Burnout might not be an option for tomorrow’s physicians

Long before COVID-19 plagued our nation and world, physicians in the United States found themselves facing their own epidemic within the profession – occupational burnout. Associated with depression and suicidal ideation as well as potential risks to patient safety, physician burnout has uniquely profound and possibly deadly implications in this field, unlike in other professions. Likewise, doctors have been consistently found to report higher rates of burnout than other members of the U.S. workforce, with an estimate by Medscape earlier this year finding 42 percent of physicians experiencing burnout in a sample of over 15,000. Anxieties had already been building for the last decade within the zeitgeist of medical professional organizations regarding how to best promote the well-being of physicians and other health care providers, with scarce tried and true results.

In what now feels like “the early days” of medicine in the times of coronavirus, the inadequate national supply of personal protective equipment (PPE) left health care workers across the country to fend for themselves. Many took to Twitter pleading for support and documenting the frontline trauma of treating patients without proper supplies alongside the vicarious trauma of watching colleagues die without necessary PPE. Others utilized online platforms like this to share emerging trends in case reports at a rate even faster than the torrential output of clinical research on coronavirus treatment protocols. Coinciding with the growing politicization of public health measures like wearing masks and social distancing to contain the spread of the virus in states facing economic turmoil, health care workers’ pleas to the public to abide by CDC guidelines fell on deaf ears by many. Yet, despite the growing examples of countries around the world that had been able to balance the forces of economics and public safety, a uniquely American, false dichotomy was established between the two, coded in the language of politics. Under circumstances like this, how would it be possible not to feel cynical as a health care provider? In the militarized language used by many when discussing the fight against this virus, our frontline soldiers had been sent off to war with no equipment, only to watch each other be possibly killed while growing swaths of the country they serve every day began denying the existence of the very enemy inciting the battle.

In the short term, prognosticators are already commenting on the abysmal future of physician burnout. And indeed, emerging research does seem to corroborate these claims. At the end of March, the Journal of the American Medical Association (JAMA) published a paper assessing mental health measures among over 1,000 health care workers in Chinese hospitals that had been hit particularly hard by coronavirus cases. Half of the respondents (50.4 percent) screened positively for symptoms of depression, and just under half (44.6 percent) screened with anxiety symptoms. Unsurprisingly, in the weeks to follow, academic journals like JAMA, national professional specialty organizations, and even regional health systems began publishing resource guides and establishing task forces addressing how physicians in the U.S. could better ensure their own mental and physical health needs and mitigate burnout while on the frontline of the pandemic. And with a large body of literature on the post-traumatic stress experienced by first responders and health care providers in the context of disaster relief, the worst is surely yet to come.

But then you have students like me. Equal parts cynically disillusioned and resiliently hopeful, we will inherit a profession that has already been irrevocably and rapidly altered by a vilely fickle and unforgiving strand of coated RNA. We’ve been privileged to observe from afar the cataclysmic impact that the initial phases of the outbreak had in places like New York, knowing just enough to make sense of emerging scientific literature about vaccines and treatments, yet not quite enough to be useful in the hospital. From our vantage points, many of us sent home both from class and clinical rotations to study remotely for board exams ad nauseum, we’ve been given the chance to introspect collectively, likely more so than any other cohort of medical students.

In this introspection, the entanglement of recent events continually reveals additional layers to the flaws within the U.S. medical system. As many of us marched with Black Lives Matter demonstrations (masked, of course) and witnessed communities of color disproportionately killed by police brutality and coronavirus alike, student committees at medical schools across the country have led the charge to reassess the systematized racism existing within our profession and systems of medical education. As we too joined in with K-pop fans and Tik-Tok activists and contributed our part to viral sensations and protests from quarantine, we’ve learned that our generation of physicians has the unprecedented means to support one another remotely and instantaneously in ways previously untapped. And as we’ll soon be left with a vaccine produced at a record speed for all of human history, we’ll know that this was only achieved through global collaboration.

Today’s medical students, that is, tomorrow’s physicians, were raised by the internet. We’re members of the generation sandwiched by millennials and Gen Z, sharing a common second nature of activism and instantaneous globetrotting communication. And this has already given us novel tools for resilience unknown to our predecessors. As the scheduling for many of our national medical board exams were disrupted with test site closures, we too took to Twitter and Reddit, eliciting signatures for circulating petitions and letters asking for improved communications with our campuses and testing procedures. With support from many of our deans, the result was measurable national action within weeks. As residency programs in all specialties began adopting rapidly changing adjustments to their match process for the coming year, medical students and recent graduates began coordinating with program directors to create transparency and connection at institutions nationwide as policies are established for the months to come. In these instances and others, we’ve been able to quickly adapt to this newfound world of necessary physical distance, and I venture to say that medical students have never before created such a strong social solidarity.

This poses a far better alternative to the future of burnout already described to us, and I choose to be hopeful. Simply, my generation of physicians will have no other option. Even if we should find ourselves again in crisis and unable to rely on the very organizations designed to protect us, this episode in history will have taught us that the only way to protect ourselves is to protect each other.

Auston Stiefer is a medical student.

Image credit: Shutterstock.com

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