<p>The COVID-19 pandemic has caused a societal burden in the form of lost jobs, shuttered businesses, strained relationships, and loss of lives. One group that has been particularly affected by the pandemic is clinicians. Provider burnout was already a concern long before the pandemic, which further amplified this mental health issue. The extraordinary stress of the pandemic was captured by a <a href="https://pubmed.ncbi.nlm.nih.gov/34041456/">survey of more than 20,000</a><a href="https://pubmed.ncbi.nlm.nih.gov/34041456/"> clinicians</a> that was published in EClinicalMedicine. This study showed that almost two-thirds of workers reported high fear of exposing themselves or their families to the virus, and about 38% experienced symptoms of anxiety and depression. 43% of those surveyed reported work overload, and about 49% reported burnout. These are significant numbers and underscore how widespread burnout is among health care workers. Another <a href="https://physiciansfoundation.org/wp-content/uploads/2020/09/2020-Physicians-Foundation-Survey-Part2.pdf">survey on COVID-19’s impact on clinician wellbeing</a> showed that about one in four clinicians knew a colleague who committed suicide, and 18% reported an increase in their use of medications, alcohol, or illicit drugs due to the effect of COVID-19 on their employment circumstances. The physical and emotional toll of the pandemic appears to be multifactorial and has been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173087/">attributed to longer shift hours, limited resources, sleep disruptions, work-life imbalance, and occupational hazards related to COVID-19 exposure</a>.</p>
<p>The COVID-19 pandemic is entering its 20th month, another European country (Latvia) recently imposed a lockdown due to an unprecedented surge in infections, and the<a href="https://www.cnbc.com/2021/10/08/cdc-director-says-when-the-covid-pandemic-ends-depends-on-human-behavior.html"> CDC cannot predict when this pandemic will end</a>. The rapid rollout of vaccine, combined with vaccine hesitancy, waning vaccine immunity, and the emergence of new and more transmissible COVID-19 strains will make the endpoint of this pandemic anyone’s guess. As the pandemic continues to unleash its mental toll on clinicians, burnout will likely remain long after the pandemic is over due to the ongoing economic fallout from the layoffs and hiring freezes.</p>
<p>This brings me to the highlight session of this year’s CHEST 2021 conference, “The New Wave of Burnout: Impact and Interventions.” The session’s main goal was to put a spotlight on the pandemic of burnout among the clinicians and discussed some interventions to address it. Session speaker Dr. Gretchen Winter, Assistant Professor at the University of Alabama, pointed out that the effects of burnout are not just limited to the providers but also by their patients and the organizations. “<a href="https://experts.umn.edu/en/publications/the-relationship-of-organizational-culture-stress-satisfaction-an">Burnout is associated with increased risk of medical errors, suboptimal patient care, and reduced patient satisfaction</a>.” She also noted that burnout was associated with a higher patient no-show rate, low provider productivity, higher stress on other team members, and a higher likelihood for the clinicians to quit their jobs. Financial impacts to the organization can be significant as losing a clinician can itself cost somewhere between “<a href="https://www.healthaffairs.org/do/10.1377/hblog20170328.059397/full/">$500,000 to $1,000,000</a>.” Dr. Rachel Quaney, Sleep Medicine Fellow at the University of Colorado, discussed the importance of addressing burnout at the institutional level and emphasized that burnout is an occupational hazard and not an individual issue, and the best treatment is prevention. Common factors that lead to burnout include <a href="https://www.atsjournals.org/doi/full/10.1164/rccm.201604-0708ST">increased workload, lack of control over the work environment, breakdown in the work community, and insufficient rewards</a>. A multifaceted approach at an organizational level is needed to address these drivers, including adequate staffing, addressing institutional inefficiencies, scheduling flexibility, professional development opportunities, improved communication and collegiality across the organization, recognizing exemplary efforts, and establishing a just culture. Dr. Saadia Faiz, a professor at MD Anderson Cancer Center, discussed recognition of burnout and noted three hallmarks of burnout, namely emotional exhaustion, depersonalization/cynicism and a reduced sense of personal accomplishment/inefficacy. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475833/">Maslach Burnout Inventory</a> is one of the tools to assess burnout and follows the same three hallmarks stated above. On recognizing burnout, Dr. Faiz emphasized that “make sure to speak up when you feel it yourself and speak up when you see it in others”. Dr. Lakshman Swamy, Assistant Professor at the University of Massachusetts Medical School, spoke on the importance of wellness in today’s society. He pointed out that interventions such as online wellness modules, surveys, pizza parties, protected time, and mindfulness exercises may be okay in some capacity, but when they are the headline for the organizational wellness program, he worries. He related these efforts to a “patient rolling into the ER with multiple gunshot wounds, and you are asking them if they had a colonoscopy. Dr. Swamy concluded by emphasizing an individualized wellness approach that is aimed at improving physical health and emotional wellbeing, improving social connections, and developing a sense of purpose. The speakers closed their session with the importance of looking out for each other in these unusual times.</p>
<p><em>Dr. Adrish is employed by the Baylor College of Medicine and has no conflicts of interest to report.</em></p>
<p><em>Image by Mary Long / Shutterstock</em></p>
