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Rethinking Physician Burnout, Mental Health and Well-Being

July 6, 2021
by David McKay Wilson

Physician burnout was at epidemic levels before COVID hit with a vengeance in 2020.

PCOM alumni offer advice for physician burnout and medical student burnoutMore than a year later, the pandemic has added to the pressures faced by a broad range of healthcare professionals and those studying to enter the professions. What they experience on the job and in the classroom can bring on the classic symptoms of burnout: emotional exhaustion, a loss of identity and feelings of inadequacy related to chronic work-related stress.

Clinicians say caregivers, who dedicate their professional lives to the service of others, often tend to forget about what they can do to care for themselves. At a time when job demands have intensified, mental health professionals and university and hospital administrators are exploring ways to address the issue.

Burnout: A heavy toll on healthcare workers

Among those on the front lines as a health psychologist is Angela L. Kurzyna, MA, PsyD ’13, BCB, executive director of Moorestown Integrative Wellness in Moorestown, New Jersey, just across the Delaware River from Philadelphia. She was one of four medical professionals who spoke to Digest Magazine about what they’ve seen in the field, and what interventions they have developed to address the issues.

“Healthcare workers are burned out, beyond a shadow of a doubt,” says Dr. Kurzyna, who supports a range of health practitioners in the Delaware Valley: physicians, physician assistants, nurses, fellow psychologists, pharmacists. “Burnout and compassion fatigue had been increasing over the past few years, but COVID was the tipping point for so many. There was a baseline of burnout going on, and then the advent of COVID made things significantly worse. Fatigued, highly anxious, experiencing sleep disturbances—so many healthcare professionals just couldn’t turn the pandemic off.”

The efforts by healthcare professionals to respond to the clinical struggles of the pandemic have taken a toll, affirms Jennifer Collins, MS ‘08, PsyD ‘10, MSCP, clinical psychologist and chief well-being officer at Penn Medicine Lancaster General Health, in Lancaster, Pennsylvania.

She pointed to a September 2020 study by the National Institute of Health Care Management that found 71 percent of physicians were reporting burnout and exhaustion, while 8 percent of physicians had outright shuttered their offices.

“There was a higher intensity of work, a rationing of supplies, mounting death totals, and feelings of inadequacy because they couldn’t cure their patients,” she says. “Even the best of healthcare professionals were falling short of the fix-it strategy. This affected those in the wards and those on the front lines; no one was immune.”

Not helping were the indifferent attitudes of many Americans toward infection-control precautions such as social distancing and masking. Masking even became politicized. Then came resistance to the COVID vaccine.

“Seeing those things in the media was particularly distressing,” Dr. Collins says. “It felt like the community wasn’t supporting healthcare workers by doing their part.”

Healthcare workers were scared, too, that they might contract the novel coronavirus.

“At the beginning there was so much fear and uncertainty,” she says. “Would they contract the virus? Would they take it home to their loved ones? There was frustration that things weren’t getting better. There was a blip of optimism when the vaccine rolled out, but that quickly halted when so many people were not accepting of the vaccine and patient cases continued to rise.”

Also troubling was the resistance among some fellow healthcare workers to getting vaccinated and skepticism about reaching herd immunity.

“We’ve experienced that resistance and skepticism in our own health system,” Dr. Collins says.

Dr. Kurzyna suggests the reaction by healthcare workers to their stressful work conditions can be better understood if viewed through the lens of researcher Hans Selye’s three-stage General Adaptation Syndrome. The first stage begins with the alarm response to stress, when one’s adrenalin kicks in. Later, the reaction turns to resistance, as one’s body remains on high alert but returns somewhat to normal. The final stage is exhaustion, in the face of unrelenting chronic stress.

Many healthcare professionals find themselves exhausted, in Selye’s final stage. For some, it has ultimately meant retirement or a career change.

“It can look like depression,” says Dr. Kurzyna. “People can’t get out of bed. They don’t have the energy for things they used to do. There is nothing left in the tank. I see people leaving jobs, leaving their specialties. They are spent. They are done.”

She says programs to combat burnout need to strengthen resiliency among healthcare professionals by building a more collegial environment in the workplace. She recalls how a decade ago, physicians, PAs, nurses would gather in lounges at hospitals to talk about cases on the floor, and their lives.

“They kept up with one another,” she says. “There was time for small talk, or case consultation. These lounges still exist, but there’s nobody in them. And if they are there, everyone is on their devices.”

She encourages healthcare centers to reinvigorate these spaces.

“They need to bring back the incentive for lounges and places built in the work milieu, where professionals have the time, space and expectation to socialize,” she says.

Strategies to combat medical student burnout during training

For Jerry R. Balentine, DO ’83, FACEP, executive vice president and chief operating officer at New York Institute of Technology, the work to address the issues of burnout must begin in medical school, where he believes students need to develop strategies that they can take with them into clinical practice.

Dr. Balentine, who was dean at NYIT’s College of Osteopathic Medicine from 2018 to 2020, says he launched a program several years ago with medical students who he observed took too little time away from the books.

PCOM alumni discuss strategies for battling medical student burnout“I saw them studying like crazy,” he recalls. “They felt that if they weren’t, they were doing something wrong.”

Dr. Balentine’s program was a no-cost, low-pressure initiative, which took place one morning a week. He’d show up in running shoes to lead a group in a 30-minute jog around NYIT’s Old Westbury campus. When the joggers arrived back, there was another half-hour when students could ask questions unrelated to their course material: How did you pick your specialty? How did you approach the body the first time you entered the anatomy lab? Do you recommend dating during medical school? Where’s the best café to grab a sandwich?

Years later, the morning runs Dr. Balentine initiated have gained popularity. Now, several faculty members participate, and as many as 50 students show up for exercise and conversation. Guests, such as the college president and Bob Nystrom, retired right-winger of the NHL’s New York Islanders, have joined in as well.

The concept has expanded, with one faculty member leading a tennis group and another playing basketball with students, while students have gathered for cooking lessons at the college’s catering hall.

“To fight burnout, you need to include fun in your life,” says Dr. Balentine. “People go to medical school because they want to help people. To keep that passion going, you need to keep enjoying your life, no matter where you work.”

He notes that may have been easier to do in earlier days when physicians left work at week’s end and were only available via pagers if an emergency arose. Today, physicians are available anytime on their smartphones, with texts and emails coming in at all hours, seeking their response. And Zoom fatigue is truly taxing.

In the past, there was much talk about creating a balance between your work and your life. Dr. Balentine says he likes to view that issue in terms of putting up barriers between your professional work and your outside personal life.

“We’re teaching our students that it’s OK to put your phone down and have some time for yourself,” he says. “Listen to music, read a book, go out dancing. Don’t sit at the dinner table, checking your mail on your phone. Let there be a barrier between your work and your life.”

At Penn Medicine, Dr. Collins has created a work group to address burnout. At a downtown hospital and community COVID test site, the health network set up self-care locations for gentle stretching classes, meditation or instruction in self-massage. At one testing site, there was a separate room in the back—away from the testing tents—where doctors and nurses could remove their PPE and relax before heading back out to swab new patients.

“We are hoping as the COVID numbers continue to decrease that we’ll be able to build support for people so they can process all that they have encountered, and find meaning and fulfillment in their work again.”

Deneen M. Hendrick, DO ’90, member of PCOM’s DO Faculty Committee on Admissions, who just finished a five-year stint as coordinator for pre-health/accelerated medical programs at Rowan University in Glassboro, New Jersey, says COVID-19 has made some students reconsider their choice of a career in the health field.

“Many go into medicine with the idea that ‘I’m going to fix it, I’m going to save the day,’ ” she explains. “But what if you cannot make the patient better? What is your role when you can’t save everyone? You multiply that with COVID, and everybody around you is dying, no matter what you do. You have to recognize what that means and reassess your role as a healthcare professional. That’s the challenge.”

Dr. Hendrick says that the COVID pandemic has highlighted the need for healthcare professionals—and students—to give themselves time for self-care. That’s crucial, in the face of grim statistics from a range of studies that indicate that the suicide rate for physicians is far higher than it is for the general public.

She says that self-care includes being willing to acknowledge that, at times, you are overwhelmed, and that speaking with an advisor or mental health professional could help you work through those feelings. But first, you must overcome the stigma some feel to seek help.

“Knowing you need help is a sign of maturity,” she says. “It’s a sign of self-awareness.”

Dr. Hendrick often counsels students considering a career in medicine, pharmacy or allied health. In the past year, she witnessed how COVID increased pressures in the high-stakes atmosphere involved in the process of applying for admission.

It became more difficult, as COVID caused the postponement of the MCAT and other exams, and students scrambled to reschedule their test. Dr. Hendrick told the students to realize that there are things in the world that are out of your control, and you need to figure out how to go with the flow.

“Why have stress over things you can’t control?” she says. “I tell them that the bend in the road doesn’t have to be the end of the road—unless you fail to make the turn. If you turn with the curve, you will stay on the road.”

The changes to life caused by COVID were also a challenge for those individuals with a Type A personality, who have a tendency to multitask, are ambitious, competitive and highly organized, and are driven to excel at school or work.

“COVID taught us that you don’t control as much as you thought you did,” Dr. Hendrick says. “You can’t control all of the stressors around you.”

That lesson was highlighted early in the pandemic, when physicians scrambled to treat the flood of patients into local emergency rooms. At that time, there were protocols in place that put many patients suffering from COVID on ventilators. Protocols were later changed after so many patients failed to survive the ventilator treatment.

“The doctors would put people on respirators, and the patients would die, despite their best efforts,” Dr. Hendrick says. “Some doctors internalized that failure.”

She says healthcare professionals need to step back, and give themselves a break.

“They have to realize that they don’t own all the world’s problems,” she says. “There are so many things that are so much bigger than all of us.”

About Digest Magazine

Digest, the magazine for alumni and friends of Philadelphia College of Osteopathic Medicine, is published by the Office of Marketing and Communications. The magazine reports on osteopathic and other professional trends of interest to alumni of the College’s Doctor of Osteopathic Medicine (DO) and graduate programs at PCOM, PCOM Georgia and PCOM South Georgia.