Being a physician has always been a high-pressure job, but 2020 cranked the stress up to a whole new level. Everyone in medicine has been affected, from those actively addressing COVID surges to those rapidly adjusting to telemedicine. Home life looks different, too, as families navigate distance learning, child care changes and working from home. Here’s a look at what employers have been doing both before and during the pandemic to keep physicians happy and healthy.
A turning point in the burnout crisis
Not too long ago, physicians faced a very different work environment. Marathon shifts, unreachable leadership and bare-bones benefits were the norm. But things have started to change - in part because employers and experts are recognizing the international crisis of physician burnout.
In 1996, social psychologist Christina Maslach was the first to identify the phenomenon of burnout. By February 2003, both the European Forum of Medical Associations and the World Health Organization had voiced serious concerns regarding burnout levels in health care providers, urging national medical associations to pay attention.
Now employers and associations alike are making efforts to reduce burnout. "Given the high rate of physician burnout, there is a movement toward employers providing access to things that promote health and wellbeing," says Sasha K. Shillcutt, M.D., cardiac anesthesiologist at the University of Nebraska Medical Center.
There are small signs that things are getting better. In Medscape’s 2020 National Physician Burnout & Suicide Report, 42 percent of respondents reported feelings of burnout - a small decline from 46 percent five years prior. Respondents were a pool of 15,000 physicians spanning 29 specialties. But while this suggests we’ve made steps in the right direction, the problem remains a serious issue.
Another reason employers care about reducing burnout is the looming physician shortage. The AAMC predicts a national shortage of nearly 122,000 physicians by 2032. Since it’s much easier and more cost-efficient to retain employees than recruit and train new ones, employers are investing more attention on keeping their current employees happy.
The changing workday
With the 24/7 nature of medicine, it’s hard for doctors to avoid unconventional hours, but many employers are working to improve physicians’ work schedules. "Time to connect with family has been linked to reduced rates of burnout," says Shillcutt, adding that University of Nebraska Medical Center has increased its emphasis on downtime. "For example, it’s required that when residents or med students work a 24-hour shift, they have 16 hours off," she explains. "Leaders regulate shifts based on the physician’s specialty. For example, in anesthesia, after 24 hours, you have to go home."
Shifts in employment models have also improved physicians’ workweeks. More doctors are opting to work for a practice group or hospital instead of going into private practice. Since more staff are available at these organizations, no individual doctor is expected to be available around the clock. Employers are more able to create shifts that work for physicians’ preferences and schedules.
Another big reason for these changes is the rising popularity of hospitalists. It’s a fairly new, but much needed, specialty. Hospitalists care for admitted patients, which means primary care physicians don’t need to travel in every time one of their patients goes to the hospital. This creates a more predictable schedule for both the hospitalist and the PCP.
Recent events suggest even better workdays may be in the future. When COVID-19 mandated widespread shutdowns, remote work became the new normal - even for some doctors. As physicians rose to the challenge of practicing telemedicine, many were pleasantly surprised by its upsides: non-existent commutes, a break from workplace stress and more time with their families. Remote work may continue to be part of the medical world long after the pandemic subsides.
It takes a village
Medical dramas might portray cutthroat competition as physicians jockey for position, but in real life, employers recognize it’s better to promote teamwork than individual achievement. "Front desk staff, administration, medical assistants and nurses are all vital in the care of patients," says Julia Baltz, M.D., a dermatologist at New England-based APDerm.
"It’s so important to know that we are all on a team working to provide the best patient care available," she explains. "By reminding staff of this and supporting activities and practices that foster a team environment, clinicians are more impassioned by their work and less subject to burnout and fatigue."
When Baltz’s offices temporarily closed due to COVID, she says team connection was more valuable than ever, and it helped keep stress at bay. "Virtual doors to leadership [were] always open. I felt just as comfortable reaching out to the CEO and COO with questions as my own office manager," she says.
In addition to encouraging teamwork, employers strive to make sure staff feel appreciated. For example, Penn Medicine has started a gratitude program to uplift medical workers’ spirits during the pandemic.
"We received so many messages of thanks from patients, families and community. These were entered into a form and turned into an electronic image, then fed into the digital displays at all six hospitals and the medical school," says Lisa Bellini, M.D., chair of Penn Medicine’s Workforce Wellness Committee.
Putting fitness and nutrition within reach
Eating well and staying active are cornerstones of mental and physical health. But when life gets busy, healthy habits like these fall to the back burner. That’s why many medical organizations are working to make it easier for employees to take care of themselves. Perks like workout rooms, onsite classes and free or discounted gym memberships have become the norm.
According to the CDC’s 2017 Workplace Health in America Survey, 83 percent of U.S. hospital employers provide workplace wellness programs, compared to 46 percent of all employers. In addition, 31 percent of hospitals provide health coaches, compared to 5 percent of all employers.
When the COVID-19 pandemic hit, hospitals knew workers would need to burn off steam. Many began offering short, accessible fitness and mindfulness classes. For instance, Indiana University Health Methodist Hospital started hosting Yoga in Scrubs sessions. These brief yoga classes took place in a courtyard and followed all social distancing guidelines, allowing employees to take part without having to change clothing, drive somewhere or adjust their schedules.
Employers are also focusing on nutrition. Like all busy workers, physicians often need quick meals during or after long shifts. This can make it hard to eat healthily. "Hospitals can be notorious for lacking in healthy food options, which can be difficult for those working late nights," says Shillcutt. "At UNMC, an effort has been underway to avoid having vending machines be the only option." The university’s cafeterias now offer healthier meals and snacks to go.
Similarly, Penn Health recently launched its Nourished program, which created a safer, quicker protocol for staff to get takeout. "It’s a way for frontline workers to order healthy food that’s safely prepared and delivered," says Bellini. As an added bonus, the program is helping local restaurants stay afloat.
Providing a getaway space
Periods of solitude can also help relieve stress, especially for introverts. That’s why some employers now provide a reset room: a quiet space that’s available for private use during shifts. Hennepin County Medical Center in Minneapolis started doing this in 2013 by repurposing an out-of-the-way office. They redecorated it with LED lights, flameless candles, a sound machine, comfortable chairs, plants, and an "In Use" sign for the door.
As COVID-19 inundates health care systems everywhere, finding a peaceful escape has become more important than ever. In response, The Mount Sinai Hospital in New York City worked with their Abilities Research Center and New York design firm Studio Elsewhere to convert unused offices into recharge rooms. The pilot program incorporates nutritious snacks and drinks, restorative audio and video content, showers and coaching to help frontline workers unwind.
Normalizing mental health care
Employers also fight physician burnout by making sure employees have access to mental health care. During the pandemic, hospitals and other employers have had to find new ways to make that care available.
"Employers have always provided access to mental health and wellness resources in the traditional way, such as employee assistance programs, call numbers," explains Bellini. "Since the pandemic, [access to mental health care] needed to be more of a push. Traditional barriers needed to be mitigated. We made a rapid pivot to get resources to medical workers at all six hospitals, as well as medical school faculty."
In early April, the university launched its PennCOBALT platform, which allows workers to access contact-free mental health care in as little as 48 hours. "The web-based platform eliminates the traditional route," she explains. "Users answer three questions and will be pointed to resources, including both virtual support as well as curated content. They can then answer another set of four questions to be triaged further." Within weeks, the platform was seeing high demand.
Making resources available is just part of the solution. Employers also have to fight the stigmas surrounding mental health care and encourage emotional wellbeing. "[It’s about] normalizing that everyone struggles. Everyone has had or will have that one case that they can’t shake off," Bellini says. "To survive in this business, you have to be able to reach out when this happens."
Teaching stress reduction
Perhaps one of the best ways that employers support physicians’ wellbeing is teaching stress management. When physicians learn healthy coping mechanisms, they’re better off on the job, in their personal lives and in the community.
Leaders at Boston Medical Center in Massachusetts found this to be true. They realized their employees were facing not only the expected stress of their jobs but also the added stress of working with an underserved population. In 2019, BMC started offering mindfulness-based stress reduction (MBSR) classes. An evidence-based training program developed in 1979, MBSR helps people deal with their anxiety, depression, chronic pain and other disorders.
BMC’s pilot program included three employee cohorts, one of which was made up of 26 clinicians. They participated in an eight-week course led by a MBSR-certified instructor. Each week’s session included techniques such as yoga, narrative medicine and meditation. After the program, the physicians’ self-reported burnout decreased from 52 percent to 26 percent. Participants also reported feeling more confident about stress management and self-care in both their personal and professional lives.
When it comes to relieving workers’ stress, employers have stepped up their game, but they’re not the only ones who can do something about it. In addition to taking advantage of resources offered at your job, you can also adopt your own self-care regimen.
Keep a routine
One way to stay grounded is to stick to a routine. Whether you’re just facing a hectic day or dealing with bigger stressors - like, say, a pandemic - having some structure can create a sense of normalcy.
"[Before the pandemic,] my routine included a wake-up time and bedtime, both of which were pretty early in my case," Baltz recalls. But by March of this year, she says that routine was nonexistent. As she struggled to organize her days, maintain productivity and minimize anxiety, Baltz reinstituted a schedule.
"Preparing in advance for the next day - not just rolling out of bed - preparing meals, outfits, etc., like you would when going to the office," she explains. "Incorporating and following a routine as you try to adjust to the new normal."
Tap into virtual help
Many doctors know their mental and physical health is important, but there are only so many hours in a day. Finding time to travel to a therapist, yoga studio or other class just isn’t going to happen. Thankfully, many reputable programs are available online. For example, UMassMemorial Medical Center offers an online eight-week MBSR program with small class sizes and qualified teachers.
Apps like Headspace and Calm are accessible options, and some even offer a discounted rate or free subscription to health care workers. It’s no wonder the AMA offers its members a free two-year subscription to Headspace. Whether you’re looking for yoga and meditation lessons, virtual psychotherapy, fitness and nutrition guidance or something else, plenty of resources are available. You can find the support you need without having to leave home.
Enlist some of your peers
It helps to team up with colleagues in caring for yourself and each other. Consider starting a group sports league, finding a diet buddy or entering a race together. You’ll not only get healthier, you’ll also get to enjoy your coworkers and motivate each other.
Of course, teaming up is harder during the age of social distancing, but it’s not impossible. A group of residents at Einstein Medical Center Philadelphia created a virtual challenge called The Health Cup to keep themselves social and healthy during the pandemic. They divided into four teams, then created a points system for wellness activities. Every time a resident shares a photo of a healthy activity - such as having fun with family, working out or relaxing - his or her team earns points.
Be your own advocate
Now more than ever, employers are looking for ways to support health care workers. This presents a golden opportunity to create change in your workplace. If you have an idea for improving office culture and reducing burnout, don’t be afraid to speak up.
Similarly, don’t hesitate to discuss concerns about your mental or physical wellbeing. "[Physicians] and employers recognize that physicians won’t last in their careers if things don’t change," says Shillcutt. "Newer doctors should absolutely speak up when they need help."
"Data suggests that if an employer allows you to do what you like 20 percent of the time, you are less likely to burn out," she adds. "That’s about one day a week. You should find your 20 percent - whatever makes you feel engaged and joyful - and advocate for doing it. Don’t wait for leadership to recognize it."
In the middle of sea change
The medical field has come a long way in the past few decades. Doctors are getting more support and recognition as employers recognize both the prevalence of burnout and the looming physician shortage. No wonder the CDC reports 56 percent of hospitals now offer stress-management programs, compared to just 20 percent of all employers.
The COVID-19 pandemic has only increased the spotlight on physician stress - opening the floodgates for more action, support and recognition. However, employers can only do so much. Individual physicians also need to monitor their own health and speak up when they need help. "[Doctors] need to work with the institution to address the challenges to wellness. We all need to be in this together," says Bellini.
By embracing the resources available to you and implementing healthy habits now, you can increase your chances of enjoying a longer, happier and healthier career.