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.
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.
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.
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."
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.