Critical Care locums demand and clinician burnout

Across the country, as the COVID-19 pandemic soars to new disastrous heights, clinicians are feeling stressed and burned out. Tens of thousands of healthcare professionals have contracted COVID-19, and hundreds of nurses and physicians have died of the disease, adding a dimension to the crisis not typical in other disasters.

“The toll was real,” said Philip Ozuah, MD, PhD, president and CEO of Montefiore Medicine in Bronx, New York, which lost 27 physicians to the virus during the first wave, during a webinar. “One was too many, and 27 was more than most of us could bear.”

Ozuah added that there was no time to grieve or reflect. More patients waited for care. Staff kept working.

Not having time to process the loss, working numerous hours, lack of resources and conflicts with personal needs are among the things that can lead to burnout. Symptoms include exhaustion, distancing oneself mentally from the job, negativity and being less efficient.

The Physicians Foundation’s 2020 Survey of America’s Physicians COVID-19 Impact Edition, Part 2, reported an increase in physicians reporting feelings of burnout, 58 percent up from 40 percent in 2018. Half of the physicians surveyed expressed experiencing inappropriate anger, anxiety or tearfulness due to COVID’s effects on their employment or practices. Women reported feelings of burnout more often than men, 68 percent to 50 percent.

Physician burnout by specialty varies. The Physician Foundation’s research found primary care physicians reported more feelings of burnout than specialists, 61 percent vs 57 percent respectively.

However, a 2020 article in Annals of Intensive Care found 51 percent of the 1,001 intensivists from 85 countries surveyed indicated having symptoms of severe burnout and 46.5 percent anxiety. Critical care burnout in COVID-19 is real. The researchers concluded “the pandemic has had an overwhelming impact on ICU specialists.”

Medical Economics 2020 Physician Burnout and Wellness Survey found even higher numbers of physicians reporting burnout, with 71 percent of the 934 respondents indicating they were feeling burned out at the time of the survey in July. Contributing factors included financial concerns, worry about their or their family’s health, and not being able to care for patients the way they would like.

Locum tenens physicians are in great demand to meet the needs of an ever-growing COVID-19 patient population. They may be at high risk for physician burnout, because they are less connected to the communities they are serving and their colleagues.

Physicians are not alone in experiencing burnout, healthcare burnout during COVID-19 is affecting clinicians across the spectrum.

Healing rather than simply coping.  

“Every time a healthcare worker, a nurse or doctor, sees something horrific and terrifying and you push it down, it’s like locking a screaming cat in the cellar,” said Mark Goulston, MD, a psychiatrist in West Los Angeles, and co-author of “Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD.”

As the days go on, more screaming cats are in the cellar as doctors know they must continue to function. But when the danger goes away, those cats or feelings come up. There are safe ways to release those feelings and heal, he said. One way is to imagine someone who loved you, a “dead mentor,” walking you through it and talking it out with him or her.

“The reason it works is if you can image thinking of someone talking you through it, it releases oxytocin,” Goulston said. “Oxytocin counteracts high cortisol.”

Additionally, he said, it’s also important to help yourself during stressful moments at work, by using tools to create a sense of calm and following healthy habits.

Simple strategies 

Avoid listening to or watching the news, advised Renee Thompson, DNP, RN, founder of the Healthy Workforce Institute in Pittsburgh, Pennsylvania, who reported that listening to three minutes of negative news in the morning can increase the chance of a bad day by 27 percent. Instead tune into music or a positive audio book.

Additionally, she suggested surrounding yourself with positive people. Negative people can bring you down with them and deplete your energy level.

“Protect the brain from negativity,” Thompson said.

Thompson also suggested not thinking about what might happen in the days or weeks ahead. Stay in the present. Focus on the things you have control over and forget the rest. Then come up with a way to make the things you can control better.

Talk about it and other tools 

Kathryn Smerling, PhD, LCSW, a clinical instructor at Mount Sinai in New York, works with residents and interns experiencing burnout or emotional stress to diffuse the pressure. That gives them an outlet to talk through their feelings.

Smerling also recommends talking with colleagues; finding joy in an activity or simple pleasures outside of work that the clinician finds relaxing; and going for walks outside in nature.

“Nature is very relaxing,” Smerling said. “It’s a balm.”

Although professional services are available and can prove helpful, physicians often avoid such care, in part due to the stigma but also that U.S. state licensing boards often ask about mental health.

America’s healthcare professionals will get through the novel coronavirus pandemic. Some may leave the profession, while others will become more resilient.

“We are almost at the end [of the COVID-19 pandemic],” Smerling said. “We have a rough two months ahead of us, but there is an end in sight. It’s not always going to be like this.”

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