellect and deplete inner emotional resources, which can impact decision-making and patient care,” she said. “It also places patients at risk, forcing us to violate our Hippocractic Oath and leading to significant moral distress.”
Eight sources of anxiety for physicians during the COVID-19 pandemic have been identified in an article published last month in the Journal of the American Medical Association.
Chief wellness officers at Stanford University School of Medicine in Stanford, California and at the Icahn School of Medicine at Mount Sinai in New York conducted “listening tours” with input of nearly 70 physicians and nurses nationwide that resulted in the eight sources of stress.
“Given that surges in critically ill patients could last weeks to months, it is also essential that health care professionals be able to perform to their full potential over an extended time interval,” Dr. Tait Shanafelt, of Stanford, and lead author, said.
A detailed plan for how hospitals and medical organizations should act to address the needs of health care workers during the crisis is offered by the American Medical Association.
The eight anxieties include having adequate personal protective equipment, access to rapid testing, access to current information about the disease, along with concerns of potentially being deployed to work elsewhere during the pandemic and having enough medical support.
Other stress factors are physicians’ exposure risk and uncertainty how their families would be kept safe and cared for by their hospital or medical organization if they, the physician, is infected.
“At the same time they cope with the societal shifts and emotional stressors faced by all people, health care professionals face greater risk of exposure, extreme workloads, moral dilemmas, and a rapidly evolving practice environment that differs greatly from what they are familiar with,” Shanafelt said.
Stress on the front lines
Sanchez-Wohlever, the physician coach in Central Florida, said physicians having to see hospitalized patients die alone because visitation is prohibited hits them hard.
“This has been one of the toughest aspects of the pandemic emotionally for us since we recognize that connection and empathy are vital to healing, including healing from this virus,” she said.
She has been in medicine for 25 years and has never seen so many expressions of sadness, deep empathy and grief before among colleagues.
Dr. Larry Antonucci, president and CEO of Lee Health, which currently has 80 patients with COVID-19 at its hospitals and has discharged 358 patients who have recovered from the disease, said the pandemic has challenged everyone in health and physicians are not immune to the toll it has taken.
“However, most physicians view medicine as their calling, and what we’ve found is that times like these unify health care workers as they come together and rely on each other," he said. "We are deeply proud of the way our medical staff has embodied our mission during this global health crisis by truly partnering with each other and administration to ensure patients get the care they need.
"Yes, they worry about getting coronavirus, or bringing it home to their family but they would rather be at work than anywhere else.”
He said the mental well-being of employees and the medical staff is important and so Lee Health has put together resources to help them.
"These resources include everything from child care and spiritual services to mental health support and financial resources," he said. "Our physicians and employees are on the front lines of protecting our community from the coronavirus, and we believe it is our duty to provide them with as many resources as we possibly can to help them feel at ease.”
Dr. Rebekah Bernard, a primary care physician in Estero and physician wellness coach active with the Florida Medical Association, said some physicians who have never experienced underlying mental health issues may struggle to cope with the trauma they are witnessing with COVID-19.
Bernard launched a physician-only Facebook page several months ago that is rapidly gaining members in Southwest Florida since the pandemic. Membership stood at 229 physicians last week.
The private physician-only Facebook page is moderated by the medical societies in both counties, Donahue, with the Collier medical society said.
In 2017, the Collier and Lee medical societies rolled out physician wellness programs with confidential psychological sessions to address burnout.
Due to COVID-19, the Collier society has expanded availability of the confidential psychologist sessions to any Collier physicians and spouses.
Ten virtual psychological sessions with a contracted psychology practice were conducted for physicians in March and seven physicians did sessions last month, Donahue said. There is no cost to the doctors; the medical society covers the expense.
The NCH Healthcare System has contributed $10,000 to the program cost, a decision that was made shortly after Paul Hiltz became president and CEO of the hospital system. There’s also been a $10,000 contribution from the Southwest Florida Physicians Association this year and last year, according to Donahue.
It’s tough for physicians to reach out and ask for counseling or other mental health help, Bernard said.
“I think physicians are cautiously optimistic that things are going to get better,” she said.
The massive support from the community to NCH and the medical staff during the pandemic through donations of masks, meals, gift cards and flowers has gone a long way for morale, she said.
“Doctors are used to being the whipping boy for so long,” she said. “What we have been seeing in the outpouring of support from the community, having that response has been such a saving grace to doctors and nurses that what they are doing is so worthwhile.”
Besides the toll physicians in hospitals face caring for patients with COVID-19, physician practices have experienced losses due to shutting down because of the pandemic and prohibition of elective surgeries that was recently lifted, according to the Florida Medical Association.
In a recent survey, the association said nearly 100% of physicians said their practices have seen a decline in revenue or they expect financial losses, with 42% report having to layoff staff.
The association did not have salary ranges for physicians in the state. The latest figure by Medscape released this week showed the average annual salary for primary care physicians earlier this year is $243,000 and for specialists it is $346,000, according to Medscape. Salaries vary tremendously by specialty and between physicians employed by hospitals or in private practice.
Healthcare Network stepping up
Emily Ptaszek, a board-certified clinical psychologist and president/CEO of Healthcare Network, said she has significant concerns about the long-term well-being of health care professionals on the front line of the pandemic.
“This is an ongoing, prolonged crisis we haven’t studied yet,” she said, referring to clinical research.
What’s more, previous ways of relieving work stress, such as through travel and social events, are no longer an option due to social distancing and that multiplies stress.
“You can’t do the things you normally rely on for help,” Ptaszek said. “There is nothing quite like this.”
Healthcare Network is providing a series of “virtual conversations” tailored for health care workers statewide to learn how to build resilience and prepare for the future, she said.
There will be four sessions that address initial reaction to the pandemic, the humans behind the personal protective masks, coping strategies and what’s next after the pandemic. The sessions are being held in May and June.
Ptaszek said the virtual conversations are a complement to what the medical society offers with the psychological sessions.
The virtual conversations are a little more basic and peer support, and potentially may lead some health care workers to realize they need professional help like what the medical society is offering.
Registration is requested for each session by going to healthcareswfl.org or call 239-658-3000.