The COVID-19 pandemic is exacerbating the national public health problem of physician burnout and weakening patients’ tie to the essential physician care they need to manage chronic conditions.
These are among the insights that AMA President Susan R. Bailey, MD, shared during an online program hosted by The Atlantic magazine examining how COVID-19 exposed longstanding inequities and deficiencies in the nation’s health care system.
“Burnout has been a problem amongst physicians and other health care workers for years,” said Dr. Bailey, an allergist and immunologist from Fort Worth, Texas, during a panel on “The Health of the Health Care System,” which was moderated by author and Emmy Award-winning journalist John Donvan.
“The AMA has been studying this very closely and developing tools for physicians, and it was one of my personal priorities for my presidency—and then coronavirus changed everything,” she added. “But, in a way, it really didn't, because burnout is a more important subject than ever.”
Burnout in the Bronx
Appearing with Dr. Bailey was Philip Ozuah, president and CEO of Montefiore Medicine in the Bronx, who told of the impact of losing 27 colleagues to COVID-19.
“It’s not simply losing a colleague,” Ozuah said. “It’s also having seen many of our colleagues on ventilators prone in the ICU for weeks. These are folks that you work with and you see them in that state struggling to breathe.”
But, he added, there was no time for staff to grieve or reflect because so many people needed their help. One way to cope, he said, is to focus on the thousands of lives that were saved.
In addition, Montefiore implemented support measures that included “everything we could think of.” This included a hotline for people who needed to talk, rest-and-relaxation options, rental cars, free parking, free meals, plus hotel rooms and laundry service “so people didn't have to worry about taking the virus home.”
Donvan mentioned to Dr. Bailey that his wife is a primary care physician and noted that, one on hand, she’s very tired. On the other, “her sense of mission” has never been higher.
“Yes, it does bring into focus why we went into medicine in the first place, which was to help others, to heal the sick, and to do the very best we can,” Dr. Bailey replied. “But you reach a certain point where you are running on fumes and you’re not sure how much you have left to give.”
In addition, physicians are at risk for developing COVID-19 and becoming ill themselves, she added.
Learn more about why doctors’ big COVID-19 worry is keeping their families safe.
Struggles in the Lone Star State
Dr. Bailey’s home state of Texas is experiencing a surge of COVID-19 patients. She recently discussed this in an “AMA COVID-19 Update” daily video and put out a joint statement with Diana L. Fite, MD, president of the Texas Medical Association, urging their fellow Texans to be safe.
“This virus is highly contagious and shows no signs of going away,” Drs. Bailey and Fite said. “Until we have a vaccine, our only option is incredible, unyielding vigilance—wear a mask, exercise safe physical distancing, and wash your hands or use hand sanitizer regularly.”
During the Atlantic program, Dr. Bailey referenced what was happening in Texas and how the timing of the surge has acted to further complicate an already highly stressful situation.
“Our surge occurred around the first of July, at the start of a new academic year, which is always a time of stress and challenge,” Dr. Bailey said. “I'm still very comfortable about the quality of care people are getting, but it’s an extra burden on the system. And I think that we have to be extra aware of the special, psychological as well as physical needs of our health care workforce to help get them through this.”
Dr. Bailey’s segment was preceded in the Atlantic program by an interview with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.
Dr. Fauci, whom Dr. Bailey called one of her heroes, also alluded to the issue of physician burnout during the pandemic.
“This is a real challenge,” he said. “This is a major challenge in public health. And it's something that we really have got to pay attention to.”
When asked how he was doing personally, Dr. Fauci assured his interviewer that he was doing fine.
“I am running a bit on fumes, but as I say, the fumes are really thick, and it’s enough to keep me going,” he said.
Learn more from Dr. Fauci about why the COVID-19 resurgence has come with fewer deaths so far.
Deferred services create long-term concern
As some physicians battle a pandemic surge, others are facing economic strife as their patient volume plummeted or they have to cope with a ceaseless struggle to obtain personal protection equipment (PPE) for themselves, their staff and their patients.
“It's an interesting spectrum,” Dr. Bailey said. “Physicians that are hospital-based that are working harder than they've ever worked in their lives, and physicians that have either been shut down by their local authorities, or by elective procedures not being done and they don't have any patients, and they’re struggling to keep the doors open and keep their staff.”
Dr. Bailey noted how the AMA is working with physicians to obtain funds from the federal Paycheck Protection Program and other government relief efforts.
But, beyond that, patients continue to isolate themselves and some are fearful of returning to their doctor’s office. This has led to a “a pent-up demand of services that have not been done and needs that have not been met,” Dr. Bailey said.
This is resulting in women not getting mammograms, children not getting immunizations and patients with diabetes or hypertension not having their chronic conditions properly managed.
“We're very concerned about the long-range implications that that is going to have for the care of chronic health,” Dr. Bailey said.
The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.