Even before the COVID-19 pandemic slammed intensive care units and battered physician practice finances, doctors and other health professionals faced high rates of burnout. The health system-level factors that drive the physician burnout phenomenon cannot be directly influenced by patients, but they can play a positive role.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.
For this installment, three AMA members took time to discuss what doctors wish patients knew about physician burnout and the small yet important steps they can do to help make things go a little more smoothly during this unprecedented time of stress. They are:
- Dawn Clark, MD, an ob-gyn who serves as chief wellness officer for the Southern California Permanente Medical Group in Pasadena.
- Kevin Hopkins, MD, primary care medical director for Cleveland Clinic Community Care.
- James Jerzak, MD, a family physician at Bellin Health in Green Bay, Wisconsin.
Physician burnout is “a combination of physical and emotional exhaustion that can lead to reduced effectiveness—either real or perceived,” Dr. Hopkins explained. “Anybody can relate to that feeling of being physically and emotionally exhausted. And that's really the first thing that we start to see in physician burnout.”
Dr. Clark added that “physician burnout is the feeling that health care professionals get when they’re asked to do too many tasks that take them away from the patient-doctor relationship.”
“Many factors are contributing to physician burnout—overwhelming workloads, increasing demands of electronic health records, relatively short appointment times considering what needs to be done,” Dr. Jerzak said.
Committed to making physician burnout a thing of the past, the AMA has studied, and is currently addressing issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face. By focusing on factors causing burnout at the system-level, the AMA assesses an organization’s well-being and offers guidance and targeted solutions to support physician well-being and satisfaction.
“It's very difficult for not just doctors—but really most health care professionals—because we came into this profession to heal people, not to fill out forms, get pre-authorization or code,” said Dr. Clark. “We’re very lucky in Kaiser Permanente that we don’t have to deal with pre-authorization [due to our integrated, prepaid model], and so many other groups do.”
Doctors and others didn’t enter health care “to do all the bureaucratic tasks that we're asked to do,” she said. “What we really want to do is to listen to our patients’ stories, to dig deep into their own personal journeys, to figure out not only what their problem is, but how it fits into the bigger picture of their lives, their hopes, their dreams.”
“None of us want to admit weakness,” said Dr. Hopkins.
“Even in physician training, whether it's med school or residency, that weakness is beat out of you, where you're sort of expected just to keep your head down and keep grinding,” he added.
“And you can do that for a while, but it feels like I’m an NFL football player and I’ve gotten up for the Super Bowl—it’s the biggest game of my life and everything that I’ve done education-wise has prepared me for this time. Yet it’s the Super Bowl that never ends.”
“You can do anything for a defined period of time when there’s an endpoint, but this has now gone on for nearly two years and we don’t see an endpoint,” he said, adding that “you just are exhausted and overwhelmed all the time.”
“Workforce shortages have hit health care hard—not just doctors, but registered nurses, rooming staff like medical assistants and licensed practical nurses, even front desk staff,” said Dr. Jerzak, noting “this is from a combination of relatively low pay in some of these jobs to high work demands for all of these roles.
“In addition, the more staff that are lost, the more demands fall on the remaining staff—it’s a vicious cycle,” he added. “This is not unique to health care, but still a major issue.”
“Temper your expectations, as we're short-staffed, people's stress levels are high,” said Dr. Hopkins.
“It's not uncommon for someone to email a physician after the visit because they forgot to ask several questions, so creating a list would then help cut down the in-basket ” said Dr. Clark, noting that the “clearer patients can be, the easier the appointment is for everyone.”
“As a physician, I still sit down with my husband—who’s also a physician—the night before one of us has a medical appointment and we review all of our questions,” said Dr. Clark. “That way not only are our questions answered, but we make sure all of our family’s questions are answered so that we don’t have to go back and keep emailing our doctors.”
“All physicians would like to always be on time, but with the complexity of patient care and unanticipated events during the day, this is not always possible,” said Dr. Jerzak. “Hopefully, the staff will keep you informed of longer delays and though it can be frustrating, try your best to be patient in the event of delays.
“It does help the staff to stay on time if patients come on time to their appointments—and even a bit earlier to complete any required paperwork,” he added.
When patients ask, “How are you?” that “is a great human connection point,” said Dr. Hopkins. “It lets you know that that person you’re talking with has some degree of empathy for you and recognizes that we're all struggling right now.
“I love it when patients ask me how I’m doing,” he added, noting that “it's nice to know that they care.”
“Some of my best days in clinic are when the patient stopped for a moment and asked how the health care team is doing,” said Dr. Clark. “They obviously have health care issues if they're in the office seeing me, and for them to stop for a moment and ask how my team's doing, that is just unbelievable.”
“The electronic patient portal can be extremely helpful, both for you and for the staff,” said Dr. Jerzak. “Make every effort to sign up for this resource” because “it makes it easier for the staff to let you know, for example, of lab results, rather than trying to track you down by phone.”
Additionally, “it allows you to message the office with simple questions or requests,” he said. “Be aware, however, that long or complicated messages are very stressful and time-consuming for the staff.
“If you have something that is not straightforward, it is usually better to make an appointment to discuss,” Dr. Jerzak added.
Learn more from the AMA STEPS Forward™ toolkit, “Patient Portal Optimization: Empower Patients as Partners in Health Care.”
While taking advantage of your physician’s patient portal can help, “be aware that the volume of phone calls and patient portal messages coming into physician offices can overwhelm the staff,” said Dr. Jerzak. “If you must call or message, make the request brief and understandable, and be patient in waiting for a response.”
“Things are going to probably take a little longer than usual—whether it's waiting for an appointment, for a return phone call or for a prescription to get refilled,” said Dr. Hopkins. “So be patient with the amount of time that it takes to get some things done.”
“One more very simple way that friends and loved ones can help is to get vaccinated, to wear masks and physically distance where applicable,” said Dr. Clark. And if people “can get all their friends and their loved ones to join in, that would be helpful because we are already burned out and in crisis as a profession and the pandemic certainly isn't helping that.”
“The COVID pandemic has certainly made life more stressful for everyone,” said Dr. Jerzak, noting that “one particular frustration for medical staff is seeing patients suffer from a disease that—for the most part—is entirely preventable.”
“The sheer volume of misinformation regarding COVID-19 and the vaccine has been beyond frustration for health care workers,” he said. “If you haven’t yet, please get the vaccine to protect those you are in contact with, and to help society finally emerge from this terrible pandemic.”
“We all suffer when we don't take the advice of our public health experts,” said Dr. Clark. “And the longer we ignore them, the longer everyone suffers.”
Table of Contents
- It’s physical and emotional exhaustion
- Other health professionals are affected too
- The pandemic continues to strain doctors
- Staff shortages are taking a toll
- Create a question list before your visit
- Get to your appointments early
- Connect with your doctor as a person
- Sign up for the patient portal
- Doctors’ inboxes are overflowing
- Get vaccinated against COVID-19