Physician groups and healthcare organizations employing physicians are facing challenging times. We have always appreciated differences between the so called “cognitive” specialties and the so called “procedural” specialties, often illustrated in stereotypes and humor. The stressors on these doctors, however, have been largely the same. Increased documentation requirements in the electronic health records, too much bureaucracy and too little autonomy, quality measures, and work-life balance have challenged physicians of all specialties and have led to high rates of burnout across the board with few exceptions.
During the current pandemic, there has been a shift in demand for physician services not seen before. Intensivists, hospitalists, emergency doctors and others have more work than they can often handle, long hours, high volumes, high acuity. The risk of burnout and exhaustion is high, stress is through the roof, and physical danger of infection is always present. These doctors require support now - and care for the trauma they are enduring as things slow down eventually.
Elective procedures being delayed
For certain procedural specialists who manage high volumes of elective procedures, there is little to do, and they are seeing declines in income and activity due to the cancelling of these procedures. There are stories of physicians being furloughed. However, this inactivity is artificial. Rather than caused by a decline in demand, or an outbreak of wellness, care is simply being delayed. As the pandemic moves past surge and elective care restarts, there will be a surge of activity and demand from people who have been waiting during isolation and are impatient to move forward. Currently these doctors are dealing with the current stress of inactivity, boredom and financial stress, but in the near future may be overwhelmed with work and demand for services.
Telehealth and redeployment
With primary care offices closed or limited, the physicians may be redeployed to telehealth and other activities, with or without attendant income loss. They too will be dealing with high levels of pent-up demand as things return to some form of normalcy. However, we believe these doctors will also be dealing with the stress of significant changes in practice. As patients become accustomed to the convenience of access to telehealth services, and understand the value of triage, practices will be forced to conform to patient expectations and continue to offer these services while attending to the post isolation patient surge.
Steps to address burnout the right way
The so called “tyranny of the urgent’ can cause leaders to make two mistakes. One is to neglect or abandon the efforts to prevent and manage burnout instead of targeting them effectively to the new reality. The second is to continue or even expand a “one size fits all” strategy that becomes irrelevant in these uncharted waters.
"Physicians are and will remain the engine that drives the system of care, and organizations that emerge from this crisis with a strong, healthy physician base will continue to prevail."
Here are some essential steps organizations should take now to optimize the future for physicians:
- Care for your doctors who are in the midst of the hurricane. Compensate them well, do everything to protect and assure time off, offer assistance to families, and most importantly, talk to them regularly to identify the barriers they face in providing care and find solutions. Implementing a program such as The Burnout Rescue Pack from SE Healthcare can reinforce your commitment to their self-care while they meet their ethical imperatives in patient care.
- Thoughtfully structure support for your physicians who have a high percentage of elective procedure practice. Devote resources to planning for the demand surge they will face as restrictions on practice and surgery are relaxed. Discuss strategies for maintaining work life balance as they meet this demand. Be intentional in discussing the boredom and financial issues they may be experiencing and be proactive in helping them catch up on CME, enhance knowledge and skills in preventing burnout, and feel useful in preparing for the upcoming surge by involving them in the planning. Most importantly, avoid income reductions and furloughs. While creating short term financial gains, such a strategy reinforces the sense of being a “widget” and will not be forgotten. Instead, maintain base income and communicate trust that the doctors will earn that back through their hard work on the next surge.
- Engage your primary care physicians in strategy and planning for what primary care will look like after the pandemic. What should the role of telemedicine be? How will they handle a potentially elevated demand for in office services? How would this new model be staffed? Is the EMR currently designed for this new model, and what would need to change? Asking these questions now is critical to preventing chaos and burnout post surge.
Resources, both financial and human, are never easy to come by in healthcare. These resources have never been so stretched, as the cost of the pandemic is high, and the revenue hit has been large. We have seen how important strong health care professionals are to our ability to handle this crisis. Recognizing the longer-term impact on different populations of physicians while investing in them for the next phase of the crisis is critical to emerging as a healthy, high performing healthcare organization.
