A Path Forward

While COVID has shone a spotlight on burnout in the healthcare community, it is a preexisting condition that predates the pandemic. Burnout is defined as a work-related stress reaction that leads to emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. Long years of training, even longer hours per shift, combined with excessive administrative duties, emotionally charged encounters with illness and death, and inadequate work-life balance has taken its toll on clinicians. The last two years have amplified this imbalance with physicians, nurses, and other clinical healthcare professionals adding personal safety concerns, misinformation regarding the pandemic, and moral dilemmas related to rationing care to their growing list of stressors. Recent surveys indicate that burnout is endemic in healthcare- with surveys citing more than 50% of both physicians and nurses admitting to key signs of burnout such as overwhelm, emotional exhaustion, and irritability. The increased visibility of physician burnout- and its impact on clinicians, their communities, and patients- has led to calls to action that incorporate systemic and policy level mandates, as well as individual-centered approaches to promote clinician wellbeing. Such multi-pronged approaches first provide individual resources that bolster fatigued clinicians while ensuring that the organization’s culture and daily processes actively support clinicians return to the joy of medicine. Traditionally, wellbeing initiatives have focused primarily at the self and people level- with an emphasis on individual and group-

based resources. However, effective strategies must include safe spaces for physicians and nurses to offer candid feedback without fear of career retaliation, increased access to free mental health care- with blocked time for clinicians to attend these services- and improved access to child and elderly care. As a result of the turmoil of COVID19, additional resources may include legal guidance for physicians asked to expand their scope of practice and financial safeguards for reduced hours or decreased pay. Healthcare organizations can further bolster clinician wellbeing by engaging in clinician-led quality improvement initiatives that directly impact their practice of medicine. These QI initiatives may include standing order sets and templates to improve EHR efficiency, addressing excess patient caseload, and utilizing other resources to improve clinicians’ daily experience in healthcare. At an organizational level, a culture of wellbeing in which senior leadership truly prioritizes clinicians can set the tone for physician and A Path Forward nurse wellbeing. Leaders can promote work-life balance by offering flexible schedules for clinicians. There are tools currently available to encourage a clinician-friendly culture such as the AMA’s evidence-based module on burnout prevention. Additionally, making a commitment to diversity and inclusion via hiring processes, equitable pay and swift responses to clinicians’ concerns regarding these topics reinforces the notion that the healthcare organization values clinician wellbeing. At a systemic level, healthcare legislation, such as those that address Medicaid, Medicare, and Telehealth reimbursement rates, which directly affect clinicians’ livelihood, documentation requirements and administrative duties, and invasive license renewal queries that ask about clinicians’ utilization of mental health resources. A health system that uses its local and national standing to lobby for clinicians’ interests will send a strong message that it truly values the wellbeing of clinicians within the organization. A singular approach to burnout cannot address its multifaceted causes. Rather, reducing clinician burnout requires a comprehensive approach that addresses its roots from the individual level all the way to the healthcare system and policy level. Within this framework, a guiding principle that puts clinicians first and prioritizes open communication and honest feedback will allow healthcare organizations to take the first steps in promoting wellbeing and much-needed healing.