AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Gerard Clancy, MD, senior associate dean for external affairs at the Carver College of Medicine at the University of Iowa in Iowa City, weighs in on the physician burnout epidemic. Dr. Clancy and American Medical Association Chief Experience Officer, Todd Unger, discuss the stressors and signs of physician burnout, what pandemic-informed burnout means, and how COVID-19 continues to impact doctors' professional well-being.
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- Gerard Clancy, MD, senior associate dean for external affairs, Carver College of Medicine at the University of Iowa in Iowa City
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about pandemic informed burnout. What it is and how to address it. Here with us today is Dr. Gerard Clancy, senior associate dean for external affairs at the Carver College of Medicine at the University of Iowa in Iowa city. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome, Dr. Clancy.
Dr. Clancy: Thank you, Todd. Thanks for having me. This is an important topic.
Unger: Well, before we dive in, I saw that in a recent interview you talked about how, on average, you walk roughly seven miles a day to personally check in with physicians and staff at your hospital and clinics. I'm sure this just isn't about reaching your daily step goals. But I'd love to hear more about how that started and what you found out by doing it every day.
Dr. Clancy: Well, it really started with the clinical assignment, which was being the consult psychiatrist for our very large academic health center 1,000-bed hospital and going and working in the intensive care units and burn units, and across the hospital and the emergency room.
So seeing lots and lots of patients with psychiatric issues, but at the same time, seeing our our staff physicians and our nurses doing the work. And so, it evolved pretty quickly into, yes, I'm taking care of patients, but I'm also seeing and hearing from our staff, our nurses and our physicians as well. And this has been throughout the entire part of the pandemic and afterwards now.
Unger: Dr. Clancy, I've heard of the term trauma informed before, but you've named what you were seeing as quote "pandemic informed" burnout. Now, this just isn't increasing levels of burnout. I'm curious. How does it differ from the type of burnout that we were seeing before the pandemic?
Dr. Clancy: Well, sure. It's a great question, and it's something that's evolving. ICD-11 officially gave criteria for burnout being cynicism, exhaustion, lack of joy in the job, and at times, a loss of effectiveness at work. But with the pandemic, we've seen so much more added to it. All the different stressors from what it was like to go to work when it was dangerous at work and dangerous coming home.
The amount of suffering that we saw. Unfortunately, the amount of death that we saw. And lately, the rough environment it has been to practice medicine as, unfortunately, some patients have become a little bit more violent. So there's new stressors compared to what we had before the pandemic. And it's changing kind of the clinical picture of what we're seeing with our clinicians.
Unger: Now, we know that even though the acute phase of the pandemic has been over for a while, reports say that a record number of physicians are still considering leaving the profession. At Iowa, you have implemented a plan to help address this. What was the thinking behind the plan and are there any kind of practical approaches that you can share?
Dr. Clancy: Very much so. The pandemic threw new stresses at us, and so we needed to actually have new strategies as well. And retention nowadays is a huge issue as far as just being able to operate and function. So, we created a plan and a set of tactics that was really based off of what we learned from the pandemic and what are these new stressors that are set up.
Unger: How's the response been so far from your teams?
Dr. Clancy: You know, what we've seen so far is that the employees very much want to talk about this. That these types of programming and discussions and planning is very much in demand. I remember talking to the entire department of obstetrics and gynecology. And I finished up my workshop part of the program and we were ready to go into discussion. And the chief resident stood up and said, "Finally, we're talking about this."
So these are issues that are on many many clinicians minds right now. What is our work environment like right now and how can we make it better?
Unger: Is there anything that kind of stands out? That story is great one. Is there anything else that stands out in terms of the response to you?
Dr. Clancy: Yeah, I do remember the time I was up staffing the medical intensive care unit and three residents came up to me and in unison said, Dr. Clancy, it's great that you're here working side by side with us. We've seen that you've taken care of a ton of COVID patients along the way, just like we have.
And then, they asked, do we all have post-traumatic stress disorder? And so this is very much on the minds of individuals. At the same time, as we address it, there was much appreciation for those embedded in doing the work alongside those clinicians that really had it tough on the front of the frontlines.
Unger: Dr. Clancy, I'm sure you know that the AMA is focused on reducing physician burnout as well. And that's a key part of our AMA Recovery Plan for America's Physicians. Now, I know that you are planning to implement the AMA's Mini Z burnout survey later this year. What do you hope to learn from that, and how do you plan to move forward from there?
Dr. Clancy: Well, we all know that this pandemic changed over time. And so maybe you had a strategy for 2020 that didn't fit for 2021 or didn't fit for 2023. The pandemic is changing, society is changing, and unfortunately, the impact on our clinicians is changing as well.
So what the Mini Z allows us is to give us regular updates on how our clinicians are doing. And I remember well in medical school learning that if I didn't have a diagnosis, I couldn't put together an accurate treatment plan. And this is all about putting together an accurate diagnosis about where our clinicians are so we can put programming in place that meets their needs.
Unger: Now, I love this quote from you. You said that when you help a physician, you help 1,000 patients. And that really underscores the importance of the work that you're doing. Do you think we're in a better situation to address physician burnout than we were prior to the pandemic? Or do we still have a lot of work to do?
Dr. Clancy: I very much believe that quote still, and I think we actually are in a better spot. I think one of the few silver linings in this pandemic has been the recognition that mental health, mental strain, mental distress can happen to anyone.
And what I'm seeing, particularly among our younger physicians, is a much more willingness to talk about it and to ask for programming and assistance with it. So I think that that old stigma of just keeping quiet, putting your head down, and going forward is fading away.
And clinicians are asking for help. We're seeing improvements in mandatory reporting. We're seeing improvements in access to care. And we're seeing improvements in being able to diagnose what are the issues, such as what the Mini Z can provide.
Unger: Well, Dr. Clancy, thanks so much for joining us and thanks for all your work at the University of Iowa. You can learn more about the Recovery Plan for America's Physicians at ama-assn.org/recovery. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.