Physician Burnout and Pandemics: Caring for our Caregivers in Times of Crisis

By Jessica A. Peck

Burnout is a psychological syndrome involving emotional exhaustion, depersonalization, and over time a sense of reduced accomplishment. While anyone may experience burnout, research suggests physicians experience higher levels of burnout than other professions, and physician burnout is on the rise. Knowing that burnout is a critical issue among the physician population, we wanted to explore how pandemics might intensify these effects and for which physician groups burnout levels might be particularly concerning.

What We Did

We used the burnout cascade and conducted a systematic review of the literature. The burnout cascade helps us understand how environmental and societal factors may contribute to burnout and the dynamic nature of this psychological syndrome. The burnout cascade involves eight progressive stages. It begins with stress and exhaustion, follows with emotional and cognitive reactions, and ends with psychosomatic reactions including serious illness or suicide. We know that burnout results from chronic job-related stress and persistent depletion of personal resources. Thus, a pandemic that increases job complexity because of new treatment protocols, results in increased job demand due to staffing constraints, and adds to personal and family risk due to potential infection is a concerning catalyst for already high levels of physician burnout. In the midst of the COVID-19 pandemic, we thought it important to explore not only the current pandemic but also to gain knowledge from the literature about physician burnout and previous pandemics. Thus, our review encapsulated articles from Severe Acute Respiratory Syndrome (SARS), Ebola, H1N1 (swine flu), Middle East Respiratory Syndrome (MERS), and Coronavirus Disease 2019 (COVID-19). We examined various mental health outcomes experienced by physicians throughout these pandemics along the burnout cascade. We searched several databases and reviewed over 2,000 articles to narrow down our sample to 30 relevant articles.

What We Learned

We found that pandemics were associated with many poor mental health outcomes for physicians along the burnout cascade. In particular, the majority of studies (19) found physicians experienced emotional reactions including anxiety, fear, and worry. In addition, many studies (13) identified cognitive impairment, lack of motivation, and depression felt by physicians.

Physicians also reported feeling stigmatized for treating patients infected with the pandemic-related disease. Over one-third of the studies we examined discussed the issue of stigma, and it was pervasive across countries and diseases. Some researchers found stigma to exacerbate other mental health challenges such as anxiety. Further, others noted family/friends treated them differently due to their role as a physician during a pandemic which led to feelings of ostracism and isolation.

Also, we found demographic and occupational differences to be important. For instance, many studies examined doctors and nurses with nurses predominantly experiencing worse mental health outcomes than doctors (in the areas of exhaustion, disengagement, avoidance behaviors, posttraumatic stress, nervousness, anxiety, depression, distress, and insomnia). In addition, women were particularly at risk for negative mental health outcomes in the areas of anxiety and depression. Similarly, younger workers and those with less training had higher stress, anxiety, and depression.

What Needs Done

Globally, physicians are hesitant to seek help for mental health issues. At the same time, stigma from treating disease places an added burden on physician mental health. Efforts to destigmatize disease and help-seeking behaviors are critical to prevent progression along the burnout cascade.

Women, younger physicians, and those with less training experienced increased negative mental health effects than men, older physicians, and those who were more experienced. Recognition of this issue means that targeted interventions may be needed to support these vulnerable groups.

Positive coping mechanisms were identified, primarily in the areas of access to information and colleague support. Providing physicians information on infection prevention, protective procedures, and regular data about the ongoing pandemic was found to be important. Further, assigning physicians mentors or team partners to offer support may be an important policy decision for health care organizations during a pandemic.

Conclusion

Physicians have played a critical role in our fight against COVID-19 and other pandemics. As they face the strain of burnout, it is important for policymakers and healthcare organizations to provide helpful interventions and supportive coping mechanisms so we can care for our caregivers.

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Article Details
Pandemics and the Impact on Physician Mental Health: A Systematic Review
Jessica A. Peck and Tracy H. Porter
First Published May 13, 2022
Medical Care Research and Review

About the Author

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Jessica A. Peck, Ph.D. is an Assistant Professor of Management in the Monte Ahuja College of Business at Cleveland State University. She teaches Management Strategy and Policy, Organizational Behavior, and Human Resource Management. Dr. Peck’s research focuses on leadership (e.g. how leader behaviors influence follower perceptions), healthcare (e.g. how the pandemic has impacted various groups such as physician mental health or women in the workplace) and bias (e.g. internalized status among marginalized groups). Her research has appeared in several scholarly journals including Medical Care Research and Review, The Leadership Quarterly, Gender Work and Organizations, and Management Decision, among others.